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Decision analysis

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89 papers 25 to 100 followers
By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
Roberta Ara, John Brazier, Ismail Azzabi Zouraq
Methodological issues of how to use health state utility values (HSUVs) in decision models arise frequently, including the most appropriate evidence to use as the baseline (e.g. the baseline HSUVs associated with avoiding a particular health condition or event), how to capture changes due to adverse events and how to appropriately capture uncertainty in progressive conditions where the expected change in quality of life is likely to be monotonically decreasing over time. As preference-based measures provide different values when collected from the same patient, it is important to ensure that all HSUVs used within a single model are obtained from the same instrument where ever possible...
December 2017: PharmacoEconomics
Courtney J Balentine, David J Vanness, David F Schneider
BACKGROUND: We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. METHODS: We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature...
January 2018: Surgery
Peter S Hall, Alison Smith, Claire Hulme, Armando Vargas-Palacios, Andreas Makris, Luke Hughes-Davies, Janet A Dunn, John M S Bartlett, David A Cameron, Andrea Marshall, Amy Campbell, Iain R Macpherson, Dan Rea, Adele Francis, Helena Earl, Adrienne Morgan, Robert C Stein, Christopher McCabe
BACKGROUND: Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy. OBJECTIVES: To use economic analysis before a large-scale clinical trial of molecular testing to confirm the value of the trial and help prioritize between candidate tests as randomized comparators...
December 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
James E Rohrer
Objective: The purpose of this commentary is to propose a flexible practice innovations decision model (PIDM) for use in health services planning and management. Method: This is an example of fuzzy decision analysis. The elements of the model are explained by applying it to the decision of whether to open a primary care clinic in retail space. The model contains 10 criteria, each of which scored as 1 (met) or 0 (not met). The scores are summed to guide the decision...
January 2017: Health Services Research and Managerial Epidemiology
Jonathan C Hong, Ron Blankstein, Leslee J Shaw, William V Padula, Alejandro Arrieta, Jonathan A Fialkow, Roger S Blumenthal, Michael J Blaha, Harlan M Krumholz, Khurram Nasir
This review evaluates the cost-effectiveness of using coronary artery calcium (CAC) to guide long-term statin therapy compared with treating all patients eligible for statins according to 2013 American College of Cardiology/American Heart Association cholesterol management guidelines for atherosclerotic cardiovascular disease. The authors used a microsimulation model to compare costs and effectiveness from a societal perspective over a lifetime horizon. Both strategies resulted in similar costs and quality-adjusted life years (QALYs)...
August 2017: JACC. Cardiovascular Imaging
Douglas K Owens, Evelyn P Whitlock, Jillian Henderson, Michael P Pignone, Alex H Krist, Kirsten Bibbins-Domingo, Susan J Curry, Karina W Davidson, Mark Ebell, Matthew W Gillman, David C Grossman, Alex R Kemper, Ann E Kurth, Michael Maciosek, Albert L Siu, Michael L LeFevre
The U.S. Preventive Services Task Force (USPSTF) develops evidence-based recommendations about preventive care based on comprehensive systematic reviews of the best available evidence. Decision models provide a complementary, quantitative approach to support the USPSTF as it deliberates about the evidence and develops recommendations for clinical and policy use. This article describes the rationale for using modeling, an approach to selecting topics for modeling, and how modeling may inform recommendations about clinical preventive services...
October 4, 2016: Annals of Internal Medicine
Kaleb Michaud, Vibeke Strand, Nancy A Shadick, Irina Degtiar, Kerri Ford, Steven N Michalopoulos, John Hornberger
OBJECTIVE: The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years. METHODS: A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility...
September 2015: Rheumatology
Brian Custer, Mart P Janssen
Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing interventions. The objective of this review is to address key considerations and limitations of current methods as they apply to blood safety. Because a voluntary blood supply is an example of a public good, analyses should be conducted from the societal perspective when possible...
August 2015: Transfusion
Deborah J Lightner
No abstract text is available yet for this article.
May 1, 2015: International Journal of Cardiology
Jennifer Mason Lobo, Adam P Dicker, Christine Buerki, Elai Daviconi, R Jeffrey Karnes, Robert B Jenkins, Nirav Patel, Robert B Den, Timothy N Showalter
BACKGROUND: Currently there is controversy surrounding the optimal way to treat patients with prostate cancer in the post-prostatectomy setting. Adjuvant therapies carry possible benefits of improved curative results, but there is uncertainty in which patients should receive adjuvant therapy. There are concerns about giving toxicity to a whole population for the benefit of only a subset. We hypothesized that making post-prostatectomy treatment decisions using genomics-based risk prediction estimates would improve cancer and quality of life outcomes...
