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Risebrough NA, Mursleen S, Ndirangu K, Shah D, Martin A, Schroeder M, Ismaila AS. The long-term clinical and economic benefits of treating advanced COPD patients with single-inhaler triple therapy in Quebec, Canada - The IMPACT trial. Respir Med 2024; 231:107694. [PMID: 38844004 DOI: 10.1016/j.rmed.2024.107694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND This cost-utility analysis assessed the long-term clinical and economic benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy vs FF/VI or UMEC/VI from a Quebec societal perspective in patients with chronic obstructive pulmonary disease (COPD) with ≥1 moderate/severe exacerbation in the previous year. METHODS The validated GALAXY disease progression model was utilized, with parameters set to baseline and efficacy data from IMPACT. Treatment costs (2017 Canadian dollars [C$]) were estimated using Quebec-specific unit costs. Costs and health outcomes were discounted at 1.5 %/year. A willingness-to-pay threshold of C$50,000/quality-adjusted life year (QALY) was considered cost-effective. Outcomes modeled were exacerbation rates, QALYs, life years (LYs), costs and incremental cost-effectiveness ratios (ICERs). Subgroup analyses were performed according to prior treatment, exacerbation history in the previous year, and baseline lung function. RESULTS Over a lifetime horizon, FF/UMEC/VI resulted in more QALYs and LYs gained, at a small incremental cost compared with FF/VI and UMEC/VI. From a societal perspective, the estimated ICER for the base case was C$18,152/QALY vs FF/VI, and C$15,847/QALY vs UMEC/VI. For the subgroup analyses (FF/UMEC/VI compared with FF/VI and UMEC/VI), ICERs ranged from: C$17,412-25,664/QALY and C$16,493-18,663/QALY (prior treatment); C$15,247-19,924/QALY and C$15,444-28,859/QALY (exacerbation history); C$14,025-34,154/QALY and C$16,083-17,509/QALY (baseline lung function). INTERPRETATION FF/UMEC/VI was predicted to improve outcomes and be cost-effective vs both comparators in the base case and all subgroup analyses, and based on this analysis would be an appropriate investment of health service funds in Quebec. CLINICAL TRIAL REGISTRATION NUMBER IMPACT trial NCT02164513.
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Affiliation(s)
- Nancy A Risebrough
- ICON Global Health Economics and Outcomes Research, ICON plc, Toronto, ON, M2N 1A2, Canada.
| | - Sara Mursleen
- Health Economics and Outcomes Research, GSK, Mississauga, ON, L5R 3G2, Canada.
| | - Kerigo Ndirangu
- ICON Global Health Economics and Outcomes Research, ICON plc, New York, NY, 11735, USA.
| | - Dhvani Shah
- ICON Global Health Economics and Outcomes Research, ICON plc, New Jersey, NJ 07302, USA.
| | - Alan Martin
- Value Evidence and Outcomes, GSK, Brentford, TW8 9GS, UK.
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, 19426-0989, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada.
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Qureshi AI, Akinci Y, Huang W, Ishfaq MF, Hassan AE, Siddiq F, Gomez CR. Cost-effectiveness analysis of endovascular treatment with or without intravenous thrombolysis in acute ischemic stroke. J Neurosurg 2023; 138:223-232. [PMID: 35901768 DOI: 10.3171/2022.4.jns22514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Intravenous (IV) recombinant tissue plasminogen activator (r-tPA) may not provide additional benefit in terms of functional outcomes in patients with acute ischemic stroke (AIS) who undergo endovascular treatment (EVT). In this context, the cost-effectiveness of EVT alone compared with its application following IV r-tPA has not been evaluated. METHODS The authors determined the average rates of death or disability in each of the two treatment groups from four randomized clinical trials that enrolled patients with AIS within 4.5 hours of symptom onset and randomly assigned patients to EVT alone and IV r-tPA and EVT. By using three sources derived from previous studies, the authors determined the cost of IV r-tPA, cost of staff time for administration, cost of the EVT, cost of hospital stay, costs of supported discharge and community care, and cost of posthospitalization care and disability. They then assessed the cost-effectiveness of EVT alone using a decision tree for the 1st year after AIS and a Markov model with a 10-year horizon, including probabilistic assessment by Monte Carlo simulations. RESULTS The 1-year cost was higher with IV r-tPA and EVT compared with EVT alone (incremental cost ranging between $3554 and $13,788 per patient). The mean incremental cost-effectiveness ratios (ICERs) were -$1589, -$78,327, and -$15,471 per quality-adjusted life-year gained for cost sources 1, 2, and 3, respectively, for EVT alone compared with IV r-tPA and EVT at 10 years. The ceiling ICER (willingness to pay) for a probability of 100% that EVT alone was more cost-effective ranged between $25,000 and $100,000 in the three models. CONCLUSIONS EVT alone appears to be more cost-effective compared with EVT and IV r-tPA for the treatment of AIS patients presenting within 4.5 hours of symptom onset.
