Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community

Tosh, Jonathan; Kearns, Benjamin; Brennan, Alan; Parry, Glenys; Ricketts, Tom; Saxon, David; Foster, Alexis; Thake, Anna; Chambers, Eleni; Hutten, Rebecca

doi:10.1186/1472-6963-13-150

Cited by 11 publications

(33 citation statements)

References 31 publications

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“…For example, within their economic analysis of oxaliplatin and capecitabine for the adjuvant treatment of colon cancer, Eggington et al [26] replicated a model of treatments for metastatic colorectal cancer [27] to inform downstream costs and health outcomes for relapsed patients (in this case, the original model was available hence it was unnecessary to fully rely on the reporting of the study publication). In another example, Kearns et al [28] produced a model simulating joint costs and outcomes of service reconfiguration options for type 2 diabetes and depression which involved replicating the underlying structure and inputs of a published depression model [29] and the United Kingdom Prospective Diabetes Study (UKPDS) outcomes model (version 2) [30][31][32] based on the study publications.…”

Section: Levels Of Model Replicationmentioning

confidence: 99%

Replicating Health Economic Models: Firm Foundations or a House of Cards?

2017

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Health economic evaluation is a framework for the comparative analysis of the incremental health gains and costs associated with competing decision alternatives. The process of developing health economic models is usually complex, financially expensive and time consuming. For these reasons, model development is sometimes based on previous model-based analyses: this endeavour is usually referred to as model replication. Such model replication activity may involve the comprehensive reproduction of an existing model or "borrowing" all or part of a previously developed model structure. Generally speaking, the replication of an existing model may require substantially less effort than developing a new de novo model by bypassing, or undertaking in only a perfunctory manner, certain aspects of model development such as the development of a complete conceptual model and/or comprehensive literature searching for model parameters. A further motivation for model replication may be to draw on the credibility or prestige of previous analyses which have been published and/or used to inform decisionmaking. The acceptability and appropriateness of replicating models depends on the decision-making context: there exists a trade-off between the "savings" afforded by model replication and the potential "costs" associated with reduced model credibility due to the omission of certain stages of model development. This paper provides an overview of the different levels of, and motivations for, replicating health economic models, and discusses the advantages, disadvantages and caveats associated with this type of modelling activity. Irrespective of whether replicated models should be considered appropriate or not, complete replicability is generally accepted as a desirable property of health economic models, as reflected in critical appraisal checklists and good practice guidelines. To this end, the feasibility of comprehensive model replication is explored empirically across a small number of recent case studies.Recommendations are put forward for improving reporting standards to enhance comprehensive model replicability. Key points for decision makers Model replicability is generally perceived to be an indicator of the quality of published models. Model replication is associated with both advantages and disadvantages. Replication may be quicker and less expensive than developing a de novo model, however model authors should be aware that these "savings" may impact upon the credibility of the model. Our pilot study indicates that even amongst a very small sample of studies, the majority of the models considered could not be fully replicated.

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Section: Levels Of Model Replicationmentioning

confidence: 99%

Replicating Health Economic Models: Firm Foundations or a House of Cards?

2017

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“…149 The other compared alternative service configurations, using a discrete event simulation model, to estimate longer-term outcomes in depression. 164 This study noted some significant evidence gaps, which would be further increased in our study as data for the Deaf population is limited. We would not have had the evidence to inform a full range of parameters needed for this approach, and, as such, the resulting model would not have been robust.…”

Section: Appendix 2 Glossary Of Terms Associated With Trial-related Imentioning

confidence: 76%

“…There is evidence from evaluations of IAPT service that service users access other primary, community and hospital services. 163,164 However, whether or not there are differences between standard and BSL IAPT in the use of these services by Deaf people with depression/anxiety is unknown.…”

Section: Scope and Model Structurementioning

confidence: 99%

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

Young

Rogers

Davies

et al. 2017

Health Serv Deliv Res

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BackgroundImproving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.Objectives(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.DesignA mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.SettingsIAPT service providers (NHS and private); the Deaf community.ParticipantsDeaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).InterventionsIAPT at steps 2 and 3.Main outcome measuresReliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.Data sourcesIAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.ResultsRandomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.LimitationsThe small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.ConclusionsThere is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.Future workA prospective observational study for definitive results is justified.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…A methodological framework for "Whole Disease Modeling" has been developed by Tappenden et al, which considers all treatments and diagnostics along the pathway of care for a simulated cohort, 56 but the only examples that we could find of this method being used were with colorectal cancer and depression. 57,58 Multi-morbidity also has implications for quality of life outcome measures which, like costs, do not behave additively over conditions. 59 Outcome measures are also problematic in particular patient groups, such as those with impaired cognitive abilities who may not be able to complete patient reported outcome measures; 60 and in particular interventions, such as palliative care, where the choice of outcome is not straightforward or uniform.…”

Section: Discussionmentioning

confidence: 99%

Priorities for Health Economic Methodological Research: Results of an Expert Consultation

Tordrup¹,

Chouaïd

Cuijpers

et al. 2017

Int J Technol Assess Health Care

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Background: The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps.Methods: The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps.Results: The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities.Conclusions: The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the “-omics” approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.

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Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community

Cited by 11 publications

References 31 publications

Replicating Health Economic Models: Firm Foundations or a House of Cards?

Replicating Health Economic Models: Firm Foundations or a House of Cards?

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

Priorities for Health Economic Methodological Research: Results of an Expert Consultation

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