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Salamanca O. Letter to the Editor: The Use of Cost-Effectiveness Analyses in Open Angle Glaucoma Management: A Systematic Review of the Current Literature. J Glaucoma 2024; 33:e81. [PMID: 38809165 DOI: 10.1097/ijg.0000000000002444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Omar Salamanca
- Department of Ophthalmology Universidad del Valle
- Grupo de Investigación en Visión y Salud Ocular (VISOC), Universidad del Valle
- Clínica de Oftalmología de Cali, Cali Colombia
- Orbis International, New York, NY
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Heilenbach N, Sood S, Al-Aswad LA. Response to Letter to the Editor: The Use of Cost-Effectiveness Analyses in Open Angle Glaucoma Management: A Systematic Review of the Current Literature. J Glaucoma 2024; 33:e81-e82. [PMID: 38814326 DOI: 10.1097/ijg.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Noah Heilenbach
- Department of Ophthalmology, School of Medicine, Loyola University, Maywood, IL
| | - Shefali Sood
- PRECISE Center, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA
| | - Lama A Al-Aswad
- Department of Ophthalmology, School of Medicine, Georgetown University Washington, DC
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Philadelphia, PA
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Wu H, Gazzard G, King A, Morgan J, Wright D, Crabb DP, Takwoingi Y, Azuara-Blanco A, Watson V, Hernández R. Cost-effectiveness of monitoring ocular hypertension based on a risk prediction tool. BMJ Open Ophthalmol 2024; 9:e001741. [PMID: 39209325 PMCID: PMC11367344 DOI: 10.1136/bmjophth-2024-001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/03/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND/AIMS To assess the cost-effectiveness of making treatment decisions for patients with ocular hypertension (OHT) based on a risk prediction (RP) tool in the United Kingdom. METHODS A discrete event simulation model was constructed to compare the cost-effectiveness of an alternative care pathway in which the treatment decision was guided by a validated RP tool in secondary care against decision-making based on the standard care (SC). Individual patient sampling was used. Patients diagnosed with OHT and with an intraocular pressure of 24 mm Hg or over entered the model with a set of predefined individual characteristics related to their risk of conversion to glaucoma. These characteristics were retrieved from electronic medical records (n=5740). Different stages of glaucoma were modelled following conversion to glaucoma. RESULTS Almost all (99%) patients were treated using the RP strategy, and less than half (47%) of the patients were treated using the SC strategy. The RP strategy produced higher cost but also higher quality-adjusted life years (QALYs) than the SC strategy. The RP strategy was cost-effective compared with the SC strategy in the base-case analysis, with an incremental cost-effectiveness ratio value of £11 522. The RP strategy had a 96% probability of being cost-effective under a £20 000 per QALY threshold. CONCLUSIONS The use of an RP tool for the management of patients with OHT is likely to be cost-effective. However, the generalisability of the result might be limited due to the high-risk nature of this cohort and the specific RP threshold used in the study.
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Affiliation(s)
- Hangjian Wu
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gus Gazzard
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- NYU Langone Health, New York, New York, USA
| | - Anthony King
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - James Morgan
- Cardiff Centre for Vision Sciences, University of Wales College of Medicine, Cardiff, UK
| | - David Wright
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - David P Crabb
- Division of Optometry & Visual Science, City University, London, UK
| | - Yemisi Takwoingi
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Verity Watson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Stewart C, Wu H, Alagappan U, Azuara-Blanco A, King AJ, Tatham AJ, Hernández R, Lowe B, Shotton D, Appiah N, Coffey T, Vadiveloo T, MacLennan G, Gillies K. Feasibility of in-home monitoring for people with glaucoma: the I-TRAC mixed-methods study. Health Technol Assess 2024; 28:1-163. [PMID: 39248430 PMCID: PMC11404360 DOI: 10.3310/gtwd6802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Background Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma. Objectives The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. Design In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks. Setting Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks. Intervention Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks. Results Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥ 80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative study that require addressing before progression to a definitive effectiveness trial. Limitations The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated. Conclusions The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated 'cautious optimism' when considering patients' and healthcare professionals' views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial. Future work Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies. Study registration This study is registered as Research Registry #6213. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Carrie Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hangjian Wu
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Uma Alagappan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Anthony J King
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Nana Appiah
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Taylor Coffey
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Thenmalar Vadiveloo
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- The Centre for Health Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- The Centre for Health Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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5
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Atalan A. A Cost Analysis with the Discrete-Event Simulation Application in Nurse and Doctor Employment Management. J Nurs Manag 2022; 30:733-741. [PMID: 35023603 DOI: 10.1111/jonm.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to analyze the treatment cost of a patient, depending on the number of patients treated, patient waiting times, and the number of nurses and doctors employed in an emergency department of a private hospital. BACKGROUND Within health systems, changes in healthcare resources can be very costly, especially if these changes are long-term. The discrete-event simulation method described in this paper allows for the monitoring and analysis of complicated changes in real systems by using computer-based modeling. METHOD The discrete event simulation model was derived from 9 scenarios according to the number of nurses and doctors, and a comparison was made between the results of the scenarios and the actual results. RESULTS Among the scenarios, scenario 6 provided the lowest treatment cost for a patient by employing three doctors and two nurses with the best performance. The cost of treatment for a patient varies betweenŧ 9.00-ŧ 11.00 depending on the value of δ, and the daily cost of these resources to the hospital is ŧ1300.77. CONCLUSIONS This study provides a clear picture of a cost analysis comparison based on changes made about the actual health system in the computer-based simulated environment. Implications for Nursing Management The workforce data of nurses and doctors offers enough detail for cost analysis in healthcare settings to calculate the cost of treatment for a patient.
