Potential cost-effectiveness for using patient decision aids to guide osteoporosis treatment

Penton, Hannah; Hiligsmann, Mickaël; Harrison, Mark; Reginster, Jean‐Yves; Boonen, Annelies; Bansback, Nick

doi:10.1007/s00198-016-3596-5

Cited by 6 publications

(11 citation statements)

References 40 publications

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“…Several decision aids are already available in osteoporosis to support the decision to start an oral bisphosphonate or not, or to select an appropriate medication (24–26). The use of decision aids has the potential to be cost-effective (27) and our results suggest that tailoring treatments to individual patients can increase their satisfaction with the treatment. As such, our findings might assist decision makers to identify treatments that are more likely to be cost-effective in practice (9).…”

Section: Discussionmentioning

confidence: 85%

Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment

et al. 2017

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We found statistically significant differences in patients' preferences for anti-osteoporosis medications between countries, especially for the mode of administration. Our findings emphasized that international treatment recommendations should allow for local adaptation, and that understanding individual preferences is important if we want to improve the quality of clinical care for patients with osteoporosis.

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Section: Discussionmentioning

confidence: 85%

Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment

et al. 2017

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“…13 The proportions of patients initiating a specific DMD treatment or opting for best supportive care were therefore assumed to differ between the groups, also following studies for other health decisions. 24,25,42,43 The treatment initiation and treatment sequencing (i.e., the categorization of DMDs in first-line treatments for mild to moderate RRMS and in secondline treatments for highly active RRMS or RRMS not responding to first-line treatment) was informed by current clinical practice in the Netherlands, based on expert opinions and recommendations provided by the Dutch Healthcare Institute, 11 in the absence of formal up-todate clinical guidelines. Effects 2 and 3 were based on the theory by Stalmeier 26 that patients develop a more pronounced attitude toward taking the medication continuously and accurately.…”

Section: Intervention Effectsmentioning

confidence: 99%

“…Including the patient's preferences in treatment decisions may change the choice. 24,25,42,43 No evidence is yet available about how shared decision making could influence the treatment choice for MS. Based on stated preference studies, we constructed a possible profile regarding the initial treatment choice for the patients making a shared decision with their health care professional. Stated preference studies report that patients value the effects of the DMD most, more than safety, ease of use, and side effects.…”

Section: Intervention Effectsmentioning

confidence: 99%

“…This resulted in an averaged absolute decrease in discontinuation rate of 11.1% over the different DMDs, which was in line with a previous economic evaluation regarding a decision aid for shared decision making in osteoporosis assuming a 10% decrease in the discontinuation after shared decision making. 42 The relative decrease in the discontinuation rate was varied to 25% and 75% in sensitivity analyses.…”

Section: Intervention Effectsmentioning

confidence: 99%

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Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

et al. 2020

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Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.

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“…Trenaman et al [ 10 ] found that a decision aid for patients considering total joint replacement was dominant, since it was cost saving and produced a small (not statistically significant) QALY gain. Penton et al [ 11 ] developed a hypothetical model of the cost effectiveness of a patient decision aid detailing the benefits and risks of bisphosphonates for patients with osteoporosis, finding the decision aid may have an incremental cost-effectiveness ratio below US$50,000/QALY.…”

Section: Introductionmentioning

confidence: 99%

Measuring the Benefits of Decision Aids for Economic Evaluation

Butt

2018

PharmacoEconomics Open

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Decision aids, sometimes known as decision-support tools, are increasingly used to help patients to understand treatment options and to reach an informed decision consistent with their own values, yet methods for their economic evaluation have received limited attention. This is at odds with the increasingly rigorous methods being applied to assess the cost effectiveness of other health technologies. This paper reviews current approaches to evaluating decision aids and proposes a new method for assessing their benefits relative to other interventions in a resource-constrained health system that seeks to improve health, equity and patient satisfaction. Current evaluation frameworks are found to be unsuitable for the economic evaluation of decision aids since their objectives are broader than health maximisation. Decision aids may generate significant nonhealth benefits such as improved patient knowledge and satisfaction, which cannot be assessed using cost-utility analysis. A stated-preference consultation time trade-off (CTTO) is proposed in which a proportion of hypothetical physician consultation is traded for use of the decision aid. A decision aid provides information for a patient to make an informed choice and therefore may be considered to be a substitute for physician time. The CTTO can be reported in consultation minutes or converted to monetary units using the cost of physician time. These values may be used, alongside the implementation cost, for economic evaluation. Key Points for Decision MakersThere are limitations with current methods to economically evaluate the benefits of decision aids.A new approach is proposed that considers decision aids as a substitute for physician consultation to obtain health care information for informed decision making.The consultation time-trade off (CTTO) allows the patient to express a preference for using the decision aid within the framework of opportunity cost.

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Potential cost-effectiveness for using patient decision aids to guide osteoporosis treatment

Cited by 6 publications

References 40 publications

Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment

Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment

Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

Measuring the Benefits of Decision Aids for Economic Evaluation

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