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Tew M, Willis M, Asseburg C, Bennett H, Brennan A, Feenstra T, Gahn J, Gray A, Heathcote L, Herman WH, Isaman D, Kuo S, Lamotte M, Leal J, McEwan P, Nilsson A, Palmer AJ, Patel R, Pollard D, Ramos M, Sailer F, Schramm W, Shao H, Shi L, Si L, Smolen HJ, Thomas C, Tran-Duy A, Yang C, Ye W, Yu X, Zhang P, Clarke P. Exploring Structural Uncertainty and Impact of Health State Utility Values on Lifetime Outcomes in Diabetes Economic Simulation Models: Findings from the Ninth Mount Hood Diabetes Quality-of-Life Challenge. Med Decis Making 2022; 42:599-611. [PMID: 34911405 PMCID: PMC9329757 DOI: 10.1177/0272989x211065479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Structural uncertainty can affect model-based economic simulation estimates and study conclusions. Unfortunately, unlike parameter uncertainty, relatively little is known about its magnitude of impact on life-years (LYs) and quality-adjusted life-years (QALYs) in modeling of diabetes. We leveraged the Mount Hood Diabetes Challenge Network, a biennial conference attended by international diabetes modeling groups, to assess structural uncertainty in simulating QALYs in type 2 diabetes simulation models. METHODS Eleven type 2 diabetes simulation modeling groups participated in the 9th Mount Hood Diabetes Challenge. Modeling groups simulated 5 diabetes-related intervention profiles using predefined baseline characteristics and a standard utility value set for diabetes-related complications. LYs and QALYs were reported. Simulations were repeated using lower and upper limits of the 95% confidence intervals of utility inputs. Changes in LYs and QALYs from tested interventions were compared across models. Additional analyses were conducted postchallenge to investigate drivers of cross-model differences. RESULTS Substantial cross-model variability in incremental LYs and QALYs was observed, particularly for HbA1c and body mass index (BMI) intervention profiles. For a 0.5%-point permanent HbA1c reduction, LY gains ranged from 0.050 to 0.750. For a 1-unit permanent BMI reduction, incremental QALYs varied from a small decrease in QALYs (-0.024) to an increase of 0.203. Changes in utility values of health states had a much smaller impact (to the hundredth of a decimal place) on incremental QALYs. Microsimulation models were found to generate a mean of 3.41 more LYs than cohort simulation models (P = 0.049). CONCLUSIONS Variations in utility values contribute to a lesser extent than uncertainty captured as structural uncertainty. These findings reinforce the importance of assessing structural uncertainty thoroughly because the choice of model (or models) can influence study results, which can serve as evidence for resource allocation decisions.HighlightsThe findings indicate substantial cross-model variability in QALY predictions for a standardized set of simulation scenarios and is considerably larger than within model variability to alternative health state utility values (e.g., lower and upper limits of the 95% confidence intervals of utility inputs).There is a need to understand and assess structural uncertainty, as the choice of model to inform resource allocation decisions can matter more than the choice of health state utility values.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Michael Willis
- The Swedish Institute for Health Economics,
Lund, Sweden
| | | | | | - Alan Brennan
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Talitha Feenstra
- Groningen University, Faculty of Science and
Engineering, GRIP, Groningen, The Netherlands,Groningen University, UMCG, Groningen, The
Netherlands,Netherlands Institute for Public Health and the
Environment (RIVM), Bilthoven, The Netherlands
| | - James Gahn
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Alastair Gray
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Heathcote
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - William H. Herman
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Deanna Isaman
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Shihchen Kuo
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Mark Lamotte
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Zaventem, Belgium
| | - José Leal
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd,
Cardiff, UK
| | | | - Andrew J. Palmer
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia,Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia
| | - Rishi Patel
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Pollard
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Mafalda Ramos
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Porto Salvo, Portugal
| | - Fabian Sailer
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Hui Shao
- Department of Pharmaceutical Outcomes and
Policy. University of Florida College of Pharmacy. Gainesville, FL,
USA
| | - Lizheng Shi
- Department of Health Policy and Management;
Tulane University School of Public Health and Tropical Medicine
| | - Lei Si
- Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia,The George Institute for Global Health, UNSW
Sydney, Kensington, Australia
| | | | - Chloe Thomas
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Chunting Yang
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Xueting Yu
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centres for
Disease Control and Prevention, Atlanta, GA, USA
| | - Philip Clarke
- Philip Clarke, Health Economics Research
Centre, Nuffield Department of Population Health, University of Oxford, Oxford,
UK; ()
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Flaherty-Robb M, Calarco M, Butterworth S, Struble L, Harden K, Franklin M, Potempa S, Laughlin C, Schmidt P, Policicchio J, Yakusheva O, Isaman D, Gallagher NA, Furspan P, Potempa K. Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults. Front Digit Health 2022; 4:795827. [PMID: 35529316 PMCID: PMC9072965 DOI: 10.3389/fdgth.2022.795827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.
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Affiliation(s)
| | - Margaret Calarco
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Laura Struble
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Karen Harden
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Mary Franklin
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stacia Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Candia Laughlin
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Patricia Schmidt
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Olga Yakusheva
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Deanna Isaman
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Philip Furspan
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Kathleen Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Kathleen Potempa
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