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"Decision analysis"

Richard C Mather, Shane J Nho, Andrew Federer, Berna Demiralp, Jennifer Nguyen, Asha Saavoss, Michael J Salata, Marc J Philippon, Asheesh Bedi, Christopher M Larson, J W Thomas Byrd, Lane Koenig
BACKGROUND: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. PURPOSE: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. STUDY DESIGN: Economic and decision analysis; Level of evidence, 2...
March 1, 2018: American Journal of Sports Medicine
Michele Molinari, Chethan Puttarajappa, Martin Wijkstrom, Armando Ganoza, Roberto Lopez, Amit Tevar
BACKGROUND: Recent studies have reported a significant decrease in wound problems and hospital stay in obese patients undergoing renal transplantation by robotic-assisted minimally invasive techniques with no difference in graft function. OBJECTIVE: Due to the lack of cost-benefit studies on the use of robotic-assisted renal transplantation versus open surgical procedure, the primary aim of our study is to develop a Markov model to analyze the cost-benefit of robotic surgery versus open traditional surgery in obese patients in need of a renal transplant...
March 8, 2018: JMIR Research Protocols
Martijn Bouwknegt, Brecht Devleesschauwer, Heather Graham, Lucy J Robertson, Joke Wb van der Giessen, The Euro-Fbp Workshop Participants
Background and aimsPriority setting is a challenging task for public health professionals. To support health professionals with this and in following a recommendation from the Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO), 35 European parasitologists attended a workshop from 8-12 February 2016 to rank food-borne parasites (FBP) in terms of their importance for Europe and regions within Europe. Methods: Countries were divided into European regions according to those used by the European Society of Clinical Microbiology and Infectious Diseases...
March 2018: Euro Surveillance: Bulletin Européen sur les Maladies Transmissibles, European Communicable Disease Bulletin
Mark P Cote
Septic arthritis is a rare but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Studies examining surgical treatment options including graft retention and removal are largely inconclusive. Although the literature indicated that 43.8% of patients who have the graft removed later go on to have a revision ACL reconstruction compared with only 6.5% among those whose graft is retained, this expected-value decision analysis found removal to be the optimal treatment for patients with septic arthritis after ACL reconstruction...
March 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Vidhush K Yarlagadda, Meredith L Kilgore, John P Selph
AIM: To identify the costs of replacing an entire malfunctioning AUS device versus an individual component at the time of device malfunction. METHODS: Decision analysis was performed by analyzing the costs associated with revising a malfunctioning artificial urinary sphincter using one of two techniques: either individual or entire device replacement. Costs were determined by including actual institutional costs. Model assumptions were based on a summary of published literature and were created based on a time horizon of 0-5 years since the original, primary AUS was placed, and models were created for malfunction of each individual component...
February 28, 2018: Neurourology and Urodynamics
Grace Baik, Scott E Brietzke
Objectives To use decision analysis modeling to compare utility and cost outcomes of intracapsular tonsillectomy (ICT) and extracapsular tonsillectomy (ECT). To use sensitivity analysis to determine the most important factors influencing outcomes favoring one surgical method versus another. Study Design Decision analysis model. Setting Hypothetical cohort. Subjects and Methods A decision analysis model was created with computer software comparing the results of ICT and ECT. The model featured complications with completion tonsillectomy, such as postsurgical bleed, dehydration, and tonsillar regrowth...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Louis P Garrison, Peter J Neumann, Richard J Willke, Anirban Basu, Patricia M Danzon, Jalpa A Doshi, Michael F Drummond, Darius N Lakdawalla, Mark V Pauly, Charles E Phelps, Scott D Ramsey, Adrian Towse, Milton C Weinstein
This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e...
February 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Charles E Phelps, Darius N Lakdawalla, Anirban Basu, Michael F Drummond, Adrian Towse, Patricia M Danzon
The fifth section of our Special Task Force report identifies and discusses two aggregation issues: 1) aggregation of cost and benefit information across individuals to a population level for benefit plan decision making and 2) combining multiple elements of value into a single value metric for individuals. First, we argue that additional elements could be included in measures of value, but such elements have not generally been included in measures of quality-adjusted life-years. For example, we describe a recently developed extended cost-effectiveness analysis (ECEA) that provides a good example of how to use a broader concept of utility...
February 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Darius N Lakdawalla, Jalpa A Doshi, Louis P Garrison, Charles E Phelps, Anirban Basu, Patricia M Danzon
The third section of our Special Task Force report identifies and defines a series of elements that warrant consideration in value assessments of medical technologies. We aim to broaden the view of what constitutes value in health care and to spur new research on incorporating additional elements of value into cost-effectiveness analysis (CEA). Twelve potential elements of value are considered. Four of them-quality-adjusted life-years, net costs, productivity, and adherence-improving factors-are conventionally included or considered in value assessments...
February 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Paula Heikkilä, Minna Mecklin, Matti Korppi
BACKGROUND: This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, compared to normal saline inhalations or standard treatment without inhalations as controls. METHODS: The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitalization rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies...
February 23, 2018: World Journal of Pediatrics: WJP
Robert Anderson, Jenny Norrman, Pär-Erik Back, Tore Söderqvist, Lars Rosén
Decision support tools (DST) are often used in remediation projects to aid in the complex decision on how best to remediate a contaminated site. In recent years, the sustainable remediation concept has brought increased attention to the often-overlooked contradictory effects of site remediation, with a number of sustainability assessment tools now available. The aim of the present study is twofold: (1) to demonstrate how and when different assessment views affect the decision support outcome on remediation alternatives in a DST, and (2) to demonstrate the contribution of a full sustainability assessment...
