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Durand-Zaleski I, Ducrocq G, Mimouni M, Frenkiel J, Avendano-Solá C, Gonzalez-Juanatey JR, Ferrari E, Lemesle G, Puymirat E, Berard L, Cachanado M, Arnaiz JA, Martínez-Sellés M, Silvain J, Ariza-Solé A, Calvo G, Danchin N, Paco S, Drouet E, Abergel H, Rousseau A, Simon T, Steg PG. Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:194-202. [PMID: 35612990 DOI: 10.1093/ehjqcco/qcac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 01/29/2023]
Abstract
AIMS To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia. METHODS AND RESULTS Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was €33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was €191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of €72 000 saved per additional MACE with the restrictive strategy. CONCLUSION In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02648113. ONE SENTENCE SUMMARY The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.
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Affiliation(s)
- Isabelle Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France.,INSERM UMR 1153 CRESS, Paris, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Maroua Mimouni
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Jerome Frenkiel
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Cristina Avendano-Solá
- Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Emile Ferrari
- Université Côte d'Azur, and CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, 06001, Nice, France
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, Institut Pasteur de Lille, Inserm U1011, F-59000 Lille, France
| | - Etienne Puymirat
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Laurence Berard
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Joan Albert Arnaiz
- Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 75013, Paris, France
| | - Albert Ariza-Solé
- University Hospital Bellvitge, Heart Disease Institute, Barcelona, Spain
| | - Gonzalo Calvo
- Àrea del Medicament, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Nicolas Danchin
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Sandra Paco
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Elodie Drouet
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Helene Abergel
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
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2
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Onuma OK. The heart of the matter: adapting cardiovascular disease guidelines for low- and middle-income countries. Eur Heart J 2023; 44:608-609. [PMID: 36582028 DOI: 10.1093/eurheartj/ehac738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Oyere K Onuma
- Department of Internal Medicine/Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, USA
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Ostrominski JW, Hirji S, Bhatt AS, Butler J, Fiuzat M, Fonarow GC, Heidenreich PA, Januzzi JL, Lam CSP, Maddox TM, O'Connor CM, Vaduganathan M. Cost and Value in Contemporary Heart Failure Clinical Guidance Documents. JACC. HEART FAILURE 2022; 10:1-11. [PMID: 34969491 DOI: 10.1016/j.jchf.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to evaluate the frequency and nature of cost/value statements in contemporary heart failure (HF) clinical guidance documents (CGDs). BACKGROUND In an era of rising health care costs and expanding therapeutic options, there is an increasing need for formal consideration of cost and value in the development of HF CGDs. METHODS HF CGDs published by major professional cardiovascular organizations between January 2010 and February 2021 were reviewed for the inclusion of cost/value statements. RESULTS Overall, 33 documents were identified, including 5 (15%) appropriate use criteria, 7 (21%) clinical practice guidelines, and 21 (64%) expert consensus documents. Most CGDs (27 of 33; 82%) included at least 1 cost/value statement, and 20 (61%) CGDs included at least 1 cost/value-related citation. Most of these statements were found in expert consensus documents (77.7%). Three (9%) documents reported estimated costs of recommended interventions, but only 1 estimated out-of-pocket cost. Of 179 cost/value-related statements observed, 116 (64.8%) highlighted the economic impact of HF or HF-related care, 6 (3.4%) advocated for cost/value issues, 15 (8.4%) reported gaps in cost/value evidence, and 42 (23.5%) supported clinical guidance recommendations. Over time, patterns of inclusion of statements and citations of cost/value have been largely stable. CONCLUSIONS Although most contemporary HF CGDs contain at least 1 cost/value statement, most CGDs focus on the high economic impact of HF and its related care; explicit inclusion of cost/value to support clinical guidance recommendations remains infrequent. These results highlight key opportunities for the integration of formalized cost/value considerations in future HF-focused CGDs.
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Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ankeet S Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St Louis, Missouri, USA
| | - Christopher M O'Connor
- Division of Cardiology, Duke University, Durham, North Carolina, USA; Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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4
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Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC: CARDIOONCOLOGY 2021; 3:236-246. [PMID: 34396329 PMCID: PMC8352280 DOI: 10.1016/j.jaccao.2021.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Background Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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Affiliation(s)
- Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Fouad Chouairi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida, USA
| | - Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, Texas, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nestor F Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
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McManus E, Turner D, Sach T. Can You Repeat That? Exploring the Definition of a Successful Model Replication in Health Economics. PHARMACOECONOMICS 2019; 37:1371-1381. [PMID: 31531833 DOI: 10.1007/s40273-019-00836-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) modelling taskforce suggests decision models should be thoroughly reported and transparent. However, the level of transparency and indeed how transparency should be assessed are yet to be defined. One way may be to attempt to replicate the model and its outputs. The ability to replicate a decision model could demonstrate adequate reporting transparency. This review aims to explore published definitions of replication success across all scientific disciplines and to consider how such a definition should be tailored for use in health economic models. A literature review was conducted to identify published definitions of a 'successful replication'. Using these as a foundation, several definitions of replication success were constructed, to be applicable to replications of economic decision models, with the associated strengths and weaknesses of such definitions discussed. A substantial body of literature discussing replicability was found; however, relatively few studies, ten, explicitly defined a successful replication. These definitions varied from subjective assessments to expecting exactly the same results to be reproduced. Whilst the definitions that have been found may help to construct a definition specific to health economics, no definition was found that completely encompassed the unique requirements for decision models. Replication is widely discussed in other scientific disciplines; however, as of yet, there is no consensus on how replicable models should be within health economics or what constitutes a successful replication. Replication studies can demonstrate how transparently a model is reported, identify potential calculation errors and inform future reporting practices. It may therefore be a useful adjunct to other transparency or quality measures.
