“…While the Discrete Event Simulation (DES) model is more flexible and offers retention of patient history and risk profile updates for each event, it is much more complicated and not readily replicable compared to the Markov model [ 19 , 21 ]. Decision models such as the decision tree are too simplistic, while the dynamic model requires advanced knowledge in statistics or programming and usually more preferable in infectious disease modelling [ 13 ]. Though important, choosing the model needs to weigh their pros and cons, at the same time very much dependent on the data availability.…”
Section: Discussionmentioning
confidence: 99%
“…Decision modelling attempts to represent reality with just enough details for decision making. The fact that data and information can come from various sources and the results are extrapolated into the future justifies the use of modelling in economic evaluation [ 13 ]. A decision tree model and a Markov model are two of the most commonly used decision models in cost-effectiveness analysis.…”
Section: Introductionmentioning
confidence: 99%
“…It is a simple model to develop and analyse. There are other models such as Discrete Event Simulation and Dynamic Model, but each has its own weaknesses and strengths [ 13 ].…”
Background
Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH).
Methods
A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model.
Results
Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies.
Conclusions
The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
“…While the Discrete Event Simulation (DES) model is more flexible and offers retention of patient history and risk profile updates for each event, it is much more complicated and not readily replicable compared to the Markov model [ 19 , 21 ]. Decision models such as the decision tree are too simplistic, while the dynamic model requires advanced knowledge in statistics or programming and usually more preferable in infectious disease modelling [ 13 ]. Though important, choosing the model needs to weigh their pros and cons, at the same time very much dependent on the data availability.…”
Section: Discussionmentioning
confidence: 99%
“…Decision modelling attempts to represent reality with just enough details for decision making. The fact that data and information can come from various sources and the results are extrapolated into the future justifies the use of modelling in economic evaluation [ 13 ]. A decision tree model and a Markov model are two of the most commonly used decision models in cost-effectiveness analysis.…”
Section: Introductionmentioning
confidence: 99%
“…It is a simple model to develop and analyse. There are other models such as Discrete Event Simulation and Dynamic Model, but each has its own weaknesses and strengths [ 13 ].…”
Background
Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH).
Methods
A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model.
Results
Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies.
Conclusions
The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
“…O modelo escolhido para a análise dos dados foi a árvore de decisão, pois é a forma mais simples de representação dos eventos e suas respectivas probabilidades de ocorrência. São representados, graficamente, possíveis caminhos que os pacientes percorreriam caso estivessem sob as estratégias ou intervenções investigadas, podendo-se atribuir custos e desfechos em saúde a cada itinerário percorrido pelos indivíduos (Silva, Silva, Pereira, 2016). Os dados foram analisados no Software TreeAge para essa representação, como vistos nas Figuras 1 e 2.…”
Objetivo: Realizar uma análise de custo-efetividade dos protocolos antineoplásicos mais utilizados no tratamento da leucemia aguda em pacientes pediátricos. Métodos: Realizou-se uma análise de custo-efetividade, com uso de modelo de árvore de decisão, a partir da consulta de dados secundários de sistemas de informação em saúde do Brasil, o SIGTAP - SUS. A população foi composta por pacientes pediátricos registrados na base de dados do RHC do INCA, na faixa-etária de 0 a 19 anos, apresentando leucemia linfocítica/linfoide/linfoblástica como neoplasia de base, no período de 1997-2017. Resultados: Para os pacientes do sexo masculino, o transplante de medula óssea (TMO) exibiu um custo incremental alto em relação às alternativas e demonstrou a menor efetividade. O tratamento realizado com Qt associada ao TMO (QtTMO), embora de custo incremental maior, apresentou efetividade muito superior às alternativas, tornando-se custo-efetiva. A associação de Qt com radioterapia (QtRxt) se revelou o tratamento com maior custo-efetividade. Para o sexo feminino, o tratamento realizado com QtTMO se apresentou como o menos custo-efetivo, juntamente com o TMO. Por sua vez, a QtRxt se mostrou com custo-efetividade maior em relação às alternativas. Conclusão: Os resultados desta análise econômica revelaram melhor custo-efetividade para a QtRxt e pior custo-efetividade para a TMO, em ambos os sexos. Essa análise mostrou diferentes cenários de acordo com o sexo do paciente, em particular, o tratamento com QtTMO pode constituir uma opção terapêutica custo-efetiva para os pacientes do sexo masculino, porém não para os do sexo feminino.
“…29 Nesse sentido, estudos baseados em modelos são alternativas interessantes aos estudos baseados em trials. 182 Conforme descrito previamente, modelos de análise de decisão são ferramentas que permitem a representação de um sistema de forma simplificada e reduzida aos seus elementos essenciais, e utilizam relações matemáticas para sintetizar as possíveis consequências do uso de determinadas tecnologias. 28 Além de menos onerosos, modelos de análise de decisão permitem a avaliação de custos e consequências em saúde por um horizonte de tempo prolongado, até por toda a vida.…”
FMUSP, pela sua orientação científica durante o doutorado, seu constante incentivo para a edificação da minha carreira acadêmica e, principalmente, por sua amizade e carinho -presentes que conservarei para a vida.
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