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Affiliation(s)
- Adnan I Qureshi
- 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri
| | - Yasemin Akinci
- 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri
| | - Wei Huang
- 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri
| | - Muhammad F Ishfaq
- 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri
| | - Ameer E Hassan
- 2Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Texas.,3Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas; and
| | - Farhan Siddiq
- 4Division of Neurosurgery, University of Missouri, Columbia, Missouri
| | - Camilo R Gomez
- 1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri
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Paly VF, Vallejo-Aparicio LA, Martin A, Izquierdo JL, Riesco JA, Soler-Cataluña JJ, Abreu C, Biswas C, Ismaila AS. Cost-Effectiveness of Once-Daily Single-Inhaler COPD Triple Therapy in Spain: IMPACT Trial. Int J Chron Obstruct Pulmon Dis 2022; 17:3097-3109. [PMID: 36561129 PMCID: PMC9766529 DOI: 10.2147/copd.s366765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose Given between-country differences in healthcare systems, treatment costs, and disease management guidelines, country-specific cost-effectiveness analyses are important. This study evaluated the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI and UMEC/VI among patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations from a Spanish healthcare system perspective. Patients and Methods Baseline data and treatment effects from the IMPACT trial were populated into the validated GALAXY COPD progression model. Utilities were estimated using Spanish observational data. Direct healthcare costs (2019 €) were informed by Spanish public sources. A 3% discount rate for costs and benefits was applied. The time horizon and treatment duration were 3 years (base case). One-way sensitivity, scenario, and probabilistic sensitivity analyses were performed. Results FF/UMEC/VI treatment resulted in fewer exacerbations over 3 years (4.130 vs 3.648) versus FF/VI, with a mean (95% confidence interval [CI]) incremental cost of €444 (€149, €713) per patient and benefit of 0.064 (0.053, 0.076) quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €6887 per QALY gained. FF/UMEC/VI was a dominant treatment strategy versus UMEC/VI, resulting in fewer exacerbations (4.130 vs 3.360), with a mean (95% CI) incremental cost of -€450 (-€844, -€149) and benefit of 0.054 (0.043, 0.064) QALYs. FF/UMEC/VI was cost-effective versus FF/VI and UMEC/VI across all analyses. Conclusion FF/UMEC/VI was predicted to be a cost-effective treatment option versus FF/VI or UMEC/VI in symptomatic COPD patients at risk of exacerbations in Spain, across all scenarios and sensitivity analyses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Correspondence: Afisi S Ismaila, Value Evidence and Outcomes, GSK, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USA, Tel +1 919 315 8229, Email
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Handels RL, Green C, Gustavsson A, Herring WL, Winblad B, Wimo A, Sköldunger A, Karlsson A, Anderson R, Belger M, Brück C, Espinosa R, Hlávka JP, Jutkowitz E, Lin P, Mendez ML, Mar J, Shewmaker P, Spackman E, Tafazzoli A, Tysinger B, Jönsson L. Cost‐effectiveness models for Alzheimer's disease and related dementias: IPECAD modeling workshop cross‐comparison challenge. Alzheimers Dement 2022; 19:1800-1820. [PMID: 36284403 PMCID: PMC10126209 DOI: 10.1002/alz.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/14/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The credibility of model-based economic evaluations of Alzheimer's disease (AD) interventions is central to appropriate decision-making in a policy context. We report on the International PharmacoEconomic Collaboration on Alzheimer's Disease (IPECAD) Modeling Workshop Challenge. METHODS Two common benchmark scenarios, for the hypothetical treatment of AD mild cognitive impairment (MCI) and mild dementia, were developed jointly by 29 participants. Model outcomes were summarized, and cross-comparisons were discussed during a structured workshop. RESULTS A broad concordance was established among participants. Mean 10-year restricted survival and time in MCI in the control group ranged across 10 MCI models from 6.7 to 9.5 years and 3.4 to 5.6 years, respectively; and across 4 mild dementia models from 5.4 to 7.9 years (survival) and 1.5 to 4.2 years (mild dementia). DISCUSSION The model comparison increased our understanding of methods, data used, and disease progression. We established a collaboration framework to assess cost-effectiveness outcomes, an important step toward transparent and credible AD models.
