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Van Goal & Bridges

With the variation in longevity of the intervention, there is a change in the ranking of
the intervention. If the interventions were effective for the minimum number of years,
the hospital∕rehabilitation intervention would be most cost effective.

Sensitivity Analysis - Take-up rates of programs

One of the major assumptions Imderpinning this analysis is that of take-up rates. It is
fairly obvious that the success of an intervention is dependent on the success of the
recruitment (e.g. recruiting GPs, individuals or other agencies). Take-up rates, the rate
at which recruitment is successful, are of importance for two of the interventions: the
GP based and the hospital / rehabilitation interventions.

The GP based strategy required recruitment of both GPs and patients. It was assumed
that 70% of GPs would screen and/or refer patients. It was further assumed that only
25% of patients would be involved in each of the programs (with overlap assumed).
Whilst the patient take-up rates were considered conservative, with dropout accounted
for, the doctor take-up was quite liberal and sensitivity analysis was needed to verify the
assumption.

For the GP based intervention, take-up rates will affect both cost and effectiveness.
However, due to relatively low set up costs, a sensitivity analysis that only varies the
take-up rates would not greatly affect the cost-effectiveness ratios. The relatively low
effects that take-up rates have on the cost-effectiveness ratio can be seen in Table 11.

TABLE 11 : SENSITIVITY ANALYSIS: VARIATION OF TAKE-UP RATE AMONG GPs.

Whilst the take-up rate does not affect the cost-effectiveness, the related concept of
adverse selection could affect the ratios. Adverse selection refers to the situation where
the effectiveness of the intervention is not Imiformly distributed across the participants.

Chere Project Report 11- November 1999

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