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Affiliation(s)
- Abdulkadir Atalan
- Department of Industrial Engineering, Marmara University, Istanbul, Turkey.,Department of Industrial Engineering, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
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Panagiotoglou D, Abrahamowicz M, Buckeridge DL, Caro JJ, Latimer E, Maheu-Giroux M, Strumpf EC. Evaluating Montréal's harm reduction interventions for people who inject drugs: protocol for observational study and cost-effectiveness analysis. BMJ Open 2021; 11:e053191. [PMID: 34702731 PMCID: PMC8549659 DOI: 10.1136/bmjopen-2021-053191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The main harm reduction interventions for people who inject drugs (PWID) are supervised injection facilities, needle and syringe programmes and opioid agonist treatment. Current evidence supporting their implementation and operation underestimates their usefulness by excluding skin, soft tissue and vascular infections (SSTVIs) and anoxic/toxicity-related brain injury from cost-effectiveness analyses (CEA). Our goal is to conduct a comprehensive CEA of harm reduction interventions in a setting with a large, dispersed, heterogeneous population of PWID, and include prevention of SSTVIs and anoxic/toxicity-related brain injury as measures of benefit in addition to HIV, hepatitis C and overdose morbidity and mortalities averted. METHODS AND ANALYSIS This protocol describes how we will develop an open, retrospective cohort of adult PWID living in Québec between 1 January 2009 and 31 December 2020 using administrative health record data. By complementing this data with non-linkable paramedic dispatch records, regional monthly needle and syringe dispensation counts and repeated cross-sectional biobehavioural surveys, we will estimate the hazards of occurrence and the impact of Montréal's harm reduction interventions on the incidence of drug-use-related injuries, infections and deaths. We will synthesise results from our empirical analyses with published evidence to simulate infections and injuries in a hypothetical population of PWID in Montréal under different intervention scenarios including current levels of use and scale-up, and assess the cost-effectiveness of each intervention from the public healthcare payer's perspective. ETHICS AND DISSEMINATION This study was approved by McGill University's Institutional Review Board (Study Number: A08-E53-19B). We will work with community partners to disseminate results to the public and scientific community via scientific conferences, a publicly accessible report, op-ed articles and open access peer-reviewed journals.
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Affiliation(s)
- Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - J Jaime Caro
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- Evidera, Boston, Massachusetts, USA
- London School of Economics and Political Science, London, UK
| | - Eric Latimer
- Douglas Research Institute, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Erin C Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- Department of Economics, McGill University, Montréal, Québec, Canada
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Albuquerque de Almeida F, Corro Ramos I, Rutten-van Mölken M, Al M. Modeling Early Warning Systems: Construction and Validation of a Discrete Event Simulation Model for Heart Failure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1435-1445. [PMID: 34593166 DOI: 10.1016/j.jval.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Developing and validating a discrete event simulation model that is able to model patients with heart failure managed with usual care or an early warning system (with or without a diagnostic algorithm) and to account for the impact of individual patient characteristics in their health outcomes. METHODS The model was developed using patient-level data from the Trans-European Network - Home-Care Management System study. It was coded using RStudio Version 1.3.1093 (version 3.6.2.) and validated along the lines of the Assessment of the Validation Status of Health-Economic decision models tool. The model includes 20 patient and disease characteristics and generates 8 different outcomes. Model outcomes were generated for the base-case analysis and used in the model validation. RESULTS Patients managed with the early warning system, compared with usual care, experienced an average increase of 2.99 outpatient visits and a decrease of 0.02 hospitalizations per year, with a gain of 0.81 life years (0.45 quality-adjusted life years) and increased average total costs of €11 249. Adding a diagnostic algorithm to the early warning system resulted in a 0.92 life year gain (0.57 quality-adjusted life years) and increased average costs of €9680. These patients experienced a decrease of 0.02 outpatient visits and 0.65 hospitalizations per year, while they avoided being hospitalized 0.93 times. The model showed robustness and validity of generated outcomes when comparing them with other models addressing the same problem and with external data. CONCLUSIONS This study developed and validated a unique patient-level simulation model that can be used for simulating a wide range of outcomes for different patient subgroups and treatment scenarios. It provides useful information for guiding research and for developing new treatment options by showing the hypothetical impact of these interventions on a large number of important heart failure outcomes.
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Neustaeter A, Nolte I, Snieder H, Jansonius NM. Genetic pre-screening for glaucoma in population-based epidemiology: protocol for a double-blind prospective screening study within Lifelines (EyeLife). BMC Ophthalmol 2021; 21:18. [PMID: 33413217 PMCID: PMC7789075 DOI: 10.1186/s12886-020-01771-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Early detection of glaucoma is paramount to maintain patients’ eyesight, however glaucomatous vision loss tends to begin in the periphery with up to 50% of patients unaware they are affected. Because glaucomatous vision loss is permanent, screening appears attractive, but currently is not cost-effective. Therefore we aim to investigate the utility of genetic pre-screening for glaucoma in a population-based setting, called EyeLife. Methods EyeLife adopts a double blind prospective design with contrasting groups. Selected participants (n = 1600) from the Lifelines cohort are 55 years of age or older, and of either the highest or lowest 20% of the genetic risk distribution for glaucoma. We obtained a highly curated list of genetic variants from the literature to obtain each participants’ genetic risk for glaucoma. Participants will undergo comprehensive ophthalmic screening. The primary outcome is the relative risk of glaucoma given a high genetic risk compared to a low genetic risk. Discussion If genetic pre-screening is successful, it will increase the yield of a glaucoma screening program by focusing on high-risk individuals. This, in turn, may improve long-term visual health of middle-aged and elderly people. Trial registration Ethics approval was obtained on January 31, 2019, and the study was retrospectively registered with the Netherlands Trial Register (NL8718) on the 17th of June, 2020.
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Affiliation(s)
- Anna Neustaeter
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700 RB, Groningen, Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Ilja Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700 RB, Groningen, Netherlands. .,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands.
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Radeva D, Hopkin G, Mossialos E, Borrill J, Osipenko L, Naci H. Assessment of technical errors and validation processes in economic models submitted by the company for NICE technology appraisals. Int J Technol Assess Health Care 2020; 36:1-6. [PMID: 32618536 DOI: 10.1017/s0266462320000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Economic models play a central role in the decision-making process of the National Institute for Health and Care Excellence (NICE). Inadequate validation methods allow for errors to be included in economic models. These errors may alter the final recommendations and have a significant impact on outcomes for stakeholders. OBJECTIVE To describe the patterns of technical errors found in NICE submissions and to provide an insight into the validation exercises carried out by the companies prior to submission. METHODS All forty-one single technology appraisals (STAs) completed in 2017 by NICE were reviewed and all were on medicines. The frequency of errors and information on their type, magnitude, and impact was extracted from publicly available NICE documentation along with the details of model validation methods used. RESULTS Two STAs (5 percent) had no reported errors, nineteen (46 percent) had between one and four errors, sixteen (39 percent) had between five and nine errors, and four (10 percent) had more than ten errors. The most common errors were transcription errors (29 percent), logic errors (29 percent), and computational errors (25 percent). All STAs went through at least one type of validation. Moreover, errors that were notable enough were reported in the final appraisal document (FAD) in eight (20 percent) of the STAs assessed but each of these eight STAs received positive recommendations. CONCLUSIONS Technical errors are common in the economic models submitted to NICE. Some errors were considered important enough to be reported in the FAD. Improvements are needed in the model development process to ensure technical errors are kept to a minimum.