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Affiliation(s)
- Ron L.H. Handels
- Maastricht University Department of Psychiatry and Neuropsychology Alzheimer Centre Limburg School for Mental Health and Neurosciences Maastricht The Netherlands
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Colin Green
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Health Economics Group University of Exeter College of Medicine and Health University of Exeter Exeter UK
| | - Anders Gustavsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Quantify Research Hantverkargatan 8 Stockholm Sweden
| | | | - Bengt Winblad
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Wimo
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Sköldunger
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Andreas Karlsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Solna Sweden
| | - Robert Anderson
- Care Policy Evaluation Centre London School of Economics London UK
| | | | - Chiara Brück
- Erasmus MC University Medical Center Department of Public Health Rotterdam The Netherlands
| | | | - Jakub P. Hlávka
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Eric Jutkowitz
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
- Providence Veterans Affairs (VA) Medical Center Center of Innovation in Long Term Services and Supports Providence Rhode Island USA
| | - Pei‐Jung Lin
- Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston Massachusetts USA
| | - Mauricio Lopez Mendez
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Javier Mar
- Osakidetza Basque Health Service Debagoiena Integrated Health Organisation Research Unit Arrasate‐Mondragón Spain
- Biodonostia Health Research Institute Donostia‐San Sebastián Spain
| | - Peter Shewmaker
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Eldon Spackman
- University of Calgary Department of Community Health Sciences Calgary Canada
- O'Brien Institute of Public Health Alberta Canada
| | | | - Bryan Tysinger
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Linus Jönsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- H. Lundbeck A/S Valby Denmark
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Maltais F, Vogelmeier CF, Kerwin EM, Bjermer LH, Jones PW, Boucot IH, Lipson DA, Tombs L, Compton C, Naya IP. Applying key learnings from the EMAX trial to clinical practice and future trial design in COPD. Respir Med 2022; 200:106918. [DOI: 10.1016/j.rmed.2022.106918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
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Qureshi AI, Suri MFK, Huang W, Akinci Y, Chaudhry MR, Pond DS, French BR, Siddiq F, Gomez CR. Annual Direct Cost of Dysphagia Associated with Acute Ischemic Stroke in the United States. J Stroke Cerebrovasc Dis 2022; 31:106407. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022] Open
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Shukla S, Shah D, Martin A, Risebrough NA, Kendall R, Vogelmeier CF, Boucot I, Tombs L, Bjermer L, Jones PW, Kerwin E, Compton C, Maltais F, Lipson DA, Ismaila AS. Economic Evaluation of Umeclidinium/Vilanterol versus Umeclidinium or Salmeterol in Symptomatic Non-Exacerbating Patients with COPD from a UK Perspective Using the GALAXY Model. Int J Chron Obstruct Pulmon Dis 2021; 16:3105-3118. [PMID: 34916789 PMCID: PMC8668403 DOI: 10.2147/copd.s331636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Dual bronchodilators are recommended as maintenance treatment for patients with symptomatic COPD in the UK; further evidence is needed to evaluate cost-effectiveness versus monotherapy. Cost-effectiveness of umeclidinium/vilanterol versus umeclidinium and salmeterol from a UK healthcare perspective in patients without exacerbations in the previous year was assessed using post hoc EMAX trial data. Methods The validated GALAXY model was populated with baseline characteristics and treatment effects from the non-exacerbating subgroup of the symptomatic EMAX population (COPD assessment test score ≥10) and 2020 UK healthcare and drug costs. Outputs included estimated exacerbation rates, costs, life-years (LYs), and quality-adjusted LYs (QALYs); incremental cost-effectiveness ratio (ICER) was calculated as incremental cost/QALY gained. The base case (probabilistic model) used a 10-year time horizon, assumed no treatment discontinuation, and discounted future costs and QALYs by 3.5% annually. Sensitivity and scenario analyses assessed robustness of model results. Results Umeclidinium/vilanterol treatment was dominant versus umeclidinium and salmeterol, providing an additional 0.090 LYs (95% range: 0.035, 0.158) and 0.055 QALYs (−0.059, 0.168) with total cost savings of £690 (£231, £1306) versus umeclidinium, and 0.174 LYs (0.076, 0.286) and 0.204 QALYs (0.079, 0.326) with savings of £1336 (£1006, £2032) versus salmeterol. In scenario and sensitivity analyses, umeclidinium/vilanterol was dominant versus umeclidinium except over a 5-year time horizon (more QALYs at higher total cost; ICER=£4/QALY gained) and at the lowest estimate of the St George’s Respiratory Questionnaire treatment effect (fewer QALYs at lower total cost; ICER=£12,284/QALY gained); umeclidinium/vilanterol was consistently dominant versus salmeterol. At willingness-to-pay threshold of £20,000/QALY, probability that umeclidinium/vilanterol was cost-effective in this non-exacerbating subgroup was 95% versus umeclidinium and 100% versus salmeterol. Conclusion Based on model predictions from a UK perspective, symptomatic patients with COPD and no exacerbations in the prior year receiving umeclidinium/vilanterol are expected to have better outcomes at lower costs versus umeclidinium and salmeterol.
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Affiliation(s)
- Soham Shukla
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | - Alan Martin
- Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK
| | - Nancy A Risebrough
- Global Health Economics, and Outcomes Research and Epidemiology, ICON, Toronto, ON, Canada
| | - Robyn Kendall
- Global Health Economics, and Outcomes Research and Epidemiology, ICON, Vancouver, BC, Canada
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | | | - Lee Tombs
- Precise Approach Ltd, Contingent Worker on Assignment at GSK, Brentford, Middlesex, UK
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Paul W Jones
- Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK
| | - Edward Kerwin
- Altitude Clinical Consulting and Clinical Research Institute of Southern Oregon, Medford, OR, USA
| | - Chris Compton
- Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK
| | - François Maltais
- Centre de Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - David A Lipson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Respiratory Clinical Sciences, GSK, Collegeville, PA, USA
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Beaubien L, Conrad C, Music J, Toze S. Evaluating Simplified Web Interfaces of Risk Models for Clinical Use: Pilot Survey Study. JMIR Form Res 2021; 5:e22110. [PMID: 34269692 PMCID: PMC8325085 DOI: 10.2196/22110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/14/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In this pilot study, we investigated sociotechnical factors that affect intention to use a simplified web model to support clinical decision making. OBJECTIVE We investigated factors that are known to affect technology adoption using the unified theory of acceptance and use of technology (UTAUT2) model. The goal was to pilot and test a tool to better support complex clinical assessments. METHODS Based on the results of a previously published work, we developed a web-based mobile user interface, WebModel, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (eg, survival time) for chronic obstructive pulmonary disease. The WebModel provides a way to combat information overload and more easily compare treatment options. It limits the number of web forms presented to a user to between 1 and 20, rather than the dozens of detailed calculations typically required. The WebModel uses responsive design and can be used on multiple devices. To test the WebModel, we designed a questionnaire to probe the efficacy of the WebModel and assess the usability and usefulness of the system. The study was live for one month, and participants had access to it over that time. The questionnaire was administered online, and data from 674 clinical users who had access to the WebModel were captured. SPSS and R were used for statistical analysis. RESULTS The regression model developed from UTAUT2 constructs was a fit. Specifically, five of the seven factors were significant positive coefficients in the regression: performance expectancy (β=.2730; t=7.994; P<.001), effort expectancy (β=.1473; t=3.870; P=.001), facilitating conditions (β=.1644; t=3.849; P<.001), hedonic motivation (β=.2321; t=3.991; P<.001), and habit (β=.2943; t=12.732). Social influence was not a significant factor, while price value had a significant negative influence on intention to use the WebModel. CONCLUSIONS Our results indicate that multiple influences impact positive response to the system, many of which relate to the efficiency of the interface to provide clear information. Although we found that the price value was a negative factor, it is possible this was due to the removal of health workers from purchasing decisions. Given that this was a pilot test, and that the system was not used in a clinical setting, we could not examine factors related to actual workflow, patient safety, or social influence. This study shows that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. We recommend further study to test this in a clinical setting and gather qualitative data from users regarding the value of the tool in practice.
