Decision Modeling to Inform Decision Making: Seeing the Wood for the Trees
Decision Modeling to Inform Decision Making: Seeing the Wood for the Trees
复制标题
决策建模为决策提供信息：只见树木，不见森林
作者：
J. Karnon;A. Brennan;R. Akehurst
Goldman和Gaspoz最近回应了一篇文章，该文章质疑氯吡格雷作为冠心病治疗的高调经济评估的一些问题。他们的回答有助于澄清他们的方法的理由，并表明他们的模型在类似的假设下预测了与我们的模型相似的结果。这封信的目的不是讨论氯吡格雷的评价，而是解决我们有争议的两个一般问题。首先，总体（AP）方法或个体队列（IC）方法是否与建模成本效益更相关；其次，泄漏（或处方蠕变）是否会破坏患者亚组成本效益分析的相关性。下面，我们将从告知第三方付款人的角度来解决这两个问题，以最大限度地从固定的医疗保健预算中获得健康收益。
Goldman and Gaspoz 1 recently responded to an article that queried some issues around a high-profile economic evaluation of clopidogrel as treatment for coronary heart disease. Their response was helpful in clarifying the justifications for their approach, as well as showing that their model predicts similar results to our model given similar assumptions. The purpose of this letter is not to discuss the evaluation of clopidogrel but to address 2 general points with which we take issue. These are, first, whether an aggregate population (AP) approach or an individual cohort (IC) approach is more relevant for modeling cost-effectiveness, and second, whether leakage (or prescription creep) undermines the relevance of cost-effectiveness analyses of patient subgroups. Below, we address these 2 issues from the perspective of informing a 3rdparty payer with respect to maximizing health gains from a fixed health care budget.