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Affiliation(s)
- Demi Radeva
- Department of Health Policy, London School of Economics and Political Science, London, UK
- United Health Group, Eden Prairie, Minnesota, USA
| | - Gareth Hopkin
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Leeza Osipenko
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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10
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Loiselle AR, de Kleine E, van Dijk P, Jansonius NM. Intraocular and intracranial pressure in glaucoma patients taking acetazolamide. PLoS One 2020; 15:e0234690. [PMID: 32555666 PMCID: PMC7302490 DOI: 10.1371/journal.pone.0234690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 11/18/2022] Open
Abstract
The alternative mechanical theory of glaucoma, in which an increased pressure difference across the lamina cribrosa (difference between intraocular and intracranial pressure; IOP and ICP), rather than solely an elevated IOP, leads to structural and functional vision loss, is still controversial. If the theory is true, a drug that simultaneously lowers both the IOP and ICP may be ineffective. The aim of this study was to determine how acetazolamide (AAZ; a drug prescribed in glaucoma that aims to lower the IOP) affects both IOP and ICP in glaucoma patients and to compare the magnitude and time course of the induced pressure changes with those of healthy subjects not taking AAZ. IOP and noninvasive ICP (measured through emissions from the ear) were measured in 20 glaucoma patients taking 125 mg of AAZ twice daily. Measurements were taken for 30 minutes before taking the drug and for 2 hours post-ingestion. Comparisons were made with 13 age-similar controls. After 12 hours with no anti-glaucoma medication, AAZ did not further reduce IOP in glaucoma patients compared to controls (P = 0.58) but did reduce ICP compared to controls (P = 0.035), by approximately 4 mmHg. Our findings suggest that there are periods during the day when the pressure difference across the lamina cribrosa is larger in case of AAZ use. Future studies should focus on improving the noninvasive ICP testing, different doses and dosing schedules of AAZ, and the time course of IOP in glaucoma patients not taking AAZ.
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Affiliation(s)
- Allison R. Loiselle
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Emile de Kleine
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nomdo M. Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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11
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Büyükkaramikli NC, Rutten-van Mölken MPMH, Severens JL, Al M. TECH-VER: A Verification Checklist to Reduce Errors in Models and Improve Their Credibility. PHARMACOECONOMICS 2019; 37:1391-1408. [PMID: 31705406 PMCID: PMC6860463 DOI: 10.1007/s40273-019-00844-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND In health economic literature, checklists or best practice recommendations on model validation/credibility always declare verification of the programmed model as a fundamental step, such as 'is the model implemented correctly and does the implementation accurately represent the conceptual model?' However, to date, little operational guidance for the model verification process has been given. In this study, we aimed to create an operational checklist for model users or reviewers to verify the technical implementation of health economic decision analytical models and document their verification efforts. METHODS Literature on model validation, verification, programming errors and credibility was reviewed systematically from scientific databases. An initial beta version of the checklist was developed based on the checklists/tests identified from the literature and from authors' previous modeling/appraisal experience. Next, the first draft checklist was presented to a number of health economists on several occasions and was tested on different models (built in different software, developed by different stakeholders, including drug manufacturers, consultancies or academia), each time leading to an update of the checklist and culminating in the final version of the TECHnical VERification (TECH-VER) checklist, introduced in this paper. RESULTS The TECH-VER necessitates a model reviewer (preferably independent), an executable and transparent model, its input sources, and detailed documentation (e.g. technical report/scientific paper) in which the conceptual model, its implementation, programmed model inputs, and results are reported. The TECH-VER checklist consists of five domains: (1) input calculations; (2) event-state (patient flow) calculations; (3) result calculations; (4) uncertainty analysis calculations; and (5) other overall checks (e.g. validity or interface). The first four domains reflect the verification of the components of a typical health economic model. For these domains, as a prerequisite of verification tests, the reviewer should identify the relevant calculations in the electronic model and assess the provided justifications for the methods used in the identified calculations. For this purpose, we recommend completeness/consistency checks. Afterwards, the verification tests can be conducted for the calculations in each of these stages by checking the correctness of the implementation of these calculations. For this purpose, the following type of tests are recommended in consecutive order: (i) black-box tests, i.e. checking if model calculations are in line with a priori expectations; (ii) white-box testing, i.e. going through the program code details line by line, or cell by cell (recommended for some crucial calculations and if there are some unexpected results from the black-box tests); and (iii) model replication/parallel programming (recommended only in certain situations, and if the issues related to the identified unexpected results from black-box tests could not be resolved through white-box testing). To reduce the time burden of model verification, we suggest a hierarchical order in tests i-iii, where going to the next step is necessary when the previous step fails. CONCLUSIONS The TECH-VER checklist is a comprehensive checklist for the technical verification of decision analytical models, aiming to help identify model implementation errors and their root causes while improving the transparency and efficiency of the verification efforts. In addition to external reviews, we consider that the TECH-VER can be used as an internal training and quality control tool for new health economists, while developing their initial models. It is the authors' aim that the TECH-VER checklist transforms itself to an open-source living document, with possible future versions, or 'bolt-on' extensions for specific applications with additional 'fit-for-purpose' tests, as well as 'tips and tricks' and some demonstrative error examples. For this reason, the TECH-VER checklist and the list of black-box tests created in this paper and a few model verification examples is uploaded to an open access, online platform (github and the website of the institute), where other users will also be able to upload their original verification efforts and tests.