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Affiliation(s)
- Louis Beaubien
- Rowe School of Business, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Colin Conrad
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Janet Music
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Sandra Toze
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
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Fenwick E, Martin A, Schroeder M, Mealing SJ, Solanke O, Risebrough N, Ismaila AS. Cost-effectiveness analysis of a single-inhaler triple therapy for COPD in the UK. ERJ Open Res 2021; 7:00480-2020. [PMID: 33778055 PMCID: PMC7983252 DOI: 10.1183/23120541.00480-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/17/2020] [Indexed: 11/05/2022] Open
Abstract
UK management costs for COPD, estimated at £1.9 billion/year, are rising. In the FULFIL (Lung Function and Quality of Life Assessment in Chronic Obstructive Pulmonary Disease with Closed Triple Therapy) study, single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (100/62.5/25 µg) improved clinical outcomes versus budesonide/formoterol (400/12 µg) in patients with symptomatic COPD at risk of exacerbations. We assessed the cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol for treating COPD from a UK National Health Service perspective. A model was developed combining a trial-based and Markov component and populated with baseline and treatment effect data from FULFIL, together with UK healthcare resource costs and disease-related utilities. Costs per life year and per quality-adjusted life year gained (costing year 2017) for fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol were calculated for a lifetime horizon. Results were explored using deterministic sensitivity, scenario and probabilistic analyses. Fluticasone furoate/umeclidinium/vilanterol was associated with gains in life years (0.533) and quality-adjusted life years (0.506) versus budesonide/formoterol, but at slightly increased total costs (£26 416 versus £25 860). This translated to incremental cost-effectiveness ratios of £1042/life year and £1098/quality-adjusted life year for fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol. In scenario analyses, incremental cost-effectiveness ratios ranged from dominant to £1547/quality-adjusted life year gained. Fluticasone furoate/umeclidinium/vilanterol provides a cost-effective treatment option versus budesonide/formoterol for patients with symptomatic COPD in the UK.
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Affiliation(s)
| | - Alan Martin
- Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK
| | | | | | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA.,Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Moll M, Qiao D, Regan EA, Hunninghake GM, Make BJ, Tal-Singer R, McGeachie MJ, Castaldi PJ, San Jose Estepar R, Washko GR, Wells JM, LaFon D, Strand M, Bowler RP, Han MK, Vestbo J, Celli B, Calverley P, Crapo J, Silverman EK, Hobbs BD, Cho MH. Machine Learning and Prediction of All-Cause Mortality in COPD. Chest 2020; 158:952-964. [PMID: 32353417 PMCID: PMC7478228 DOI: 10.1016/j.chest.2020.02.079] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COPD is a leading cause of mortality. RESEARCH QUESTION We hypothesized that applying machine learning to clinical and quantitative CT imaging features would improve mortality prediction in COPD. STUDY DESIGN AND METHODS We selected 30 clinical, spirometric, and imaging features as inputs for a random survival forest. We used top features in a Cox regression to create a machine learning mortality prediction (MLMP) in COPD model and also assessed the performance of other statistical and machine learning models. We trained the models in subjects with moderate to severe COPD from a subset of subjects in Genetic Epidemiology of COPD (COPDGene) and tested prediction performance in the remainder of individuals with moderate to severe COPD in COPDGene and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared our model with the BMI, airflow obstruction, dyspnea, exercise capacity (BODE) index; BODE modifications; and the age, dyspnea, and airflow obstruction index. RESULTS We included 2,632 participants from COPDGene and 1,268 participants from ECLIPSE. The top predictors of mortality were 6-min walk distance, FEV1 % predicted, and age. The top imaging predictor was pulmonary artery-to-aorta ratio. The MLMP-COPD model resulted in a C index ≥ 0.7 in both COPDGene and ECLIPSE (6.4- and 7.2-year median follow-ups, respectively), significantly better than all tested mortality indexes (P < .05). The MLMP-COPD model had fewer predictors but similar performance to that of other models. The group with the highest BODE scores (7-10) had 64% mortality, whereas the highest mortality group defined by the MLMP-COPD model had 77% mortality (P = .012). INTERPRETATION An MLMP-COPD model outperformed four existing models for predicting all-cause mortality across two COPD cohorts. Performance of machine learning was similar to that of traditional statistical methods. The model is available online at: https://cdnm.shinyapps.io/cgmortalityapp/.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Elizabeth A Regan
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | | | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Raul San Jose Estepar
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - James M Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David LaFon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew Strand
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Russell P Bowler
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, CO; Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and the Manchester University NHS Foundation Trust, Manchester, England
| | - Bartolome Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peter Calverley
- Department of Medicine, University of Liverpool, Liverpool, England
| | - James Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.
