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. 2011 Jul 21;6(7):e22512. doi: 10.1371/journal.pone.0022512

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Clermont et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

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The mean estimate of incremental costs and effects suggest that the PAC is both more expensive and less effective (panel A). The 95% confidence ellipse only marginally dips below the 50 k/QALY willingness-to-pay threshold with the vast majority of trials agreeing with the mean estimate that the PAC is an inferior strategy. The corresponding cost-effectiveness acceptability curve conveys the probability of the PAC to be cost-effective at various willingness-to-pay thresholds (Panel B, x-axis). Even if willingness-to-pay was unlimited, there is only a 20.8% probability of the PAC to be cost effective (Panel B, dotted line). The PAC displays a better cost-effectiveness profile in subjects treated with a conservative fluid strategy (panel C) than those receiving a liberal strategy. A similar trend is seen in subjects where the study protocol was instituted early after enrolment (panel D). Yet, for both subgroups, there was a high probability for the PAC to be an ineffective strategy.