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Affiliation(s)
- Nasuh C Büyükkaramikli
- Institute for Medical Technology Assessment (iMTA), Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment (iMTA), Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan L Severens
- Institute for Medical Technology Assessment (iMTA), Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maiwenn Al
- Institute for Medical Technology Assessment (iMTA), Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kazemian P, Helm JE, Lavieri MS, Stein JD, Van Oyen MP. Dynamic Monitoring and Control of Irreversible Chronic Diseases with Application to Glaucoma. PRODUCTION AND OPERATIONS MANAGEMENT 2019; 28:1082-1107. [PMID: 31485154 PMCID: PMC6724710 DOI: 10.1111/poms.12975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To manage chronic disease patients effectively, clinicians must know (1) how to monitor each patient (i.e., when to schedule the next visit and which tests to take), and (2) how to control the disease (i.e., what levels of controllable risk factors will sufficiently slow progression). Our research addresses these questions simultaneously and provides the optimal solution to a novel linear quadratic Gaussian state space model. For the objective of minimizing the relative change in state over time (i.e., disease progression), which is necessary for managing irreversible chronic diseases while also considering the cost of tests and treatment, we show that the classical two-way separation of estimation and control holds. This makes a previously intractable problem solvable by decomposition into two separate, tractable problems while maintaining optimality. The resulting optimization is applied to the management of glaucoma. Based on data from two large randomized clinical trials, we validate our model and demonstrate how our decision support tool can provide actionable insights to the clinician caring for a patient with glaucoma. This methodology can be applied to a broad range of irreversible chronic diseases to devise patient-specific monitoring and treatment plans optimally.
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Affiliation(s)
- Pooyan Kazemian
- Medical Practice Evaluation Center, Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Jonathan E Helm
- Operations and Decision Technologies, Kelley School of Business, Indiana University, 1309 E 10th St, Bloomington, IN 47405
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI 48109
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105
| | - Mark P Van Oyen
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI 48109
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13
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Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application. Processes (Basel) 2019. [DOI: 10.3390/pr7010048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the present study, problems in emergency services (ESs) were dealt with by analyzing the working system of ESs in Turkey. The purpose of this study was to reduce the waiting times spent in hospitals by employing advanced nurses (ANs) to treat patients who are not urgent, or who may be treated as outpatients in ESs. By applying discrete-event simulation on a 1/24 (daily) and 7/24 (weekly) basis, and by employing ANs, it was determined that the number of patients that were treated increased by 26.71% on a 1/24 basis, and by 15.13% on a 7/24 basis. The waiting time that was spent from the admission to the ES until the treatment time decreased by 38.67% on a 1/24 basis and 53.66% on a 24/7 basis. Similarly, the length of stay was reduced from 82.46 min to 53.97 min in the ES. Among the findings, it was observed that the efficiency rate of the resources was balanced by the employment of ANs, although it was not possible to obtain sufficient efficiency from the resources used in the ESs prior to the present study.
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Wang HI, Roman E, Crouch S, Aas E, Burton C, Patmore R, Smith A. A Generic Model for Follicular Lymphoma: Predicting Cost, Life Expectancy, and Quality-Adjusted-Life-Year Using UK Population-Based Observational Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1176-1185. [PMID: 30314618 PMCID: PMC6191529 DOI: 10.1016/j.jval.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/21/2018] [Accepted: 03/05/2018] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To use real-world data to develop a flexible generic decision model to predict cost, life expectancy, and quality-adjusted life-years (QALYs) for follicular lymphoma (FL) in the general patient population. METHODS All patients newly diagnosed with FL in the UK's population-based Haematological Malignancy Research Network (www.hmrn.org) between 2004 and 2011 were followed until 2015 (N = 740). Treatment pathways, QALYs, and costs were incorporated into a discrete event simulation to reflect patient heterogeneity, including age and disease management. Two scenario analyses, based on the latest National Institute for Health and Clinical Excellence (NICE) guidelines (rituximab induction therapy for newly diagnosed asymptomatic patients and rituximab maintenance therapy for patients between treatments), were conducted and their economic impacts were compared to current practice. RESULTS Incidence-based analysis revealed expected average lifetime costs ranging from £6,165 [US$7,709] to £63,864 [US$79,862] per patient, and average life expectancy from 75 days to 17.56 years. Prevalence-based analysis estimated average annual treatment costs of £60-65 million [US$75-80 million], accounting for approximately 10% of the United Kingdom's annual National Health Service budget for hematological cancers as a whole. Assuming that treatment effects reported in trials are applicable to all patient groups, scenario analyses for two recent NICE guidelines demonstrated potential annual cost savings for the United Kingdom that ranged with uptake frequency from £0.6 million to £11 million [US$0.75-2.75 million]. CONCLUSIONS Costs, survival, and QALYs associated with FL vary markedly with patient characteristics and disease management. Allowing the production of more realistic outcomes across the patient population as a whole, our model addresses this heterogeneity and is a useful tool with which to evaluate new technologies/treatments to support healthcare decision makers.
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Affiliation(s)
- Han-I Wang
- Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK.
| | - Eve Roman
- Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Simon Crouch
- Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo; Oslo, Norway
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, UK
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK
| | - Alexandra Smith
- Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
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Hicklin KT, Ivy JS, Wilson JR, Cobb Payton F, Viswanathan M, Myers ER. Simulation model of the relationship between cesarean section rates and labor duration. Health Care Manag Sci 2018; 22:635-657. [PMID: 29995263 DOI: 10.1007/s10729-018-9449-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022]
Abstract
Cesarean delivery is the most common major abdominal surgery in many parts of the world, and it accounts for nearly one-third of births in the United States. For a patient who requires a C-section, allowing prolonged labor is not recommended because of the increased risk of infection. However, for a patient who is capable of a successful vaginal delivery, performing an unnecessary C-section can have a substantial adverse impact on the patient's future health. We develop two stochastic simulation models of the delivery process for women in labor; and our objectives are (i) to represent the natural progression of labor and thereby gain insights concerning the duration of labor as it depends on the dilation state for induced, augmented, and spontaneous labors; and (ii) to evaluate the Friedman curve and other labor-progression rules, including their impact on the C-section rate and on the rates of maternal and fetal complications. To use a shifted lognormal distribution for modeling the duration of labor in each dilation state and for each type of labor, we formulate a percentile-matching procedure that requires three estimated quantiles of each distribution as reported in the literature. Based on results generated by both simulation models, we concluded that for singleton births by nulliparous women with no prior complications, labor duration longer than two hours (i.e., the time limit for labor arrest based on the Friedman curve) should be allowed in each dilation state; furthermore, the allowed labor duration should be a function of dilation state.
