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. 2019 Mar 13;4(1):62–72. doi: 10.1089/can.2018.0027

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© Griffin A. Tyree et al. 2019; Published by Mary Ann Liebert, Inc.

This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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FIG. 2. — One-way sensitivity analysis tornado diagram. ICER represents the incremental cost per QALY gained from second-line adjunctive cannabis when compared to usual care. The dotted vertical line represents the base-case ICER of $48,594/QALY, while the horizontal bars indicate the magnitude of change in ICER caused by varying the parameter over its specified range. A negative ICER value, at which second-line adjunctive cannabis was dominated by usual care, is represented by an arrow tip on the end of the horizontal bar. All variables were examined in analysis; the five parameters shown caused the greatest change in ICER. Varying adherence threshold caused usual care to dominate second-line adjunctive cannabis. Varying moderate-to-severe pain state utility, mild pain state utility, and adherence to adjunctive cannabis over their respective ranges for sensitivity analysis caused the ICER to cross the $100,000/QALY threshold and second-line adjunctive cannabis to lose cost-effectiveness. However, second-line adjunctive cannabis remained cost-effective across the range of values for daily THC dose inputs. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; THC, tetrahydrocannabinol.