Med Decis Making - The value of heterogeneity for cost-effectiveness subgroup analysis: conceptual framework and application.

Tópicos

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{ cost(1906) reduc(1198) effect(832) }
{ measur(2081) correl(1212) valu(896) }
{ studi(2440) review(1878) systemat(933) }
{ data(3008) multipl(1320) sourc(1022) }
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Resumo

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy.

Resumo Limpo

articl develop general framework guid use subgroup costeffect analysi decis make collect fund health system address key polici question name identif select subgroup distinguish sourc potenti valu associ heterogen valu reveal factor associ heterogen cost outcom use exist evid static valu valu acquir subgrouprel evid resolv uncertainti given current understand heterogen dynam valu consider sourc valu can guid subgroupspecif treatment decis inform whether research conduct resolv uncertainti explain variabl cost outcom appli propos method costeffect analysi manag patient acut coronari syndrom studi present expect net benefit current perfect inform subgroup defin base use combin binari covari result case studi confirm theoret expect subgroup consid margin net benefit gain obtain current inform show diminish margin return expect valu perfect inform show decreas trend present suggest algorithm synthes result guid polici

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