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Affiliation(s)
- Karen T Hicklin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Julie S Ivy
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - James R Wilson
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Fay Cobb Payton
- College of Management, North Carolina State University, Raleigh, NC, 27695, USA
| | | | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, 27710, USA
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Agrawal P, Bradshaw SE. Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery (MIGS) in Primary Open-Angle Glaucoma. Ophthalmol Ther 2018; 7:49-73. [PMID: 29725860 PMCID: PMC5997597 DOI: 10.1007/s40123-018-0131-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Primary open-angle glaucoma is estimated to affect 3% of the population aged 40-80 years. Trabeculectomy is considered the gold standard in surgical management of glaucoma; however, it is a technically complex procedure that may result in a range of adverse outcomes. Device-augmented, minimally invasive procedures (micro-invasive glaucoma surgeries, MIGS) have been developed aiming for safer and less invasive intraocular pressure (IOP) reduction compared with traditional surgery. METHODS This paper presents results from a systematic literature review conducted in accordance with National Institute for Health and Care Excellence requirements for the Medical Technology Evaluation Programme via multiple databases from 2005 to 2016. For clinical outcomes, randomized clinical trials (RCTs) comparing MIGS with trabeculectomy or other therapies, observational studies, and other non-RCTs were included. Clinical outcomes reviewed were the change from baseline in mean IOP levels and change in topical glaucoma medication. Safety was assessed by reported harm and adverse events. For economic evidence, trials on cost-effectiveness, cost-utility, cost-benefit, cost-consequences, cost-minimization, cost of illness, and specific procedure costs were included. Risk of bias was assessed for clinical studies using the Cochrane Risk of Bias tool. RESULTS A total of nine RCTs (seven iStents®, one Hydrus®, and one CyPass®), seven non-RCTs (three iStent®, three CyPass®, and one Hydrus®), and 23 economic studies were analyzed. While various forms of trabeculectomy can achieve postoperative IOP of between 11.0 and 13.0 mmHg, MIGS devices described in this review were typically associated with higher postoperative IOP levels. In addition, MIGS devices may result in increased hypotony rates or bleb needling in subconjunctival placed devices, requiring additional medical resources to manage. There is limited available evidence on the cost-effectiveness of MIGS and therefore it remains unclear whether the cost of using MIGS is outweighed by cost savings through decreased medication and need for further interventions. CONCLUSION Larger randomized trials and real-world observational studies are needed for MIGS devices to better assess clinical and economic effectiveness. Given the shortage of published data and increasing use of such procedures, living systematic reviews may help to provide ongoing and timely evidence-based direction for clinicians and decision makers. This review highlights the current unmet need for treatments that are easy to implement and reduce long-term IOP levels without increasing postoperative aftercare and cost. FUNDING Santen GmbH, Germany.
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Affiliation(s)
- Pavi Agrawal
- Nottingham University Hospital Queens Medical Centre, Nottingham, UK
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17
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Development and calibration of a constrained resource health outcomes simulation model of hospital-based glaucoma services. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Albuquerque De Almeida F, Al M, Koymans R, Caliskan K, Kerstens A, Severens JL. Early warning systems for the management of chronic heart failure: a systematic literature review of cost-effectiveness models. Expert Rev Pharmacoecon Outcomes Res 2017; 18:161-175. [PMID: 29235882 DOI: 10.1080/14737167.2018.1417841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Describing the general and methodological characteristics of decision-analytical models used in the economic evaluation of early warning systems for the management of chronic heart failure patients and performing a quality assessment of their methodological characteristics is expected to provide concise and useful insight to inform the future development of decision-analytical models in the field of heart failure management. AREAS COVERED The literature on decision-analytical models for the economic evaluation of early warning systems for the management of chronic heart failure patients was systematically reviewed. Nine electronic databases were searched through the combination of synonyms for heart failure and sensitive filters for cost-effectiveness and early warning systems. EXPERT COMMENTARY The retrieved models show some variability with regards to their general study characteristics. Overall, they display satisfactory methodological quality, even though some points could be improved, namely on the consideration and discussion of any competing theories regarding model structure and disease progression, identification of key parameters and the use of expert opinion, and uncertainty analyses. A comprehensive definition of early warning systems and further research under this label should be pursued. To improve the transparency of economic evaluation publications, authors should make available detailed technical information regarding the published models.
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Affiliation(s)
| | - Maiwenn Al
- a ESHPM - Erasmus School of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , The Netherlands.,b iMTA - Institute for Medical Technology Assessment , Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Ron Koymans
- c Professional Health Services and Solutions , Philips Research , Eindhoven , The Netherlands
| | - Kadir Caliskan
- d Department of Cardiology , Erasmus Medical Center , Rotterdam , Netherlands
| | - Ankie Kerstens
- e MSc Student in Health Economics, Policy and Law, Erasmus School of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Johan L Severens
- a ESHPM - Erasmus School of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , The Netherlands.,b iMTA - Institute for Medical Technology Assessment , Erasmus University Rotterdam , Rotterdam , The Netherlands
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Elshout M, Webers CA, van der Reis MI, de Jong-Hesse Y, Schouten JS. Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: a systematic review and quality of life study. BMC Ophthalmol 2017; 17:120. [PMID: 28693519 PMCID: PMC5504631 DOI: 10.1186/s12886-017-0514-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/30/2017] [Indexed: 11/22/2022] Open
Abstract
Background Describing the natural course of neovascular age-related macular degeneration (nAMD) is essential in discussing prognosis and treatment options with patients and to support cost-effectiveness studies. Methods First, we performed a literature search in PubMed, Embase, and Cochrane. We included randomized clinical trials and prospective observational studies reporting visual acuity (VA) in non-treated patients, 24 studies in total. We integrated VA data using best fit on Lineweaver-Burke plots and modelled with non-linear regression using reciprocal terms. Second, we performed a quality-of-life (QoL) study in nAMD patients. We measured VA with Radner reading charts and QoL with the Health Utilities Index issue 3 (HUI-3) questionnaire in 184 participants. We studied the relation VA-QoL with linear regression. Third, with Monte Carlo simulation, we integrated the VA model from the literature review and the relation VA-QoL from the QoL study. Results Visual acuity was 0.4 and 0.07 after 5 years in the better-seeing, and worse-seeing eye, respectively. After 4.3 years, VA was <0.5 in the better-seeing eye; <0.3 after 7 years; 0.05 after 17 years. QoL score decreased from 0.6 to 0.45 after 10 years. Conclusions The natural course of nAMD in both eyes needs to be considered when informing patients. Visual acuity in the best eye decreases to below 0.5 in 4.3 years. This affects QoL significantly. Electronic supplementary material The online version of this article (doi:10.1186/s12886-017-0514-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mari Elshout
- Maastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Carroll A Webers
- Maastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Margriet I van der Reis
- Maastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Yvonne de Jong-Hesse
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan S Schouten
- Maastricht University Medical Center, University Eye Clinic Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Ni W, Jiang Y. Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model. Osteoporos Int 2017; 28:529-538. [PMID: 27581955 DOI: 10.1007/s00198-016-3751-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old. INTRODUCTION Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population. METHODS A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. RESULTS In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. CONCLUSIONS The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.