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11
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Schroeder M, Benjamin N, Atienza L, Biswas C, Martin A, Whalen JD, Izquierdo Alonso JL, Riesco Miranda JA, Soler-Cataluña JJ, Huerta A, Ismaila AS. Cost-Effectiveness Analysis of a Once-Daily Single-Inhaler Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease (COPD) Using the FULFIL Trial: A Spanish Perspective. Int J Chron Obstruct Pulmon Dis 2020; 15:1621-1632. [PMID: 32764908 PMCID: PMC7360413 DOI: 10.2147/copd.s240556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/24/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose To evaluate the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs twice-daily budesonide/formoterol (BUD/FOR) in patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations, from the Spanish National Healthcare System perspective. Patients and Methods The validated GALAXY-COPD model was used to simulate disease progression and predict healthcare costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 3-year time horizon for a Spanish population. Patient characteristics from published literature were supplemented by data from FULFIL (NCT02345161), which compared FF/UMEC/VI vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations. Treatment effects, extrapolated to 3 years, were based on Week 24 results in the FULFIL intent-to-treat population, including change in forced expiratory volume in 1 second, St. George’s Respiratory Questionnaire score, and exacerbation rates. Treatment, exacerbations, and COPD management costs (2019€) were informed by Spanish public sources and published literature. A 3% discount rate for costs and benefits was applied. One-way sensitivity and scenario analyses, and probabilistic sensitivity analysis (PSA), were performed. Results FF/UMEC/VI treatment led to fewer moderate and severe exacerbations (2.126 and 0.306, respectively) vs BUD/FOR (2.608 and 0.515, respectively), with a mean incremental cost of €69 and gain of 0.107 QALYs, which resulted in an ICER of €642 per QALY gained. In sensitivity analyses, the ICER was most sensitive to treatment effect variations in exacerbations and healthcare resource utilization/event costs. Overall, 95% of 1000 PSA simulations resulted in an ICER less than €11,000 per QALY gained for FF/UMEC/VI vs BUD/FOR, confirming robustness of the results. The probability of FF/UMEC/VI being cost-effective vs BUD/FOR was 100% at a willingness-to-pay threshold of €30,000 per QALY gained. Conclusion At the accepted Spanish ICER threshold of €30,000, FF/UMEC/VI represents a cost-effective treatment option vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations.
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Affiliation(s)
| | | | | | | | - Alan Martin
- Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK
| | | | | | - Juan Antonio Riesco Miranda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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12
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Ismaila AS, Risebrough N, Schroeder M, Shah D, Martin A, Goodall EC, Ndirangu K, Criner G, Dransfield M, Halpin DMG, Han MK, Lomas DA. Cost-Effectiveness Of Once-Daily Single-Inhaler Triple Therapy In COPD: The IMPACT Trial. Int J Chron Obstruct Pulmon Dis 2019; 14:2681-2695. [PMID: 31819401 PMCID: PMC6890193 DOI: 10.2147/copd.s216072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022] Open
Abstract
Background We assessed the cost-effectiveness of single-inhaler fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus FF/VI or UMEC/VI from a Canadian public healthcare perspective, incorporating data from the IMPACT trial in chronic obstructive pulmonary disease (COPD) (NCT02164513). Methods Baseline inputs and treatment effects from IMPACT were populated into the validated GALAXY-COPD disease progression model. Canadian unit costs and drug costs (Canadian dollars [C$], 2017) were applied to healthcare resource utilization and treatments. Future costs and health outcomes were discounted at 1.5% annually. Analyses were probabilistic, and outputs included exacerbation rates, costs, and life years (LYs) and quality-adjusted life years (QALYs) gained. Results Compared with FF/VI and UMEC/VI over a lifetime horizon, the analyses predicted that treatment with FF/UMEC/VI resulted in fewer moderate and severe exacerbations, more LYs and more QALYs gained, with a small incremental cost. The base-case incremental cost-effectiveness ratio (ICER) per QALY gained was C$18,989 (95% confidence interval [CI]: C$14,665, C$25,753) versus FF/VI and C$13,776 (95% CI: C$9787, C$19,448) versus UMEC/VI. FF/UMEC/VI remained cost-effective versus both FF/VI and UMEC/VI in all sensitivity analyses, including in scenario analyses that considered different intervention and comparator discontinuation rates, and treatment effects for subsequent therapy. Conclusion Treatment with FF/UMEC/VI was predicted to improve outcomes and be a cost-effective treatment option for patients with symptomatic COPD and a history of exacerbations compared with FF/VI or UMEC/VI, in Canada.
