Decision Rule Net Benefit Pathway

Use synthetic examples to see how comparative costs and health outcomes support a conditional cost-effectiveness conclusion. The pathway keeps budget impact and wider HTA considerations visible because cost-effectiveness alone does not guarantee adoption.

The decision pathway

The pathway first checks whether one option is both less costly and more effective. If dominance does not settle the comparison, the analysis applies the stated threshold and net-benefit rule before examining uncertainty and the wider decision context.

1. Compare evidenceEstimate incremental costs and health outcomes.

2. Check dominanceIdentify options that cost more and produce less health.

3. Apply the ruleUse the threshold and incremental or expected net benefit.

4. Examine uncertaintySeparate expected value from probability of cost-effectiveness.

5. Add wider evidenceConsider budget impact, equity, severity and implementation.

6. State the conclusionReport a conditional recommendation and its assumptions.

Compare a new option with current care

Enter incremental values for the new option minus current care. The tool identifies the cost-effectiveness-plane quadrant, checks strict dominance, calculates an ICER when it can be interpreted, and applies incremental net monetary benefit.

Incremental cost (£) Incremental health effect (QALYs) Threshold (£ per QALY)

Quadrant—

Dominance—

ICER—

INMB—

Conditional conclusion

Apply the decision rule to see the result.

INMB = threshold × incremental QALYs − incremental cost

Do not stop at cost-effectiveness. A positive INMB supports the new option under the stated assumptions. Budget impact, uncertainty, clinical evidence, equity and implementation may still affect the final HTA recommendation.

Compare several alternatives consistently

Enter expected cost and QALYs for three to six alternatives. The tool marks strict dominance, identifies the lower convex cost-effectiveness frontier, calculates expected net monetary benefit and identifies the option with the greatest expected net benefit.

Threshold (£ per QALY)

Alternative	Expected cost (£)	Expected QALYs	Status	Expected NMB (£)

Conditional conclusion

Analyse the alternatives to see the result.

Frontier status is not the final institutional decision. The greatest expected net benefit identifies the preferred option on the stated economic rule. A complete decision can also require evidence about affordability and other HTA considerations.

Assumptions and interpretation

This educational tool uses expected costs and QALYs and assumes that all alternatives use the same perspective, time horizon, price basis and evidence framework. It does not estimate uncertainty, budget impact or patient-level outcomes and must not be used for a real reimbursement decision without a complete validated analysis.

The two-option result treats positive INMB as favouring the evaluated option on cost-effectiveness grounds at the stated threshold.
The multi-option result marks an alternative strictly dominated when another option has no higher cost and no lower QALYs, with at least one strict improvement.
The multi-option frontier is the lower convex envelope after strict dominance; an option below that efficiency standard is marked subject to extended dominance.
The example values are synthetic and do not describe a real healthcare technology, population or institution.
The tool stores no data and makes no external network requests.