 Incremental net monetary benefit

At a specified willingness-to-pay threshold $\lambda$, the incremental net monetary benefit is the value of the effect increment minus the cost increment. It avoids dividing by a potentially near-zero or negative effect estimate. For estimates with variances $v_E,v_C$ and covariance $v_{CE}$, its estimated variance is ${\lambda }^2{v}_E+v_C-2\lambda v_{CE}$. A normal approximation therefore gives a confidence interval directly on the net-benefit scale. The economic sign criterion does not require a positive effect increment.