Signature
ENHB_j = sum_(n=1)^N [E_jn - C_jn / lambda] / N
| Inputs | Definition | Unit |
|---|---|---|
E_jn | QALYs of option j in simulation n, listed across all simulations | QALYs per person |
C_jn | Total relevant cost of option j in simulation n, listed across all simulations | currency per person |
lambda | Value used to convert cost into health units, the cost at which one QALY is taken to be forgone elsewhere | currency per QALY |
N | Number of probabilistic simulations averaged | count |
ENHB_j | Mean across simulations of option j's health effect minus its cost converted to health at lambda | QALYs per person |
|---|
Function
Expected net benefit function
Maps the joint distribution of an option's uncertain costs and health effects, and a threshold, to the mean of its net benefit. The option with the highest expected net benefit is the one to adopt on current evidence, and the same quantity is the baseline for value of information analysis.
Try this function
Implementations
Excel
Expected net health benefit from a simulation table
Excel subtracts the mean simulated cost divided by the threshold from the mean simulated effect, using the same named ranges as the monetary form.
=AVERAGE(SimEffects)-AVERAGE(SimCosts)/Threshold
Assumptions
Cost expressed as health forgone
C_jn divided by lambda is the health expected to be given up elsewhere when lambda reflects the opportunity cost of spending, as set out on the cost-effectiveness threshold page. Lambda is greater than zero.
Worked examples
Standard care in health units
Using the same five simulations and a threshold of £25,000 per QALY, standard care A has net health benefits of 5.52, 5.36, 5.68, 5.12 and 5.42 QALYs, with a mean of 5.42 QALYs, which is £135,500 divided by £25,000.
lambda = 25000; N = 5; E_jn = [6.00,5.80,6.20,5.60,5.90]; C_jn = [12000,11000,13000,12000,12000]; ENHB_j = 5.42
New treatment in health units
New treatment B has a mean net health benefit of 5.508 QALYs at £25,000 per QALY, 0.088 QALYs per patient more than A, the same ranking as in monetary units. At £35,000 per QALY the values are about 5.557 QALYs for A and 5.741 QALYs for B.
lambda = 25000; N = 5; E_jn = [6.20,6.04,6.48,6.20,6.70]; C_jn = [21000,20000,22000,19000,20000]; ENHB_j = 5.508
Common errors
Reading the level of expected net benefit
The level of expected net benefit for one option depends on which costs are counted and has no absolute meaning. Only differences between options at the same threshold, 0.088 QALYs or £2,200 per patient in the worked examples, inform the decision.
Sources
Net health benefits in cost-effectiveness analysis
Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Medical Decision Making. 1998;18(2 Suppl):S68-S80.
NICE manual on expected net health benefits
National Institute for Health and Care Excellence. NICE technology appraisal and highly specialised technologies guidance: the manual (PMG36). Published 31 January 2022, last updated 31 March 2026. Chapter 4 Economic evaluation, section 4.2.16 (expected net health benefits presented as well as ICERs, using values placed on a QALY gain of £25,000 and £35,000; net monetary benefits can also be shown).
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