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Affiliation(s)
- Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | - Dhvani Shah
- ICON Health Economics, ICON plc, New York, NY, USA
| | - Alan Martin
- Value Evidence and Outcomes, GlaxoSmithKline plc, Uxbridge, UK
| | - Emma C Goodall
- Health Economics and Outcomes Research, GlaxoSmithKline plc, Mississauga, ON, Canada
| | | | - Gerard Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - MeiLan K Han
- University of Michigan, Pulmonary and Critical Care, Ann Arbor, MI, USA
| | - David A Lomas
- UCL Respiratory, University College London, London, UK
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13
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Kent S, Becker F, Feenstra T, Tran-Duy A, Schlackow I, Tew M, Zhang P, Ye W, Lizheng S, Herman W, McEwan P, Schramm W, Gray A, Leal J, Lamotte M, Willis M, Palmer AJ, Clarke P. The Challenge of Transparency and Validation in Health Economic Decision Modelling: A View from Mount Hood. PHARMACOECONOMICS 2019; 37:1305-1312. [PMID: 31347104 PMCID: PMC6860461 DOI: 10.1007/s40273-019-00825-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Transparency in health economic decision modelling is important for engendering confidence in the models and in the reliability of model-based cost-effectiveness analyses. The Mount Hood Diabetes Challenge Network has taken a lead in promoting transparency through validation with biennial conferences in which diabetes modelling groups meet to compare simulated outcomes of pre-specified scenarios often based on the results of pivotal clinical trials. Model registration is a potential method for promoting transparency, while also reducing the duplication of effort. An important network initiative is the ongoing construction of a diabetes model registry (https://www.mthooddiabeteschallenge.com). Following the 2012 International Society for Pharmacoeconomics and Outcomes Research and the Society of Medical Decision Making (ISPOR-SMDM) guidelines, we recommend that modelling groups provide technical and non-technical documentation sufficient to enable model reproduction, but not necessarily provide the model code. We also request that modelling groups upload documentation on the methods and outcomes of validation efforts, and run reference case simulations so that model outcomes can be compared. In this paper, we discuss conflicting definitions of transparency in health economic modelling, and describe the ongoing development of a registry of economic models for diabetes through the Mount Hood Diabetes Challenge Network, its objectives and potential further developments, and highlight the challenges in its construction and maintenance. The support of key stakeholders such as decision-making bodies and journals is key to ensuring the success of this and other registries. In the absence of public funding, the development of a network of modellers is of huge value in enhancing transparency, whether through registries or other means.
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Affiliation(s)
- Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frauke Becker
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Talitha Feenstra
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services Research, Bilthoven, The Netherlands
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ping Zhang
- Division of Diabetes Translation, Centres for Disease Control and Prevention, Atlanta, USA
| | - Wen Ye
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Shi Lizheng
- Department of Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - William Herman
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Phil McEwan
- Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Michael Willis
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Andrew J Palmer
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Menzies Institute for Medical Research, The University of Tasmania, Hobart, Australia
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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14
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Sampson CJ, Arnold R, Bryan S, Clarke P, Ekins S, Hatswell A, Hawkins N, Langham S, Marshall D, Sadatsafavi M, Sullivan W, Wilson ECF, Wrightson T. Transparency in Decision Modelling: What, Why, Who and How? PHARMACOECONOMICS 2019; 37:1355-1369. [PMID: 31240636 PMCID: PMC8237575 DOI: 10.1007/s40273-019-00819-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transparency in decision modelling is an evolving concept. Recently, discussion has moved from reporting standards to open-source implementation of decision analytic models. However, in the debate about the supposed advantages and disadvantages of greater transparency, there is a lack of definition. The purpose of this article is not to present a case for or against transparency, but rather to provide a more nuanced understanding of what transparency means in the context of decision modelling and how it could be addressed. To this end, we review and summarise the discourse to date, drawing on our collective experience. We outline a taxonomy of the different manifestations of transparency, including reporting standards, reference models, collaboration, model registration, peer review and open-source modelling. Further, we map out the role and incentives for the various stakeholders, including industry, research organisations, publishers and decision makers. We outline the anticipated advantages and disadvantages of greater transparency with respect to each manifestation, as well as the perceived barriers and facilitators to greater transparency. These are considered with respect to the different stakeholders and with reference to issues including intellectual property, legality, standards, quality assurance, code integrity, health technology assessment processes, incentives, funding, software, access and deployment options, data protection and stakeholder engagement. For each manifestation of transparency, we discuss the 'what', 'why', 'who' and 'how'. Specifically, their meaning, why the community might (or might not) wish to embrace them, whose engagement as stakeholders is required and how relevant objectives might be realised. We identify current initiatives aimed to improve transparency to exemplify efforts in current practice and for the future.
