The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal

McManus, Emma; Sach, Tracey; Levell, N. J.

doi:10.1007/s40273-017-0564-7

Cited by 9 publications

(10 citation statements)

References 55 publications

(37 reference statements)

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“…McManus et al . performed an SR and critical appraisal of current economic models used to evaluate 24 interventions (12 preventions and 12 treatments) for AE.…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

What’s new in atopic eczema? An analysis of systematic reviews published in 2017. Part 2: epidemiology, aetiology and risk factors

et al. 2019

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This article forms part of a series of annual updates that summarizes the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2017, and focuses on the epidemiology, aetiology and risk factors of AE. AE is the largest single contributor to morbidity associated with skin disease worldwide, once mortality has been excluded. There is a high prevalence of sleep disturbance in individuals with AE and they take more sick leave than controls. While there is a lack of skin bacterial diversity in patients with AE, there is a relative abundance of Staphylococcus aureus and Staphylococcus epidermidis. Compared with controls, affected individuals more often show an IgE response to S. aureus antigens and have higher serum interleukin-31 levels. Early antibiotic exposure, environmental pollutants, maternal atopy and food allergy are associated with an increased risk of AE, and very preterm birth is associated with decreased risk. Patients with AE have a reduced risk of meningioma, but are more likely to develop attention-deficit hyperactivity disorder compared with controls. Patients with eosinophilic oesophagitis are significantly more likely than unaffected individuals to have AE. There is no significant overall association between AE and allergic contact dermatitis (ACD), and in children referred for patch testing, ACD was more common in those without AE. Hand eczema is more prevalent in patients with AE. There is no association between AE and Type 2 diabetes, hypertension, stroke or myocardial infarction.

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“…McManus et al . performed an SR and critical appraisal of current economic models used to evaluate 24 interventions (12 preventions and 12 treatments) for AE.…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

What’s new in atopic eczema? An analysis of systematic reviews published in 2017. Part 2: epidemiology, aetiology and risk factors

et al. 2019

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“…The best resource‐allocation decisions are likely to be made where an array of evidence exists, which can be integrated to inform an economic model. Economic decision models often facilitate this, but in the area of eczema these models tend to be of insufficient time frame and quality . The evidence in Table S3 suggests that current decisions are likely to be made either on the basis of no evidence (where none exists) or based on a single influential trial.…”

Section: Resultsmentioning

confidence: 99%

“…Economic decision models often facilitate this, but in the area of eczema these models tend to be of insufficient time frame and quality. 100 The evidence in Table S3 suggests that current decisions are likely to be made either on the basis of no evidence (where none exists) or based on a single influential trial. The CLOTHES trial, 13 for example, seems to provide the sole evidence justifying guidance suggesting silk garments should not be routinely prescribed in any circumstance in NHS primary care.…”

Section: Cost-effectiveness Results For Interventions To Prevent and mentioning

confidence: 99%

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Understanding economic evidence for the prevention and treatment of atopic eczema

2019

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Summary Background Atopic eczema is an inflammatory skin condition, with a similar impact on health‐related quality of life as other chronic diseases. Increasing pressures on resources within the National Health Service increase the importance of having good economic evidence to inform their allocation. Objectives To educate dermatologists about economic methods with reference to currently available economic evidence on eczema. Methods The role of different types of economic evidence is illustrated by evidence found in a systematic literature search conducted across 12 online databases up to 22 May 2017. Primary empirical studies either reporting the results of a cost‐of‐illness study or evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema were included. Two reviewers independently assessed studies for eligibility and performed data abstraction, with disagreements resolved by a third reviewer. Evidence tables of results were produced for narrative discussion. The reporting quality of economic evaluations was assessed. Results Seventy‐eight studies (described in 80 papers) were deemed eligible. Thirty‐three (42%) were judged to be economic evaluations, 12 (15%) cost analyses, six (8%) utility analyses, 26 (33%) cost‐of‐illness studies and one a feasibility study (1%). The calcineurin inhibitors tacrolimus and pimecrolimus, as well as barrier creams, had the most economic evidence available. Partially hydrolysed infant formula was the most commonly evaluated prevention. Conclusions The current level of economic evidence for interventions aimed at preventing and treating eczema is limited compared with that available for clinical outcomes, suggesting that greater collaboration between clinicians and economists might be beneficial.

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“…This paper reviews the most common modelling approaches used within economic evaluations, using real‐world examples found within a systematic review of modelling studies for atopic eczema . As it is often easier to learn through mistakes than successes, where possible, the examples cited throughout this paper have been chosen to highlight elements that could have been improved within the modelling methodology.…”

Section: Introductionmentioning

confidence: 99%

An introduction to the methods of decision‐analytic modelling used in economic evaluations for Dermatologists

McManus

Sach

Levell

2019

Acad Dermatol Venereol

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Economic evaluations are used to identify which health treatments or preventions offer the most effective use of resources, or value for money. This is achieved by identifying, measuring and valuing the inputs and outcomes of alternative interventions. These evaluations are often conducted alongside clinical trials; however, these trials may end before the outcomes of economic interest have been observed and measured. An alternative to within trial economic evaluation is to use decision modelling, which can model the cost-effectiveness of interventions over an extended time period. This paper aims to provide an overview for clinicians of the different modelling techniques used within health economic evaluations and to introduce methods for critical appraisal. The most common modelling approaches, and their associated strengths and weaknesses, were discussed. Alongside this, practical examples specific to dermatology were given.These examples include studies where the model chosen or the methods used may not have been the most appropriate.Methods for critical appraisal were also highlighted. Common modelling approaches include Decision Trees, Markov Cohort, extensions to the Markov model (Monte Carlo Simulation) and Discrete Event Simulation models. Items of the Philips Checklist were discussed in the context of performing critical appraisal. Health economic decision models are multi-faceted and can often be complex. Full critical appraisal requires clinicians' unique knowledge, which is complementary to the knowledge of health economists.

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The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal

Cited by 9 publications

References 55 publications

What’s new in atopic eczema? An analysis of systematic reviews published in 2017. Part 2: epidemiology, aetiology and risk factors

What’s new in atopic eczema? An analysis of systematic reviews published in 2017. Part 2: epidemiology, aetiology and risk factors

Understanding economic evidence for the prevention and treatment of atopic eczema

An introduction to the methods of decision‐analytic modelling used in economic evaluations for Dermatologists

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