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Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients: Before Clinical Research Starts.
MedLine Citation:
PMID:  22814385     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Health economic evaluations are increasingly used to make the decision to adopt new medical interventions. Before such decisions, various stakeholders have invested in clinical research. But health economic factors are seldom considered in research funding decisions. Cost-effectiveness analyses could be informative before the launch of clinical research projects, particularly when a targeted intervention is resource-intensive, total cost for the trial is very high, and expected gain of health benefits is uncertain. This study analyzed cost-effectiveness using a decision analytic model before initiating a large clinical research project on goal-directed hemodynamic treatment of elderly patients with hip fracture. METHODS:: A probabilistic decision analytic cost-effectiveness model was developed; the model contains a decision tree for the postoperative short-term outcome and a Markov structure for long-term outcome. Clinical effect estimates, costs, health-related quality-of-life measures, and long-term survival constituted model input that was extracted from clinical trials, national databases, and surveys. Model output consisted of estimated medical care costs related to quality-adjusted life-years. RESULTS:: In the base case analysis, goal-directed hemodynamic treatment reduced average medical care costs by &OV0556;1,882 and gained 0.344 quality-adjusted life-years. In 96.5% of the simulations, goal-directed hemodynamic treatment is less costly and provides more quality-adjusted life-years. The results are sensitive to clinical effect size variations, although goal-directed hemodynamic treatment seems to be cost-effective even with moderate clinical effect. CONCLUSION:: This study demonstrates that cost-effectiveness analysis is feasible, meaningful, and recommendable before launch of costly clinical research projects.
Authors:
Erzsebet Bartha; Thomas Davidson; Ami Hommel; Karl-Göran Thorngren; Per Carlsson; Sigridur Kalman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-18
Journal Detail:
Title:  Anesthesiology     Volume:  -     ISSN:  1528-1175     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
* Research Assistant, Karolinska Institute, CLINTEC, Division of Anesthesiology, Karolinska University Hospital, Stockholm, Sweden. † Assistant Professor, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden. ‡ Assistant Professor, Department of Health Sciences, Lund University, Lund, Sweden. § Professor, Department of Orthopedics, Lund University Hospital, Lund, Sweden. ∥ Professor, Center for Medical Technology Assessment, Linköping University. # Professor, Karolinska Institute, CLINTEC, Division of Anesthesiology, Karolinska University Hospital.
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