2015: PloS One
Jeffrey D Stone, Lisa M Vaccaro, R Colin Brabender, Alfred V Hess
PURPOSE: To evaluate the utility of radiographs taken 2 weeks following plate fixation of distal radius fractures. METHODS: A retrospective review of patients requiring operative fixation of distal radius fractures was performed with the objective of determining the utility of a 2-week postoperative radiograph in patient management. RESULTS: Three out of 268 (1%) patients had loss of fixation noted radiographically at the 2-week visit that resulted in a reoperation...
June 2015: Journal of Hand Surgery
JoAnn Mick
This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at
June 2015: Worldviews on Evidence-based Nursing
Kelly Yamasato, Bliss Kaneshiro, Jennifer Salcedo
AIM: Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates...
July 2015: Journal of Obstetrics and Gynaecology Research
Mehdi Najafzadeh, Sebastian Schneeweiss, Niteesh Choudhry, Katsiaryna Bykov, Kristijan H Kahler, Diane P Martin, Joshua J Gagne
BACKGROUND: Patients, physicians, and other decision makers make implicit but inevitable trade-offs among risks and benefits of treatments. Many methods have been proposed to promote transparent and rigorous benefit-risk analysis (BRA). OBJECTIVE: To propose a framework for classifying BRA methods on the basis of key factors that matter most for patients by using a common mathematical notation and compare their results using a hypothetical example. METHODS: We classified the available BRA methods into three categories: 1) unweighted metrics, which use only probabilities of benefits and risks; 2) metrics that incorporate preference weights and that account for the impact and duration of benefits and risks; and 3) metrics that incorporate weights based on decision makers' opinions...
March 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Zoltán Kaló, Anke-Peggy Holtorf, Rafael Alfonso-Cristancho, Jie Shen, Tamás Ágh, András Inotai, Diana Brixner
Policymakers tend to focus on improving patented drug policies because they are under pressure from patients, physicians, and manufacturers to increase access to novel therapies. The success of pharmaceutical innovation over the last few decades has led to the availability of many off-patent drugs to treat disease areas with the greatest public health need. Therefore, the success of public health programs in improving the health status of the total population is highly dependent on the efficiency of generic drug policies...
March 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Catherine Juillard, Randi Smith, Nancy Anaya, Arturo Garcia, James G Kahn, Rochelle A Dicker
BACKGROUND: Victims of violence are at significant risk for injury recidivism, including fatality. We previously demonstrated that our hospital-based violence intervention program (VIP) resulted in a fourfold reduction in injury recidivism, avoiding trauma care costs of $41,000 per injury. Given limited trauma center resources, assessing cost-effectiveness of interventions is fundamental to inform use of these programs in other institutions. This study examines the cost-effectiveness of hospital-based VIP...
February 2015: Journal of Trauma and Acute Care Surgery
Carlos E Rodríguez-Martínez, Monica P Sossa-Briceño, Elkin Vladimir Lemos
INTRODUCTION: Allergic rhinitis (AR) is one of the most common chronic respiratory diseases observed in the pediatric population, producing a significant morbidity, and an economic burden due to direct medical costs and indirect costs. Despite the high prevalence of AR in children and the importance of the use of topical intranasal corticosteroids for its treatment, comparative analyses of alternative treatments in pediatric patients, in terms of both cost and effectiveness are lacking...
March 2015: Advances in Therapy
Hassan M Ghomrawi, Ashley A Eggman, Andrew D Pearle
BACKGROUND: Trade-offs between upfront benefits and later risk of revision of unicompartmental knee arthroplasty compared with those of total knee arthroplasty are poorly understood. The purpose of our study was to compare the cost-effectiveness of unicompartmental knee arthroplasty with that of total knee arthroplasty across the age spectrum of patients undergoing knee replacement. METHODS: Using a Markov decision analytic model, we compared unicompartmental knee arthroplasty with total knee arthroplasty with regard to lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a societal perspective for patients undergoing surgery at forty-five, fifty-five, sixty-five, seventy-five, or eighty-five years of age...
March 4, 2015: Journal of Bone and Joint Surgery. American Volume
Bernice Tsoi, Ron Goeree, Jathishinie Jegathisawaran, Jean-Eric Tarride, Gord Blackhouse, Daria O'Reilly
When choosing a modeling approach for health economic evaluation, certain criteria are often considered (e.g., population resolution, interactivity, time advancement mechanism, resource constraints). However, whether these criteria and their associated modeling approach impacts results remain poorly understood. A systematic review was conducted to identify cross-validation studies (i.e., modeling a problem using different approaches with the same body of evidence) to offer insight on this topic. With respect to population resolution, reviewed studies suggested that both aggregate- and individual-level models will generate comparable results, although a practical trade-off exists between validity and feasibility...
June 2015: Expert Review of Pharmacoeconomics & Outcomes Research
Huseyin Naci, Gert van Valkenhoef, Julian P T Higgins, Rachael Fleurence, A E Ades
No abstract text is available yet for this article.
September 2014: Circulation. Cardiovascular Quality and Outcomes
2015-03-04 07:08:09
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