February 20, 2018: Science of the Total Environment
Ole Rogeberg, Daniel Bergsvik, Lawrence D Phillips, Jan van Amsterdam, Niamh Eastwood, Graeme Henderson, Micheal Lynskey, Fiona Measham, Rhys Ponton, Steve Rolles, Anne Katrin Schlag, Polly Taylor, David Nutt
BACKGROUND: Drug policy, whether for legal or illegal substances, is a controversial field that encompasses many complex issues. Policies can have effects on a myriad of outcomes and stakeholders differ in the outcomes they consider and value, while relevant knowledge on policy effects is dispersed across multiple research disciplines making integrated judgements difficult. METHODS: Experts on drug harms, addiction, criminology and drug policy were invited to a decision conference to develop a multi-criterion decision analysis (MCDA) model for appraising alternative regulatory regimes...
February 16, 2018: International Journal on Drug Policy
Ronnie L Shammas, Nathan Mela, Scott Wallace, Betty C Tong, Joel Huber, Suhail K Mithani
PURPOSE: We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. METHODS: Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture...
February 15, 2018: Journal of Hand Surgery
Elizabeth H Parlato, Doug P Armstrong
Predicting reintroduction outcomes before populations are released is inherently challenging. It becomes even more difficult when the species being considered for reintroduction no longer co-exists with the key threats limiting its distribution. However, data from other species facing the same threats can be used to make predictions under these circumstances. We present an integrated Bayesian modelling approach for predicting growth of a reintroduced population at a range of predator densities when no data are available for the species in the presence of that predator...
February 17, 2018: Conservation Biology: the Journal of the Society for Conservation Biology
Tara R Semenkovich, Roheena Z Panni, Jessica L Hudson, Theodore Thomas, Leisha C Elmore, Su-Hsin Chang, Bryan F Meyers, Benjamin D Kozower, Varun Puri
OBJECTIVES: We compared the effectiveness of upfront esophagectomy versus induction chemoradiation followed by esophagectomy for overall survival in patients with clinical T2N0 (cT2N0) esophageal cancer. We also assessed the influence of the diagnostic uncertainty of endoscopic ultrasound on the expected benefit of chemoradiation. METHODS: We created a decision analysis model representing 2 treatment strategies for cT2N0 esophageal cancer: upfront esophagectomy that may be followed by adjuvant therapy for upstaged patients and induction chemoradiation for all patients with cT2N0 esophageal cancer followed by esophagectomy...
January 12, 2018: Journal of Thoracic and Cardiovascular Surgery
Scott B Rosenfeld, Katherine Schroeder, Sylvia I Watkins-Castillo
BACKGROUND: Musculoskeletal conditions are among the most common and costly conditions suffered by Americans. In 2011, there was an estimated $213 billion in annual cost of direct treatment for and lost wages due to musculoskeletal disease in the United States. Data on economic burden, however, comes mostly from the adult population, with significantly less information regarding the burden of these conditions in young patients available. The purpose of this report is to provide data on the economic burden of musculoskeletal diseases in children and adolescents in the United States...
February 2, 2018: Journal of Pediatric Orthopedics
Angela R Wateska, Mary Patricia Nowalk, Richard K Zimmerman, Kenneth J Smith, Chyongchiou J Lin
BACKGROUND: Adults aged 18-64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation Program (4 Pillars Program) increases uptake of pneumococcal polysaccharide vaccine, influenza vaccine and tetanus-diphtheria-acellular pertussis vaccine by 5-10% among adults with high-risk medical conditions, but its cost-effectiveness is unknown. METHODS: A decision tree model estimated the cost-effectiveness of implementing the 4 Pillars Program in primary care practices compared to no program for a population of adults 18-64 years of age at high risk of illness complications over a 10 year time horizon...
January 25, 2018: BMC Infectious Diseases
E Kay, L Owen, M Taylor, L Claxton, L Sheppard
BACKGROUND: Economic evaluations are important tools for decision makers to determine the best allocation of resources in a healthcare system. This study explored the use of economic evaluation in oral health promotion. METHODS: A literature review identified oral health promotion programmes that measured both the health impact and costs of oral health interventions. A decision analysis model was constructed to examine the cost utility of preventing dental caries in 5 and 12-year-old children via tooth brushing schemes and fluoride varnish programmes...
March 1, 2018: Community Dental Health
Nikhil R Nayak, Matthew Piazza, Andrew Milby, Jayesh P Thawani, Lachlan J Smith, Sherman C Stein, Neil R Malhotra
BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) often leads to cervical myelopathy. While multiple procedures have been shown to be effective in the treatment of OPLL, outcomes are less predictable than in degenerative cervical myelopathy and surgery is associated with high rates of complications and re-operation which affect quality of life. In this study, we perform a decision analysis utilizing post-operative complication data and health-related quality of life (HRQoL) utility scores to assess the average expected health utility and 5-year quality-adjusted life years (QALYs) associated with the most common surgical approaches for multilevel cervical OPLL...
January 16, 2018: World Neurosurgery
Kunihiro Iwata, Toshiharu Moriya, Sadahiro Nakagawa, Katsuhiko Ogasawara
1) to evaluate efficiencies of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) for preoperative assessment of liver metastases from colorectal carcinoma, and 2) to compare them with other diagnostic imaging modalities. The subjects of the analysis were outpatients with advanced colorectal cancer who are at risk of developing liver metastases (initial setting: pre-test probability=20%). At initial setting, we performed a decision analysis to calculate numbers of true positive (TP), false negative (FN), false positive (FP) and true negative (TN) test results per 1000 patients of Gd-EOB-MRI and other imaging modalities (conventional contrast agent-enhanced MRI, contrast-enhanced CT and 18F-FDG PET/CT)...
2018: Nihon Hoshasen Gijutsu Gakkai Zasshi
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