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Affiliation(s)
- W Ni
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD Suite 210, Los Angeles, CA, 90089-3333, USA
| | - Y Jiang
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD Suite 210, Los Angeles, CA, 90089-3333, USA.
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Jiang Y, Ni W. Expected lifetime numbers, risks, and burden of osteoporotic fractures for 50-year old Chinese women: a discrete event simulation incorporating FRAX. J Bone Miner Metab 2016; 34:714-722. [PMID: 26590159 DOI: 10.1007/s00774-015-0724-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
This work was undertaken to provide an estimation of expected lifetime numbers, risks, and burden of fractures for 50-year-old Chinese women. A discrete event simulation model was developed to simulate the lifetime fractures of 50-year-old Chinese women at average risk of osteoporotic fracture. Main events in the model included hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture. Fracture risks were calculated using the FRAX® tool. Simulations of 50-year-old Chinese women without fracture risks were also carried out as a comparison to determine the burden of fractures. A 50-year-old Chinese woman at average risk of fracture is expected to experience 0.135 (95 % CI: 0.134-0.137) hip fractures, 0.120 (95 % CI: 0.119-0.122) clinical vertebral fractures, 0.095 (95 % CI: 0.094-0.096) wrist fractures, 0.079 (95 % CI: 0.078-0.080) humerus fractures, and 0.407 (95 % CI: 0.404-0.410) other fractures over the remainder of her life. The residual lifetime risk of any fracture, hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture for a 50-year-old Chinese woman is 37.36, 11.77, 10.47, 8.61, 7.30, and 27.80 %, respectively. The fracture-attributable excess quality-adjusted life year (QALY) loss and lifetime costs are estimated at 0.11 QALYs (95 % CI: 0.00-0.22 QALYs) and US $714.61 (95 % CI: US $709.20-720.02), totaling a net monetary benefit loss of US $1,104.43 (95 % CI: US $904.09-1,304.78). Chinese women 50 years of age are at high risk of osteoporotic fracture, and the expected economic and quality-of-life burden attributable to osteoporotic fractures among Chinese women is substantial.
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Affiliation(s)
- Yawen Jiang
- Department of Pharmaceutical and Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Verna and Peter Dauterive Hall (VPD) 635 Downey Way, Los Angeles, CA, 90089-3333, USA.
| | - Weiyi Ni
- Department of Pharmaceutical and Health Economics, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Verna and Peter Dauterive Hall (VPD) 635 Downey Way, Los Angeles, CA, 90089-3333, USA
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Boodhna T, Crabb DP. More frequent, more costly? Health economic modelling aspects of monitoring glaucoma patients in England. BMC Health Serv Res 2016; 16:611. [PMID: 27770792 PMCID: PMC5075403 DOI: 10.1186/s12913-016-1849-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Yet frequent examination better determines disease worsening and speed of VF loss under treatment. We examine the cost-effectiveness of increasing frequency of VF examinations during follow-up using a health economic model. METHODS Two different VF monitoring schemes defined as current practice (annual VF testing) and proposed practice (three VF tests per year in the first 2 years after diagnosis) were examined. A purpose written health economic Markov model is used to test the hypothesis that cost effectiveness improves by implementing proposed practice on groups of patients stratified by age and severity of COAG. Further, a new component of the model, estimating costs of visual impairment, was added. Results were derived from a simulated cohort of 10000 patients with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used as main outcome measures. RESULTS An ICER of £21,392 per QALY was derived for proposed practice improving to a value of £11,382 once savings for prevented visual impairment was added to the model. Proposed practice was more cost-effective in younger patients. Proposed practice for patients with advanced disease at diagnosis generated ICERs > £60,000 per QALY; these cases would likely be on the most intensive treatment pathway making clinical information on speed of VF loss redundant. Sensitivity analysis indicated results to be robust in relation to hypothetical willingness to pay threshold identified by national guidelines, although greatest uncertainty was allied to estimates of implementation and visual impairment costs. CONCLUSION Increasing VF monitoring at the earliest stages of follow-up for COAG appears to be cost-effective depending on reasonable assumptions about implementation costs. Our health economic model highlights benefits of stratifying patients to more or less monitoring based on age and stage of disease at diagnosis; a prospective study is needed to prove these findings. Further, this works highlights gaps in knowledge about long term costs of visual impairment.
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Affiliation(s)
- Trishal Boodhna
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London,, EC1V 0HB, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London,, EC1V 0HB, UK.