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Affiliation(s)
| | - Renée Arnold
- Arnold Consultancy & Technology, LLC, 15 West 72nd Street-23rd Floor, New York, NY, 10023-3458, USA
| | - Stirling Bryan
- University of British Columbia, 701-828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Philip Clarke
- University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Sean Ekins
- Collaborations Pharmaceuticals Inc., 840 Main Campus Drive, Lab 3510, Raleigh, NC, 27606, USA
| | | | - Neil Hawkins
- University of Glasgow, Lilybank Gardens 1, Glasgow, G12 8RZ, UK
| | - Sue Langham
- Maverex Limited, 5 Brooklands Place, Brooklands Road, Sale, Cheshire, M33 3SD, UK
| | - Deborah Marshall
- University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
| | - Will Sullivan
- BresMed Health Solutions, Steel City House, West Street, Sheffield, S1 2GQ, UK
| | - Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Tim Wrightson
- Adis International Limited, 5 The Warehouse Way, Northcote, 0627, Auckland, New Zealand
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15
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Chen S, Zhang Z, Chen L, Zhang J. miRNA‑101‑3p.1 as an independent diagnostic biomarker aggravates chronic obstructive pulmonary disease via activation of the EGFR/PI3K/AKT signaling pathway. Mol Med Rep 2019; 20:4293-4302. [PMID: 31545413 DOI: 10.3892/mmr.2019.10657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/28/2019] [Indexed: 11/06/2022] Open
Abstract
Exploring independent biomarkers and delineating pathogenic mechanisms could improve the early diagnosis and treatment of chronic obstructive pulmonary disease (COPD). In the present study, a study was conducted to determine the diagnostic potential of miRNA‑101‑3p.1 in identifying stable COPD (SCOPD) and acute exacerbation of COPD (AECOPD) patients and to reveal the molecular mechanism by which miRNA‑101‑3p.1 regulates COPD progression. miRNA‑101‑3p.1 profiles in peripheral blood mononuclear cells of COPD patients were evaluated. Subsequently, receiver operating characteristic curves were created to demonstrate the diagnostic accuracy of miRNA‑101‑3p.1 in discriminating SCOPD and AECOPD. Finally, the molecular mechanism by which miRNA‑101‑3p.1 regulates COPD progression was explored. The present study revealed that patients with COPD, and especially patients with AECOPD, had significantly increased levels of miRNA‑101‑3p.1 and the level of miRNA‑101‑3p.1 was closely correlated with CAT score and FEV1% predicted. Notably, miRNA‑101‑3p.1 accurately discriminated SCOPD and AECOPD. Furthermore, increasing miRNA‑101‑3p.1 promoted cell proliferation and induced the expression of inflammatory cytokines. Mechanistic investigations revealed that miRNA‑101‑3p.1 inhibited the expression of von Hippel‑Lindau tumor suppressor (pVHL) and ubiquitin conjugating enzyme E2 D1 (UBE2D1). pVHL and UBE2D1 co‑upregulated HIF‑1α, and HIF‑1α mediated activation of the EGFR/PI3K/AKT signaling pathway. The present results collectively demonstrated that miRNA‑101‑3p.1 could act as an independent biomarker for the diagnosis of SCOPD and AECOPD, and that miRNA‑101‑3p.1 facilitates COPD progression by activating the EGFR/PI3K/AKT signaling pathway.
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Affiliation(s)
- Shuifang Chen
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zeying Zhang
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Lina Chen
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianli Zhang
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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16
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Briggs ADM, Wolstenholme J, Scarborough P. Estimating the cost-effectiveness of salt reformulation and increasing access to leisure centres in England, with PRIMEtime CE model validation using the AdViSHE tool. BMC Health Serv Res 2019; 19:489. [PMID: 31307459 PMCID: PMC6631881 DOI: 10.1186/s12913-019-4292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND PRIMEtime CE is a multistate life table model that can directly compare the cost effectiveness of public health interventions affecting diet and physical activity levels, helping to inform decisions about how to spend finite resources. This paper estimates the costs and health outcomes in England of two scenarios: reformulating salt and expanding subsidised access to leisure centres. The results are used to help validate PRIMEtime CE, following the steps outlined in the Assessment of the Validation Status of Health-Economic decision models (AdViSHE) tool. METHODS The PRIMEtime CE model estimates the difference in quality adjusted life years (QALYs) and difference in NHS and social care costs of modelled interventions compared with doing nothing. The salt reformulation scenario models how salt consumption would change if food producers met the 2017 UK Food Standards Agency salt reformulation targets. The leisure centre scenario models change in physical activity levels if the Birmingham Be Active scheme (where swimming pools and gym access is free to residents during defined periods) was rolled out across England. The AdViSHE tool was developed by health economic modellers and divides model validation into five parts: validation of the conceptual model, input data validation, validation of computerised model, operational validation, and other validation techniques. PRIMEtime CE is discussed in relation to each part. RESULTS Salt reformulation was dominant compared with doing nothing, and had a 10-year return on investment of £1.44 (£0.50 to £2.94) for every £1 spent. By contrast, over 10 years the Be Active expansion would cost £727,000 (£514,000 to £1,064,000) per QALY. PRIMEtime CE has good face validity of its conceptual model and has robust input data. Cross-validation produces mixed results and shows the impact of model scope, input parameters, and model structure on cost-per-QALY estimates. CONCLUSIONS This paper illustrates how PRIMEtime CE can be used to compare the cost-effectiveness of two different public health measures affecting diet and physical activity levels. The AdViSHE tool helps to validate PRIMEtime CE, identifies some of the key drivers of model estimates, and highlights the challenges of externally validating public health economic models against independent data.
