Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncope.
Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncope.
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DOI：
10.1186/1472-6963-6-68
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发表时间：
2006-06-06
影响因子：
2.8
通讯作者：
Krahn AD
中科院分区：
文献类型：
--
作者：
Hoch JS;Rockx MA;Krahn AD
成本-效果可接受性曲线（CEAC）描述了新的治疗或干预措施具有成本效益的概率。净效益回归框架允许在简单的回归框架中进行成本效益分析。本文的目的是说明如何净效益回归可以用来构建一个CEAC。100例因晕厥或晕厥前期而转诊进行动态监测的患者被随机分配至1个月外部循环记录仪（n = 49）或48小时霍尔特监测仪（n = 51）。主要终点是监测期间的心律相关性。直接成本是根据2003年安大略健康保险计划（OHIP）费用表，结合医院病例诊断检测和相关设备的劳动力、材料、服务和间接成本计算的。在循环记录仪组中，63.27%的患者（31/49）有症状复发和成功激活，而霍尔特组为23.53%（12/51）。循环记录的成本为648.50美元，霍尔特监测的成本为212.92美元。循环记录仪的增量成本效益比（ICER）为每额外成功诊断1，096美元。使用净效益回归估计与霍尔特监测仪相比，循环记录仪具有成本效益的概率，并绘制在CEAC上。在敏感性分析中，采用自举法来检查分布假设的影响。NBRF易于使用和解释。围绕回归系数产生的不确定性与CEAC有关。当从回归的p值到成本效益概率的联系是试探性的时，可以使用自举法。
Cost-effectiveness acceptability curves (CEACs) describe the probability that a new treatment or intervention is cost-effective. The net benefit regression framework (NBRF) allows cost-effectiveness analysis to be done in a simple regression framework. The objective of the paper is to illustrate how net benefit regression can be used to construct a CEAC. One hundred patients referred for ambulatory monitoring with syncope or presyncope were randomized to a one-month external loop recorder (n = 49) or 48-hour Holter monitor (n = 51). The primary endpoint was symptom-rhythm correlation during monitoring. Direct costs were calculated based on the 2003 Ontario Health Insurance Plan (OHIP) fee schedule combined with hospital case costing of labour, materials, service and overhead costs for diagnostic testing and related equipment. In the loop recorder group, 63.27% of patients (31/49) had symptom recurrence and successful activation, compared to 23.53% in the Holter group (12/51). The cost in US dollars for loop recording was $648.50 and $212.92 for Holter monitoring. The incremental cost-effectiveness ratio (ICER) of the loop recorder was $1,096 per extra successful diagnosis. The probability that the loop recorder was cost-effective compared to the Holter monitor was estimated using net benefit regression and plotted on a CEAC. In a sensitivity analysis, bootstrapping was used to examine the effect of distributional assumptions. The NBRF is straightforward to use and interpret. The resulting uncertainty surrounding the regression coefficient relates to the CEAC. When the link from the regression's p-value to the probability of cost-effectiveness is tentative, bootstrapping may be used.
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影响因子：
4.8
作者：
Krahn, AD;Klein, GJ;Manda, V
通讯作者：
Manda, V
影响因子：
4.8
作者：
Mahoney, EM;Mehta, S;Weintraub, WS
通讯作者：
Weintraub, WS
影响因子：
10.5
作者：
McCrone, P;Knapp, M;Tylee, A
通讯作者：
Tylee, A
影响因子：
5.9
作者：
CALKINS, H;BYRNE, M;MORADY, F
通讯作者：
MORADY, F
影响因子：
2.8
作者：
GIBSON, TC;HEITZMAN, MR
通讯作者：
HEITZMAN, MR