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van Gestel A, Schouten JSAG, Beckers HJM, Severens JL, Hendrikse F, Webers CAB. The long term effectiveness and cost-effectiveness of initiating treatment for ocular hypertension. Acta Ophthalmol 2014; 92:513-23. [PMID: 24330516 DOI: 10.1111/aos.12328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the long-term health and economic consequences of direct treatment initiation in ocular hypertension patients. METHODS A cost-effectiveness analysis with a societal perspective and a lifelong horizon was performed. The primary outcomes were the incremental quality-adjusted life years (QALYs) and costs of direct pressure-lowering treatment for ocular hypertension, compared to a strategy where treatment is postponed until conversion to glaucoma has been observed. We used a decision analytic model based on individual patient simulation to forecast disease progression and treatment decisions in both strategies in a representative heterogeneous patient population and in 18 patient subgroups stratified by initial intraocular pressure and additional risk factors for conversion. RESULTS The incremental discounted health gain of direct treatment was 0.27 QALYs, whereas the incremental discounted costs were -€ 649 during an average lifetime of 26 years. In the simulations of patient subgroups, the model outcomes moved towards higher health gains and lower incremental costs with increasing risk of conversion in the patient population. The incremental cost-effectiveness ratio of direct treatment ranged from € 15,425 per QALY gained in the lowest-risk subgroup to dominance in the highest-risk subgroup. Probabilistic sensitivity analysis indicated that uncertainty surrounding the model input parameters did not affect the conclusions. CONCLUSION Direct, early, pressure-lowering treatment is a dominant cost-effective treatment strategy over a strategy to start the same treatment approach later, after glaucoma has occurred for patients with ocular hypertension. Its implementation and consequences should be discussed with ophthalmologists and individual patients.
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Affiliation(s)
- Aukje van Gestel
- University Eye Clinic Maastricht; University Medical Center; Maastricht the Netherlands
| | - Jan S. A. G. Schouten
- University Eye Clinic Maastricht; University Medical Center; Maastricht the Netherlands
| | - Henny J. M. Beckers
- University Eye Clinic Maastricht; University Medical Center; Maastricht the Netherlands
| | - Johan L. Severens
- Institute of Health Policy and Management; Erasmus University Rotterdam; Rotterdam the Netherlands
- Department of Health Organisation, Policy and Economics; School for Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht the Netherlands
| | - Fred Hendrikse
- University Eye Clinic Maastricht; University Medical Center; Maastricht the Netherlands
| | - Carroll A. B. Webers
- University Eye Clinic Maastricht; University Medical Center; Maastricht the Netherlands
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Karnon J, Haji Ali Afzali H. When to use discrete event simulation (DES) for the economic evaluation of health technologies? A review and critique of the costs and benefits of DES. PHARMACOECONOMICS 2014; 32:547-558. [PMID: 24627341 DOI: 10.1007/s40273-014-0147-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Modelling in economic evaluation is an unavoidable fact of life. Cohort-based state transition models are most common, though discrete event simulation (DES) is increasingly being used to implement more complex model structures. The benefits of DES relate to the greater flexibility around the implementation and population of complex models, which may provide more accurate or valid estimates of the incremental costs and benefits of alternative health technologies. The costs of DES relate to the time and expertise required to implement and review complex models, when perhaps a simpler model would suffice. The costs are not borne solely by the analyst, but also by reviewers. In particular, modelled economic evaluations are often submitted to support reimbursement decisions for new technologies, for which detailed model reviews are generally undertaken on behalf of the funding body. This paper reports the results from a review of published DES-based economic evaluations. Factors underlying the use of DES were defined, and the characteristics of applied models were considered, to inform options for assessing the potential benefits of DES in relation to each factor. Four broad factors underlying the use of DES were identified: baseline heterogeneity, continuous disease markers, time varying event rates, and the influence of prior events on subsequent event rates. If relevant, individual-level data are available, representation of the four factors is likely to improve model validity, and it is possible to assess the importance of their representation in individual cases. A thorough model performance evaluation is required to overcome the costs of DES from the users' perspective, but few of the reviewed DES models reported such a process. More generally, further direct, empirical comparisons of complex models with simpler models would better inform the benefits of DES to implement more complex models, and the circumstances in which such benefits are most likely.
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Affiliation(s)
- Jonathan Karnon
- School of Population Health, University of Adelaide, Adelaide, Australia,
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Handels RLH, Wolfs CAG, Aalten P, Joore MA, Verhey FRJ, Severens JL. Diagnosing Alzheimer's disease: a systematic review of economic evaluations. Alzheimers Dement 2013; 10:225-37. [PMID: 23727080 DOI: 10.1016/j.jalz.2013.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/31/2013] [Accepted: 02/06/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study is to systematically review the literature on economic evaluations of interventions for the early diagnosis of Alzheimer's disease (AD) and related disorders and to describe their general and methodological characteristics. We focused on the diagnostic aspects of the decision models to assess the applicability of existing decision models for the evaluation of the recently revised diagnostic research criteria for AD. METHODS PubMed and the National Institute for Health Research Economic Evaluation database were searched for English-language publications related to economic evaluations on diagnostic technologies. Trial-based economic evaluations were assessed using the Consensus on Health Economic Criteria list. Modeling studies were assessed using the framework for quality assessment of decision-analytic models. RESULTS The search retrieved 2109 items, from which eight decision-analytic modeling studies and one trial-based economic evaluation met all eligibility criteria. CONCLUSIONS Diversity among the study objective and characteristics was considerable and, despite considerable methodological quality, several flaws were indicated. Recommendations were focused on diagnostic aspects and the applicability of existing models for the evaluation of recently revised diagnostic research criteria for AD.
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Affiliation(s)
- Ron L H Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, University Medical Centre, Maastricht, The Netherlands.
| | - Claire A G Wolfs
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, University Medical Centre, Maastricht, The Netherlands
| | - Pauline Aalten
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, University Medical Centre, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Health Organization, Policy, and Economics, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, University Medical Centre, Maastricht, The Netherlands
| | - Johan L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Hagman J. Comparison of resource utilization in the treatment of open-angle glaucoma between two cities in Finland: is more better? Acta Ophthalmol 2013; 91 Thesis 3:1-47. [PMID: 23621767 DOI: 10.1111/aos.12141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma. OBJECTIVE AND METHODS This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score. RESULTS When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently. CONCLUSIONS Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument.
