Model-Based Cost-Effectiveness Analyses for the Treatment of Acute Stroke Events: A Review and Summary of Challenges
Model-Based Cost-Effectiveness Analyses for the Treatment of Acute Stroke Events: A Review and Summary of Challenges
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DOI：
10.1111/j.1524-4733.2008.00467.x
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发表时间：
2009-06-01
期刊：
影响因子：
4.5
通讯作者：
Joshi, Ashish V.
中科院分区：
文献类型：
--
作者：
Earnshaw, Stephanie R.;Wilson, Michele;Joshi, Ashish V.
为了总结已发表的评估急性卒中治疗干预措施的决策分析模型中使用的方法学方法，强调卒中治疗决策分析模型的关键组成部分，并讨论开发卒中决策模型的挑战。通过对文献的分析，确定了卒中模型的关键组成部分，并指出了缺乏数据的领域。我们确定了13个已发表的急性卒中治疗模型。这些模型通常具有短期处理模块和长期后处理模块。以下方面的经济建模被认为是相关的中风模型的发展：建模方法和健康状态;健康状态转移概率;估计短期，长期和间接成本;健康状态的效用;中风后死亡率;时间范围;模型验证;估计参数的不确定性。为了更准确地评估中风新疗法的长期增量影响，未来的研究需要解决这些数据缺口。我们建议将用于检查急性卒中治疗的成本效益的模型的复杂性保持在最低限度，以便它可以包含当前可用的数据，而无需围绕数据进行大量假设。
To summarize the methodological approaches used in published decision-analytic models evaluating interventions for acute stroke treatment, to highlight key components of decision-analytic models of stroke treatment, and to discuss challenges for developing stroke decision models.A review of the published literature was performed using Medline, to identify studies involving mathematical decision models to evaluate interventions for acute stroke treatment. Articles were analyzed to determine key components of a stroke model and to note areas in which data are lacking.We identified 13 published models of acute stroke treatment. These models typically possessed a short-term treatment module and a long-term post-treatment module. The following aspects of economic modeling were found to be relevant for developing a stroke model: modeling approach and health state; health state transition probabilities; estimation of short-term, long-term, and indirect costs; health state utilities; poststroke mortality; time horizon; model validation; and estimation of parameter uncertainty.Data gaps have limited the development of economic models in stroke to date. In order to more accurately assess the long-term incremental impact of a new treatment of stroke, future research is needed to address these data gaps. We recommend that the complexity of models for examining the cost-effectiveness of an acute stroke treatment be kept to a minimum such that it can incorporate the currently available data without making a large number of assumptions around the data.