The use of probabilistic decision models in technology assessment: The case of total hip replacement

被引：37

作者：

Briggs A. ^{[1
,7
]}

Sculpher M. ^{[2
]}

Dawson J. ^{[3
]}

Fitzpatrick R. ^{[4
]}

Murray D. ^{[5
]}

Malchau H. ^{[6
]}

机构：

[1] Health Economics Research Centre, Department of Public Health, University of Oxford, Headington, Oxford

[2] Centre for Health Economics, University of York, Heslington, York

[3] School of Health and Social Care, Oxford Brookes University, Oxford

[4] Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford

[5] Nuffield Orthopaedic Centre, Headington, Oxford

[6] Department of Orthopaedics, Massachusetts General Hospital, Boston, MA

[7] Department of Public Health, Health Economics Research Centre, University of Oxford, Headington, Oxford

来源：

Applied Health Economics and Health Policy | 2004年 / 3卷 / 2期

关键词：

Revision Rate; Probabilistic Sensitivity Analysis; Revision Procedure; Late Failure; Revision Risk;

D O I：

10.2165/00148365-200403020-00004

中图分类号：

学科分类号：

摘要：

There is increasing recognition that decision modelling is central to health technology assessment and, in particular, to analyses to support formal decision making regarding the funding of the use of new technologies. In part, the key role of decision analysis stems from the need to handle multiple sources of uncertainty in the available evidence. The use of probabilistic decision analysis is a means of reflecting the parameter uncertainty in models and presenting this in a comprehensible manner to decision makers. In this article, we demonstrate the potential role of probabilistic models using the case study of total hip replacement surgery. A cost-effectiveness model was constructed to compare the Charnley and Spectron hip prostheses in terms of lifetime costs and quality-adjusted life-years (QALYs). Revision rates were estimated from the Swedish National Total Hip Arthroplasty Register (1992-2000); the risk of revision with the Spectron prosthesis relative to the Charnley prosthesis was 0.67 (95% confidence interval [CI] 0.32, 1.02) for early revisions and 0.26 (95% CI 0.07, 0.46) for late revisions. This lower revision risk resulted in the Spectron generating more QALYs than the Charnley prosthesis. Based on mean costs and QALYs, the Spectron results in cost savings in younger patients, and generates incremental cost-effectiveness ratios of between £1000 and £16 000 in older patient groups. The probabilistic results from the model indicated that, if it is assumed that decision makers are willing to pay up to £20 000 per additional QALY, the probability of the Spectron being the more cost-effective prosthesis ranged between 70% and 100%, depending on the age and sex of the patient. This article looks at the application of probabilistic decision modelling using total hip replacement as a case study to emphasis the need for decision models to quantify all sources of parameter uncertainty and to clearly distinguish parameter uncertainty from subgroup heterogeneity. © 2004 Adis Data Information BV. All rights reserved.

引用

页码：79 / 89

页数：10

共 31 条

[1]

Hjelmgren J., Berggren F., Andersson F., Health economic guidelines: Similarities, differences and some implications, Value Health, 4, 3, pp. 225-250, (2001)

[2]

Guide to the Methods of Technology Appraisal, (2004)

[3]

Claxton K., Sculpher M., Drummond M., A rational framework for decision making by the National Institute for Clinical Excellence, Lancet, 360, pp. 711-715, (2002)

[4]

Briggs A.H., A Bayesian approach to stochastic cost-effectiveness analysis, Health Econ, 8, pp. 257-262, (1999)

[5]

Fenwick E., Claxton K., Sculpher M., Representing uncertainty: The role of cost-effectiveness acceptability curves, Health Econ, 10, pp. 779-789, (2001)

[6]

Van Hout B.A., Al M.J., Gordon G.S., Et al., Costs, effects and c/e-ratios alongside a clinical trial, Health Econ, 3, pp. 309-319, (1994)

[7]

Claxton K., The irrelevance of inference: A decision-making approach to the stochastic evaluation of health care technologies, J Health Econ, 18, pp. 342-364, (1999)

[8]

Claxton K., Posnett J., An economic approach to clinical trial design and research priority-setting, Health Econ, 5, pp. 513-524, (1996)

[9]

Chang R.W., Pellissier J.M., Hazen G.B., A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip, JAMA, 275, pp. 858-865, (1996)

[10]

Fitzpatrick R., Shortall E., Sculpher M., Et al., Primary total hip replacement surgery: A systematic review of outcomes and modelling of cost-effectiveness associated with different prostheses, Health Technol Assess, 2, 20, pp. 1-64, (1998)

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