Evidence‐Based Medicine in Otolaryngology, Part XI: Modeling and Analysis to Support Decisions

Caulley, Lisa; Hunink, M. G. Myriam; Randolph, Gregory W.; Shin, Jennifer J.

doi:10.1177/0194599820948827

Cited by 4 publications

(3 citation statements)

References 77 publications

(339 reference statements)

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“…Testing the effectiveness of such an intervention could pose challenges because patient expectations may not be well articulated preoperatively. Tools to assess patient preferences, 42 supports to decision-making, 43,44 and education about thyroid surgery expectations 45 could help improve the effectiveness of interventions designed to align patient-clinician treatment understanding and treatment experience building on our findings.…”

Section: Discussionmentioning

confidence: 92%

Analysis of Unmet Information Needs Among Patients With Thyroid Cancer

Karcioglu

Dhillon

Davies

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceCounseling prior to thyroid cancer (TC) treatment is an essential component of informed consent. An informed patient affects treatment-related expectations and patient engagement, factors that contribute significantly to patient-reported quality-of-life outcomes.ObjectiveTo describe experiences with pretreatment counseling among survivors of TC and to test factors associated with self-reported treatment meeting expectations.Design, Setting, and ParticipantsA cross-sectional survey was administered between October 18, 2019, and February 8, 2020, to members of ThyCa: Thyroid Cancer Survivors’ Association Inc, and to individuals accessing the public-facing ThyCa website. Survey respondents were asked 55 questions, including 4 free-text questions and 2 multiple-choice questions about pretreatment counseling.Main Outcomes and MeasuresRespondents self-reported (1) their unmet information needs, (2) rates of treatment meeting expectations, and (3) rates of treatment understanding. A mixed-methods analysis was performed, including qualitative content analysis of free-text responses and multivariable logistic regression of factors associated with self-reported levels of treatment meeting expectations.ResultsOf the 1412 survey respondents, 1249 were women (88.4%). The median age at diagnosis was 48 years (range, 18-85 years), and the median age at the time of survey completion was 60 years (range, 18-87 years). A total of 1259 respondents (89.2%) provided free-text responses to the question, “What would you tell someone newly diagnosed with your same condition?” Of these individuals, 526 (37.2%) reported inadequate pretreatment plan understanding and 578 (40.9%) reported that their treatment experience did not meet their expectations. Treatment met expectations for only 95 respondents (18.1%) reporting an inadequate pretreatment plan understanding. Of the 526 survivors of TC reporting a lack of understanding, 473 (90.0%) provided additional textual comments, most commonly in the categories of postoperative treatment, surveillance, and treatment effects. On multivariable logistic regression, self-reported failure to have an understanding of TC treatment was independently associated with failure of treatment to meet expectations (odds ratio, 5.1 [95% CI, 3.7-6.9]). Patients reporting a full understanding of their treatment plan were 5-fold more likely to indicate that their initial treatment experience was on par with expectations, independent of reported postoperative complications, age, sex, and other potential confounders.Conclusions and RelevanceIn this survey study, a substantial proportion of survivors of TC reported inadequate pretreatment understanding. This gap in understanding was associated with high levels of self-reported failure of treatment to meet expectations, which in turn is associated in other studies with poorer patient-reported quality-of-life outcomes. These outcomes may be improved by addressing gaps in patient understanding so expectations more closely match TC diagnosis and treatment pathways.

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Section: Discussionmentioning

confidence: 92%

Analysis of Unmet Information Needs Among Patients With Thyroid Cancer

Karcioglu

Dhillon

Davies

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…A value of information analysis is a quantitative method of valuing the expected gain from reducing uncertainty in the model parameters [ 58 – 64 ]. These analyses can help quantify the value of selecting an immediate decision, based on the best available evidence, as compared to a delayed decision in favor of additional research to establish more accurate parameter estimates.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas

et al. 2022

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Purpose The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. Methods We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. Conclusions Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment.

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“…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%

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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Evidence‐Based Medicine in Otolaryngology, Part XI: Modeling and Analysis to Support Decisions

Cited by 4 publications

References 77 publications

Analysis of Unmet Information Needs Among Patients With Thyroid Cancer

Analysis of Unmet Information Needs Among Patients With Thyroid Cancer

Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas

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

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