Decision Modeling for Economic Evaluation in Otolaryngology–Head and Neck Surgery: Review of Techniques

Forner, David; Hoit, Graeme; Noel, Christopher W.; Eskander, Antoine; Almeida, John R. de; Rigby, Matthew H.; Naimark, David

doi:10.1177/0194599820957288

Cited by 3 publications

(5 citation statements)

References 48 publications

(73 reference statements)

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“…In addition, values in a decision tree are static with respect to time, which may also limit the generalizability of this study as costs may vary per practice and over time. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Another limitation of the study is the variation in effectiveness rates for adults with allergic rhinitis undergoing immunotherapy—for this reason, we used a range of values in a sensitivity analysis. In addition, values in a decision tree are static with respect to time, which may also limit the generalizability of this study as costs may vary per practice and over time 14 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, values in a decision tree are static with respect to time, which may also limit the generalizability of this study as costs may vary per practice and over time. 14 At this point, the analysis is limited to immunotherapy treatment of allergic rhinitis in adults. Future directions include cost-effective analysis of SLIT vs SCIT for asthma and allergic conjunctivitis, as well, with additional studies aimed at pediatric populations rather than adults.…”

Section: Discussionmentioning

confidence: 99%

“…A decision tree was thoughtfully constructed following recently published technique guidelines 14 , 15 to study the cost-effectiveness of the 2 modalities in a population of 100 theoretical patients with clinical diagnoses of allergic rhinitis ( Figure 1 ). The purpose of this decision model was to address the mean objectives of demonstrating the cost-effectiveness of SLIT from the payor’s perspective and promoting widespread insurance coverage for this service.…”

Section: Methodsmentioning

confidence: 99%

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Cost‐effective Analysis of Subcutaneous vs Sublingual Immunotherapy From the Payor’s Perspective

2021

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Objective Compare the cost-effectiveness of subcutaneous immunotherapy (SCIT) and aqueous sublingual immunotherapy (SLIT) as treatment modalities for adult patients with allergic rhinitis and conjunctivitis who undergo testing and qualify for allergen immunotherapy (AIT). Methods A systematic review was performed to identify key statistics for analysis, including the compliance and efficacy rates for each treatment. The body of literature on this topic is highly heterogeneous, so ranges were obtained and assumptions stated clearly where they were made. Charges were derived from average commercial payor charges from a single hospital institution. A hypothetical 100 patients are examined for the study. Results A cost-effectiveness sensitivity analysis was then performed using a decision tree model to compare the modalities. A sensitivity and threshold analysis was then performed to assess the strength of recommendations after identifying results at baseline. Discussion Assuming an 80% compliance rate with allergen immunotherapy and an estimated efficacy (assumed to be clinically significant improvement in symptoms) of 70% for SLIT and 80% for SCIT, at the 12-month mark, the baseline total cost to the payor of SLIT per successful treatment outcome is $1196 while the charge of SCIT per successful treatment outcome is $2691. Our analysis favors SLIT as the more cost-effective modality per successful outcome. Implications for Practice When compared to SCIT, SLIT is economically favorable and should be considered the financially conscious option for patients with >40% adherence to therapy.

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“…In addition, values in a decision tree are static with respect to time, which may also limit the generalizability of this study as costs may vary per practice and over time. 14 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Cost‐effective Analysis of Subcutaneous vs Sublingual Immunotherapy From the Payor’s Perspective

2021

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“…We used a 2-dimensional simulation. 53 The 2 dimensions were defined in terms of parameter-level iterations and individual-level iterations. The parameter-level iterations captured input parameter uncertainty for parameters that were relevant for groups of persons, while the individual-level iterations (microsimulations) captured patient-level stochasticity.…”