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Affiliation(s)
- Emma McManus
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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Stevens ER, Farrell D, Jumkhawala SA, Ladapo JA. Quality of health economic evaluations for the ACC/AHA stable ischemic heart disease practice guideline: A systematic review. Am Heart J 2018; 204:17-33. [PMID: 30077048 DOI: 10.1016/j.ahj.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The American College of Cardiology/American Heart Association (ACC/AHA) recently published a rigorous framework to guide integration of economic data into clinical guidelines. We assessed the quality of economic evaluations in a major ACC/AHA clinical guidance report. METHODS We systematically identified cost-effectiveness analyses (CEAs) of RCTs cited in the ACC/AHA 2012 Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease. We extracted: (1) study identifiers; (2) parent RCT information; (3) economic analysis characteristics; and (4) study quality using the Quality of Health Economic Studies instrument (QHES). RESULTS Quality scores were categorized as high (≥75 points) or low (<75 points). Of 1,266 citations in the guideline, 219 were RCTs associated with 77 CEAs. Mean quality score was 81 (out of 100) and improved over time, though 29.9% of studies were low-quality. Cost-per-QALY was the most commonly reported primary outcome (39.0%). Low-quality studies were less likely to report study perspective, use appropriate time horizons, or address statistical and clinical uncertainty. Funding was overwhelmingly private (83%). A detailed methodological assessment of high-quality studies revealed domains of additional methodological issues not identified by the QHES. CONCLUSIONS Economic evaluations of RCTs in the 2012 ACC/AHA ischemic heart disease guideline largely had high QHES scores but methodological issues existed among "high-quality" studies. Because the ACC/AHA has generally been more systematic in its integration of scientific evidence compared to other professional societies, it is likely that most societies will need to proceed more cautiously in their integration of economic evidence.
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Ferket BS, Oxman JM, Iribarne A, Gelijns AC, Moskowitz AJ. Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies. J Thorac Cardiovasc Surg 2018; 155:1671-1681.e11. [PMID: 29338858 PMCID: PMC6497446 DOI: 10.1016/j.jtcvs.2017.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jonathan M Oxman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Iribarne
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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8
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Can Economic Model Transparency Improve Provider Interpretation of Cost-Effectiveness Analysis? A Response. Med Care 2017; 55:912-914. [PMID: 29028754 DOI: 10.1097/mlr.0000000000000811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To enhance the credibility and the value of health economic analyses, we argue that the computer model source code underlying these analyses should be made publicly available. Only with open publication is it possible for others to assess whether alternative assumptions, beyond those examined by the model authors, alter the model's findings. Because reproducibility is critical for scientific acceptance and because computation increasingly permeates scientific inquiry, other fields have moved toward open publication of computer models, and health economics should avoid falling behind. Making source code available shines a light on these otherwise black boxes and facilitates their complete evaluation and understandability. The preceding commentary makes 2 arguments against open publication. It claims first that open publication would undermine intellectual property rights and discourage work in this field. We respond that the impact on intellectual property would be minimal, and that open publication could even increase model value. The second argument against open publication is the possibility of model misuse. If anything, however, open publication would reduce this risk by making the model implementation completely transparent. We argue finally that open publication of models would have ancillary benefits by making the research more amenable for adaptation and innovation. Moving toward open publication will present challenges, but we believe that the benefits of increased scientific credibility and utility, particularly for health policy and clinical practice decisions, will certainly outweigh the harms.
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9
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Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine. Med Care 2017; 55:909-911. [PMID: 29028753 DOI: 10.1097/mlr.0000000000000810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.
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Mechanick JI, Pessah-Pollack R, Camacho P, Correa R, Figaro MK, Garber JR, Jasim S, Pantalone KM, Trence D, Upala S. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY PROTOCOL FOR STANDARDIZED PRODUCTION OF CLINICAL PRACTICE GUIDELINES, ALGORITHMS, AND CHECKLISTS - 2017 UPDATE. Endocr Pract 2017; 23:1006-1021. [PMID: 28786720 DOI: 10.4158/ep171866.gl] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Clinical practice guideline (CPG), clinical practice algorithm (CPA), and clinical checklist (CC, collectively CPGAC) development is a high priority of the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE). This 2017 update in CPG development consists of (1) a paradigm change wherein first, environmental scans identify important clinical issues and needs, second, CPA construction focuses on these clinical issues and needs, and third, CPG provide CPA node/edge-specific scientific substantiation and appended CC; (2) inclusion of new technical semantic and numerical descriptors for evidence types, subjective factors, and qualifiers; and (3) incorporation of patient-centered care components such as economics and transcultural adaptations, as well as implementation, validation, and evaluation strategies. This third point highlights the dominating factors of personal finances, governmental influences, and third-party payer dictates on CPGAC implementation, which ultimately impact CPGAC development. The AACE/ACE guidelines for the CPGAC program is a successful and ongoing iterative exercise to optimize endocrine care in a changing and challenging healthcare environment. ABBREVIATIONS AACE = American Association of Clinical Endocrinologists ACC = American College of Cardiology ACE = American College of Endocrinology ASeRT = ACE Scientific Referencing Team BEL = best evidence level CC = clinical checklist CPA = clinical practice algorithm CPG = clinical practice guideline CPGAC = clinical practice guideline, algorithm, and checklist EBM = evidence-based medicine EHR = electronic health record EL = evidence level G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GAC = guidelines, algorithms, and checklists HCP = healthcare professional(s) POEMS = patient-oriented evidence that matters PRCT = prospective randomized controlled trial.
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