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Affiliation(s)
- Adam D. M. Briggs
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention and NIHR Biomedical Research Centre at Oxford, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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17
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Briggs ADM, Cobiac LJ, Wolstenholme J, Scarborough P. PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity. BMC Health Serv Res 2019; 19:485. [PMID: 31307442 PMCID: PMC6633614 DOI: 10.1186/s12913-019-4237-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/10/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes. METHODS The multistate life table model, PRIMEtime Cost Effectiveness (PRIMEtime CE), is developed from the Preventable Risk Integrated ModEl (PRIME) and the PRIMEtime model. PRIMEtime CE uses routinely available data to estimate how changing diet and physical activity in England affects morbidity and mortality from heart disease, stroke, diabetes, liver disease, and cancers either directly or via raised blood pressure, cholesterol, and body weight. RESULTS Model outcomes are change in quality adjusted life years, and change in English National Health Service and social care costs. CONCLUSION This paper describes PRIMEtime CE and highlights its main strengths and limitations. The model can be used to compare any number of public policies affecting diet and physical activity, allowing decision makers to understand how they can maximise population health with limited financial resources.
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Affiliation(s)
- Adam D. M. Briggs
- Centre on Population Approaches for Non-Communicable Disease Prevention and NIHR Biomedical Research Centre at Oxford, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Linda J. Cobiac
- Centre on Population Approaches for Non-Communicable Disease Prevention and NIHR Biomedical Research Centre at Oxford, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention and NIHR Biomedical Research Centre at Oxford, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
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18
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van Boven JFM, van de Hei SJ, Sadatsafavi M. Making sense of cost-effectiveness analyses in respiratory medicine: a practical guide for non-health economists. Eur Respir J 2019; 53:13993003.01816-2018. [PMID: 30578398 DOI: 10.1183/13993003.01816-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Susanne J van de Hei
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, BC, Canada
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19
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Sadatsafavi M, Ghanbarian S, Adibi A, Johnson K, FitzGerald JM, Flanagan W, Bryan S, Sin D. Development and Validation of the Evaluation Platform in COPD (EPIC): A Population-Based Outcomes Model of COPD for Canada. Med Decis Making 2019; 39:152-167. [PMID: 30678520 DOI: 10.1177/0272989x18824098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We report the development, validation, and implementation of an open-source population-based outcomes model of chronic obstructive pulmonary disease (COPD) for Canada. METHODS Evaluation Platform in COPD (EPIC) is a discrete-event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception. Multiple original data analyses, as well as values reported in the literature, were used to populate the model. Extensive face validity and internal and external validity evaluations were performed. RESULTS The model was internally validated on demographic projections, mortality rates, lung function trajectories, COPD exacerbations, costs and health state utility values, and stability of COPD prevalence over time within strata of risk factors. In external validation, it moderately overestimated the rate of overall exacerbations in 2 independent trials but generated consistent estimates of rate of severe exacerbations and mortality. LIMITATIONS In its current version, EPIC does not consider uncertainty in the evidence. Several components such as additional (e.g., environmental and occupational) risk factors, treatment, symptoms, and comorbidity will have to be added in future iterations. Predictive validity of EPIC needs to be examined prospectively against future empirical studies. CONCLUSIONS EPIC is the first multipurpose, open-source, outcome- and policy-focused model of COPD for Canada. Platforms of this type have the capacity to be iteratively updated to incorporate the latest evidence and to project the outcomes of many different scenarios within a consistent framework.
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Affiliation(s)
- Mohsen Sadatsafavi
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahzad Ghanbarian
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amin Adibi
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kate Johnson
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - J Mark FitzGerald
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Don Sin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Schroeder M, Shah D, Risebrough N, Martin A, Zhang S, Ndirangu K, Briggs A, Ismaila AS. Cost-effectiveness analysis of a single-inhaler triple therapy for patients with advanced chronic obstructive pulmonary disease (COPD) using the FULFIL trial: A UK perspective. RESPIRATORY MEDICINE: X 2019. [DOI: 10.1016/j.yrmex.2019.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Driessen MT, Whalen J, Seewoodharry Buguth B, Vallejo-Aparicio LA, Naya IP, Asukai Y, Alcázar-Navarrete B, Miravitlles M, García-Río F, Risebrough NA. Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective. Respir Res 2018; 19:224. [PMID: 30458866 PMCID: PMC6245710 DOI: 10.1186/s12931-018-0916-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. METHODS This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. RESULTS UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. CONCLUSION UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.
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Affiliation(s)
- M. T. Driessen
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS UK
| | - J. Whalen
- ICON Health Economics, ICON plc, Abingdon, UK
| | | | | | - I. P. Naya
- Global Respiratory Franchise, GSK, Brentford, Middlesex, UK
| | - Y. Asukai
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS UK
| | | | - M. Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Shah D, Driessen M, Risebrough N, Baker T, Naya I, Briggs A, Ismaila AS. Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:17. [PMID: 29773969 PMCID: PMC5946544 DOI: 10.1186/s12962-018-0101-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. METHODS A linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George's Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model. RESULTS Over a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (- 0.053; 95% CI: - 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: - £645, - £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (- 0.033; 95% CI: - 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses. CONCLUSIONS For treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611.
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Affiliation(s)
- Dhvani Shah
- ICON Health Economics, ICON, New York, NY USA
| | | | | | | | - Ian Naya
- Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK
| | - Andrew Briggs
- Health Economics & Health Technology Assessment Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Afisi S. Ismaila
- Value Evidence & Outcomes, GSK, 5 Moore Drive, PO Box 13398, Research Triangle Park, NC 27709-3398 USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
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