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Affiliation(s)
- Juha Hagman
- Department of Ophthalmology, Faculty of Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
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van Gestel A, Webers CA, Severens JL, Beckers HJ, Jansonius NM, Hendrikse F, Schouten JS. The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma. Acta Ophthalmol 2012; 90:20-31. [PMID: 22289192 DOI: 10.1111/j.1755-3768.2011.02318.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care. METHODS Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discrete event simulation. The model structure and parameter estimates were based on literature, particularly clinical studies on the natural course of glaucoma and the effect of treatment. We simulated heterogeneous cohorts of 3000 patients and explored the impact of uncertainty with sensitivity analyses. RESULTS The incremental cost-effectiveness ratio (ICER) of initial treatment with a prostaglandin analogue compared with a β-blocker was €12.931 per quality-adjusted life year (QALY) gained. A low initial target pressure (15 mmHg) resulted in 0.115 QALYs gained and €1550 saved compared to a gradual decrease from 21 to 15 mmHg upon progression. Visual field (VF) measurements every 6 rather than 12 months lead to health gains at increased costs (ICER €173,486 per QALY gained), whereas measurements every 24 months lead to health losses at reduced costs (ICER €21,516 per QALY lost). All treatment strategies were dominant over 'withholding treatment'. CONCLUSIONS From a cost-effectiveness point of view, it seems advantageous to aim for a low intraocular pressure in all glaucoma patients. The feasibility of this strategy should therefore be investigated. Additionally, the cost-effectiveness outcomes of initiating monotherapy with a prostaglandin analogue and reducing the frequency of VF testing may be acceptable.
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Affiliation(s)
- Aukje van Gestel
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
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van Gestel A, Grutters J, Schouten J, Webers C, Beckers H, Joore M, Severens J. The role of the expected value of individualized care in cost-effectiveness analyses and decision making. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:13-21. [PMID: 22264967 DOI: 10.1016/j.jval.2011.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 06/03/2011] [Accepted: 07/07/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the feasibility and potential role of the expected value of individualized care (EVIC) framework. METHODS The EVIC quantifies how much benefits are forgone when a treatment decision is based on the best-expected outcomes in the population rather than in the individual patient. We have reviewed which types of patient-level attributes contribute to the EVIC and how they affect the interpretation of the outcomes. In addition, we have applied the EVIC framework to the outcomes of a microsimulation-based cost-effectiveness analysis for glaucoma treatment. RESULTS For EVIC outcomes to inform decisions about clinical practice, we need to calculate the parameter-specific EVIC of known or knowable patient-level attributes and compare it with the real costs of implementing individualized care. In the case study, the total EVIC was €580 per patient, but patient-level attributes known at treatment decision had minimal impact. A subgroup policy based on individual disease progression could be worthwhile if a predictive test for glaucoma progression could be developed and implemented for less than €130 per patient. CONCLUSIONS The EVIC framework is feasible in cost-effectiveness analyses and can be informative for decision making. The EVIC outcomes are particularly informative when they are (close to) zero. When the EVIC has a high value, implications depend on the type of patient-level attribute. EVIC can be a useful tool to identify opportunities to improve efficiency in health care by individualization of care and to quantify the maximal investment opportunities for implementing subgroup policy.
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Affiliation(s)
- Aukje van Gestel
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
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Boonen A, Severens JL. Evaluating treatment strategies in patients with early rheumatoid arthritis: merging modeling theory with clinical practice. J Rheumatol 2011; 38:1538-1540. [PMID: 21807783 DOI: 10.3899/jrheum.110790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Economic considerations of the diagnosis and management for glaucoma in the developed world. Curr Opin Ophthalmol 2011; 22:102-9. [PMID: 21192264 DOI: 10.1097/icu.0b013e3283437bf0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review evaluates the last 18-month literature related to costs and glaucoma. The emphasis is to look at evidence as a big picture and evaluate the critical points and challenges in methodology, current knowledge and future research. RECENT FINDINGS On the basis of simulation models, treating glaucoma appears to be cost-effective compared with no treatment. The results of the simulation models are, however, not consistent regarding when to treat ocular hypertension and when comparing different therapeutic interventions. Most models simulated starting treatment with prostaglandins compared with other medications, whereas one study simulated also initial laser therapy which appeared to be cost saving compared with medical therapy. The models utilized input data both from randomized controlled trials (ideal outcomes) and observational studies (with incomplete and selective reporting). Models suffer from unreliability of data, for example data from randomized diagnostic trials, empirical data of utility values and glaucoma-induced visual disability are limited. SUMMARY As the number of economic evaluations increases, the interpretation and evaluation of their extensive reporting appears very challenging. The published studies highlight the range of uncertainties due to the shortages of our current knowledge and evidence. There is a need for reliable and 'realistic' data for economic evaluations, preferably data from pragmatic randomized trials of 'usual patients'. Similar to emphasizing the cost-effectiveness of care, there is a need to evaluate the expected payback and cost-effectiveness of research interventions. However, even high-quality evidence cannot help our patients if we do not adopt cost-effective interventions.
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Current World Literature. Curr Opin Ophthalmol 2011; 22:141-6. [DOI: 10.1097/icu.0b013e32834483fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caro JJ, Möller J, Getsios D. Discrete event simulation: the preferred technique for health economic evaluations? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:1056-60. [PMID: 20825626 DOI: 10.1111/j.1524-4733.2010.00775.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To argue that discrete event simulation should be preferred to cohort Markov models for economic evaluations in health care. METHODS The basis for the modeling techniques is reviewed. For many health-care decisions, existing data are insufficient to fully inform them, necessitating the use of modeling to estimate the consequences that are relevant to decision-makers. These models must reflect what is known about the problem at a level of detail sufficient to inform the questions. Oversimplification will result in estimates that are not only inaccurate, but potentially misleading. RESULTS Markov cohort models, though currently popular, have so many limitations and inherent assumptions that they are inadequate to inform most health-care decisions. An event-based individual simulation offers an alternative much better suited to the problem. A properly designed discrete event simulation provides more accurate, relevant estimates without being computationally prohibitive. It does require more data and may be a challenge to convey transparently, but these are necessary trade-offs to provide meaningful and valid results. CONCLUSION In our opinion, discrete event simulation should be the preferred technique for health economic evaluations today.
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Affiliation(s)
- Jaime J Caro
- Department of Epidemiology, Biostatistics and Occupational Health, Division of General Internal Medicine, McGill University, Montreal, QC, Canada.
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