A Comprehensive Probabilistic-Micro-Simulation Model to Assess Cost-Effectiveness

用于评估成本效益的综合概率微观模拟模型

• 批准号: 8035726
• 负责人: ANIRBAN BASU
• 金额: $ 19.44万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8035726
• 关键词: Accounting; Address; Adverse effects; Affect; Algorithms; Antipsychotic Agents; Attention; Behavior; Biological; Caring; Chronic; Clinical Trials; Clozapine; Cognition; Complex; Consensus; Costs and Benefits; Credentialing; Decision Modeling; Delusions; Development; Diabetes Mellitus; Disease; Economics; Ensure; Evaluation; Expenditure; Face; Family member; Funding; Future; Generations; Goals; Growth; Guidelines; Hallucinations; Health Care Costs; Healthcare; Impaired cognition; Inpatients; Intervention; Investments; Lead; Length; Life; Literature; Malignant Neoplasms; Measures; Medical; Mental disorders; Mentored Research Scientist Development Award; Methods; Modeling; Moods; National Institute of Mental Health; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacological Treatment; Physicians; Policies; Policy Maker; Population; Prevalence; Principal Investigator; Probability; Process; Psychiatrist; Publishing; Randomized; Reporting; Research; Research Priority; Resource Allocation; Resources; Risk; Role; Schizophrenia; Science; Series; Severities; Social Welfare; Societies; Specific qualifier value; Symptoms; Syndrome; Tardive Dyskinesia; Technology Assessment; Time; Treatment outcome; Uncertainty; Vulnerable Populations; Woman; Work; alternative treatment; atypical antipsychotic; base; cardiovascular risk factor; case-based; comparative effectiveness; cost; cost effectiveness; effective intervention; evidence base; improved; innovation; insight; men; models and simulation; programs; psychologic; statistics; treatment effect

DESCRIPTION (provided by applicant): Schizophrenia affects about 1.3% of the population and yet is responsible for US$28 billion in annual health care costs. The burden of schizophrenia to the patients, their family members and to the society is large. Antipsychotic drugs are the first line of treatment of schizophrenia and have helped some patients with this disease to lead productive and fulfilling lives. With the advent of the second-generation of antipsychotic drugs, which are typically much more expensive than first generation antipsychotics, the growth in medical expenditures among these patients have risen steadily, calling into question the marginal value of the newer second-generation antipsychotic drugs (atypicals) over the older generation neuroleptics. There is also ambiguous evidence on whether pharmaceutical expenditures can offset the expensive inpatient care for these patients. Consequently, controversies are growing regarding the use of these newer and more expensive drugs, especially when some of them have recently documented evidence of increasing cardiovascular risks in this already vulnerable population. This debate is further fueled by the recently published results from the NIMH funded CATIE study that reported equivalence of continuation rates between patient randomized to receiving first-generation versus atypical antipsychotic drugs. In the presence of such controversy, there remain crucial questions to be answered. These questions span a variety of policies, both present and future, influence a wide range of stake-holders, and primarily focus on the comparative effectiveness, costs and cost-effectiveness of the atypicals versus the neuroleptics. They can only be answered with careful research on evaluating treatment options in schizophrenia and identifying research priorities in this field. This proposal attempts to address these questions using innovative methods in economics, statistics and decision sciences. In this work, we propose to develop and apply a comprehensive probabilistic micro-simulation model in schizophrenia to provide information about population level costs, effectiveness and cost-effectiveness of pharmacological treatments and treatment algorithms. The work proposed here is important methodologically and clinically. The methodological advancements that are proposed will have major applications for technology assessment in many domains in health care and hope to provide valuable insights for their potential application in many other contexts. Clinically, our findings have the potential to have important implications for the treatment of schizophrenia by providing physicians and their patients with rich information on the distribution of outcomes of treatments that can help guide them in making more informed treatment choices. Furthermore, the proposed value of information analyses will direct future research and resources in this field by identifying research priorities on those parameters where more precise estimates would be most valuable. Controversies are growing regarding the use of second generation versus the first generation antipsychotics by patients with schizophrenia in the face of rising costs and ambiguous evidence on the benefits of the newer drugs. Frequent switching between alternative drugs indicates that no one drug may be optimal for a patient. Enormous uncertainties in current estimates of treatment effect imply that the value of future research in this filed may be substantial. In order to address these questions, the proposed work aims to develop a comprehensive micro-simulation model to assess the costs, effectiveness, cost-effectiveness of alternative pharmacological treatment algorithms in schizophrenia and to conduct value of information and value of future research analyses in this field.

描述（由申请人提供）：精神分裂症影响约 1.3% 的人口，但每年造成 280 亿美元的医疗保健费用。精神分裂症给患者、家属和社会带来很大的负担。抗精神病药物是治疗精神分裂症的一线药物，并帮助一些患有这种疾病的患者过上了富有成效和充实的生活。随着第二代抗精神病药物（通常比第一代抗精神病药物昂贵得多）的出现，这些患者的医疗支出稳步上升，这使人们对新型第二代抗精神病药物（非典型药物）相对于老一代抗精神病药物的边际价值产生了质疑。关于药品支出是否可以抵消这些患者昂贵的住院治疗费用，也存在不明确的证据。因此，关于使用这些更新且更昂贵的药物的争议越来越大，特别是当其中一些药物最近有证据表明在这个已经很脆弱的人群中心血管风险增加时。 NIMH 资助的 CATIE 研究最近发表的结果进一步加剧了这场争论，该研究报告了随机接受第一代抗精神病药物与非典型抗精神病药物的患者之间的持续率相当。在存在这样的争议的情况下，仍然有一些关键问题需要回答。这些问题涉及当前和未来的各种政策，影响广泛的利益相关者，并且主要集中在非典型药物与抗精神病药物的相对有效性、成本和成本效益上。只有通过仔细研究评估精神分裂症的治疗方案并确定该领域的研究重点，才能回答这些问题。该提案试图利用经济学、统计学和决策科学的创新方法来解决这些问题。在这项工作中，我们建议开发和应用精神分裂症的综合概率微观模拟模型，以提供有关药物治疗和治疗算法的人口水平成本、有效性和成本效益的信息。这里提出的工作在方法论和临床上都很重要。所提出的方法论进步将在医疗保健许多领域的技术评估中具有重要应用，并希望为其在许多其他情况下的潜在应用提供有价值的见解。在临床上，我们的研究结果有可能对精神分裂症的治疗产生重要影响，为医生及其患者提供有关治疗结果分布的丰富信息，帮助指导他们做出更明智的治疗选择。此外，信息分析的拟议价值将通过确定这些参数的研究重点来指导该领域的未来研究和资源，其中更精确的估计将是最有价值的。面对成本上升以及新药益处的证据不明确，关于精神分裂症患者使用第二代抗精神病药与第一代抗精神病药的争议越来越大。替代药物之间的频繁切换表明没有一种药物可能最适合患者。目前对治疗效果的估计存在巨大的不确定性，这意味着该领域未来研究的价值可能很大。为了解决这些问题，本文的工作旨在开发一个全面的微观模拟模型，以评估精神分裂症替代药物治疗算法的成本、有效性和成本效益，并进行该领域的信息价值和未来研究分析的价值。