Brendan L Limone1, William L Baker2, Elizabeth S Mearns1, C Michael White1, Jeffrey Kluger3, Craig I Coleman4. 1. Evidence-Based Practice Center, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT 06102, USA. 2. University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT 06102, USA. 3. Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA. 4. Evidence-Based Practice Center, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT 06102, USA. Electronic address: craig.coleman@hhchealth.org.
Abstract
OBJECTIVES: Decision makers use models to assist in evaluating the cost-effectiveness of pharmacologic stroke prevention in atrial fibrillation (SPAF). STUDY DESIGN AND SETTING: We performed a search of databases through October 3, 2012 to identify pharmacologic SPAF cost-effectiveness models. RESULTS: Of 30 identified models, 28 included warfarin, but only 60% assessed the impact of warfarin control on conclusions. Aspirin, dual antiplatelet, and newer anticoagulants were included in 41%, 10%, and 63% of models, respectively. Models used similar structures but included varying health states and made varying assumptions. They rarely reported performing a literature search to identify anticoagulant-specific inputs and used similar and older sources. Sixteen models used a lone randomized trial to reflect the efficacy and safety of main comparisons. One-third of models claimed a societal perspective; however, none included indirect costs. Patients typically initiated anticoagulation in the sixth or seventh decade of life and are followed for their lifetimes. Almost 70% of incremental cost-effectiveness ratios were below reported willingness-to-pay thresholds. All used deterministic sensitivity analyses and 77% conducted Monte Carlo simulation. Less than half of the models were rated "high quality," yet were frequently published in high-impact journals. CONCLUSION: Pharmacologic SPAF cost-effectiveness models have been extensively reported, but many may have flaws giving reason for decision makers to use caution. We provide 10 recommendations to avoid common flaws in SPAF cost-effectiveness models.
OBJECTIVES: Decision makers use models to assist in evaluating the cost-effectiveness of pharmacologic stroke prevention in atrial fibrillation (SPAF). STUDY DESIGN AND SETTING: We performed a search of databases through October 3, 2012 to identify pharmacologic SPAF cost-effectiveness models. RESULTS: Of 30 identified models, 28 included warfarin, but only 60% assessed the impact of warfarin control on conclusions. Aspirin, dual antiplatelet, and newer anticoagulants were included in 41%, 10%, and 63% of models, respectively. Models used similar structures but included varying health states and made varying assumptions. They rarely reported performing a literature search to identify anticoagulant-specific inputs and used similar and older sources. Sixteen models used a lone randomized trial to reflect the efficacy and safety of main comparisons. One-third of models claimed a societal perspective; however, none included indirect costs. Patients typically initiated anticoagulation in the sixth or seventh decade of life and are followed for their lifetimes. Almost 70% of incremental cost-effectiveness ratios were below reported willingness-to-pay thresholds. All used deterministic sensitivity analyses and 77% conducted Monte Carlo simulation. Less than half of the models were rated "high quality," yet were frequently published in high-impact journals. CONCLUSION: Pharmacologic SPAF cost-effectiveness models have been extensively reported, but many may have flaws giving reason for decision makers to use caution. We provide 10 recommendations to avoid common flaws in SPAF cost-effectiveness models.
Authors: Jeffrey D Miller; Xin Ye; Gregory M Lenhart; Amanda M Farr; Oth V Tran; W Jackie Kwong; Elizabeth A Magnuson; William S Weintraub Journal: Clinicoecon Outcomes Res Date: 2016-05-20