Section: Two-dimensional Simulationmentioning

confidence: 99%

Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands

Li,

Viceconti,

et al. 2023

MDM Policy & Practice

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Objective. To conduct cost-utility analyses for Computed Tomography To Strength (CT2S), a novel osteoporosis screening service, compared with dual-energy X-ray absorptiometry (DXA), treat all without screening, and no screening methods for Dutch postmenopausal women referred to fracture liaison service (FLS). CT2S uses CT scans to generate femur models and simulate sideways fall scenarios for bone strength assessment. Methods. Early health technology assessment (HTA) was adopted to evaluate CT2S as a novel osteoporosis screening tool for secondary fracture prevention. We constructed a 2-dimensional simulation model considering 4 strategies (no screening, treat all without screening, DXA, CT2S) together with screening intervals (5 y, 2 y), treatments (oral alendronate, zoledronic acid), and discount rate scenarios among Dutch women in 3 age groups (60s, 70s, and 80s). Strategy comparisons were based on incremental cost-effectiveness ratios (ICERs), considering an ICER below €20,000 per QALY gained as cost-effective in the Netherlands. Results. Under the base-case scenario, CT2S versus DXA had estimated ICERs of €41,200 and €14,083 per QALY gained for the 60s and 70s age groups, respectively. For the 80s age group, CT2S was more effective and less costly than DXA. Changing treatment from weekly oral alendronate to annual zoledronic acid substantially decreased CT2S versus DXA ICERs across all age groups. Setting the screening interval to 2 y increased CT2S versus DXA ICERs to €100,333, €55,571, and €15,750 per QALY gained for the 60s, 70s, and 80s age groups, respectively. In all simulated populations and scenarios, CT2S was cost-effective (in some cases dominant) compared with the treat all strategy and cost-saving (more effective and less costly) compared with no screening. Conclusion. CT2S was estimated to be potentially cost-effective in the 70s and 80s age groups considering the willingness-to-pay threshold of the Netherlands. This early HTA suggests CT2S as a potential novel osteoporosis screening tool for secondary fracture prevention. Highlights For postmenopausal Dutch women who have been referred to the FLS, direct access to CT2S may be cost-effective compared with DXA for age groups 70s and 80s, when considering the ICER threshold of the Netherlands. This study positions CT2S as a potential novel osteoporosis-screening tool for secondary fracture prevention in the clinical setting. A shorter screening interval of 2 y increases the effectiveness of both screening strategies, but the ICER of CT2S compared with DXA also increased substantially, which made CT2S no longer cost-effective for the 70s age group; however, it remains cost-effective for individuals in their 80s. Annual zoledronic acid treatment with better adherence may contribute to a lower cost-effectiveness ratio when comparing CT2S to DXA screening and the treat all strategies for all age groups.

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Decision analysis in cardiac surgery: a scoping review and methodological primer

Vervoort,

Lee,

Lia

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Randomized controlled trials are the gold standard for evidence generation in medicine but are limited by their real-world generalizability, resource needs, shorter follow-up durations, and inability to be conducted for all clinical questions. Decision analysis models may simulate trials and observational studies by using existing data and evidence- and expert-informed assumptions, and extend analyses over longer time horizons, different study populations, and specific scenarios, helping to translate population outcomes to patient-specific clinical and economic outcomes. Here, we present a scoping review and methodological primer on decision analysis for cardiac surgery research. METHODS A scoping review was performed using the PubMed/MEDLINE, EMBASE, and Web of Science databases for cardiac surgery decision analysis studies published until December 2021. Articles were summarized descriptively to quantify trends and ascertain methodological consistency. RESULTS 184 articles were identified, among which Markov models (N = 92, 50.0%) were the most commonly used models. The most common outcomes were costs (N = 107, 58.2%), quality-adjusted life-years (N = 96, 52.2%), and incremental cost-effectiveness ratios (N = 89, 48.4%). Most (N = 165, 89.7%) articles applied sensitivity analyses, most frequently in the form of deterministic sensitivity analyses (N = 128, 69.6%). Reporting of guidelines to inform the model development and/or reporting was present in 22.3% of articles. CONCLUSION Decision analysis methods are increasing but remain limited and highly variable in cardiac surgery. A methodological primer is presented and may provide researchers with the foundation to start with or improve decision analysis, as well as provide readers and reviewers with the fundamental concepts to review decision analysis studies.

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Decision Modeling for Economic Evaluation in Otolaryngology–Head and Neck Surgery: Review of Techniques

Cited by 3 publications

References 48 publications

Cost‐effective Analysis of Subcutaneous vs Sublingual Immunotherapy From the Payor’s Perspective

Cost‐effective Analysis of Subcutaneous vs Sublingual Immunotherapy From the Payor’s Perspective

Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands

Decision analysis in cardiac surgery: a scoping review and methodological primer

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