Cost‐Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia

Moran, Dane; Shrime, Mark G.; Nang, Sam; Vycheth, Iv; Vuthy, Din; Hong, Raksmey; Padula, William V.; Park, Kee B.

doi:10.1007/s00268-017-4022-7

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…We found that 16 cost-per-QALY studies (1.4%) reported a total of 68 cost-per-QALY ratios from a healthcare sector and a societal perspective (34 ratios from each perspective), and five cost-per-DALY studies (0.7%) reported a total of 72 cost-per-DALY ratios (36 ratios from each perspective). Seven of 16 cost-per-QALY studies reported one ratio from each perspective [28][29][30][31][32][33][34], whereas two studies reported five and six intervention-specific ratios from each perspective, respectively [35,36]. Four of five cost-per-DALY studies reported one or two ratios from each perspective [37][38][39][40], and one multicountry study reported 31 ratios from each perspective [41].…”

Section: Main Analysis 3: the Use Of Impact Inventory And Multiple Perspectivesmentioning

confidence: 99%

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

et al. 2020

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Objective Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). Methods We analyzed the Tufts Medical Center’s CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. Results Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900–110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67–3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017–2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991–49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486–77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. Conclusion Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.

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Section: Main Analysis 3: the Use Of Impact Inventory And Multiple Perspectivesmentioning

confidence: 99%

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

et al. 2020

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“…Moreover, whilst certain institutions may be early adopters with exposure to digital neurosurgical simulation technologies, others may be unable to gain the required exposure due to organisational financial constraints. In fact, various teams have highlighted that the costs of neurosurgical simulation can be high and hence have developed further methods like app-based communication platforms to reduce costs [26,28,31,61,75,79,113]. Study designs for centres with established track records and budgets for neurosurgical simulation differ from centres with financial constraints undertaking an initial study into its usefulness for their trainees.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance

et al. 2020

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At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI − 0.482; − 0.167, p < 0.001), and speed by 25% (ES − 0.25, CI − 0.399; − 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.

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“…19 An example of a Monte Carlo simulation can be found in the study by Moran et al, who investigated the costeffectiveness of craniotomy for epidural hematomas. 18 The authors utilized a Monte Carlo simulation across 1000 iterations to capture variability in direct costs associated with surgery, indirect costs associated with lost earning potential, and health utilities associated with each Glasgow Outcome Scale score by providing a mean and standard deviation for each model input. A sample PSA diagram can be found in Fig.…”

Section: Model Robustness: 1-way 2-way and Probabilistic Sensitivitmentioning

confidence: 99%

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research

Wali¹,

Brandel²,

Santiago-Dieppa³

et al. 2018

Neurosurgical Focus

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OBJECTIVEMarkov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research.METHODSThe PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs.RESULTSA total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided.CONCLUSIONSAs neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.

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Cost‐Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia

Abstract: Craniotomy is a cost-effective treatment for patients with a traumatic EDH who meet criteria for operation when trained neurosurgeons are available onsite.

Cited by 5 publications

References 28 publications

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research

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