| A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies. | |
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MedLine Citation:
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PMID: 16997929 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. METHODS: We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. RESULTS: Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. CONCLUSION: The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies. |
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Authors:
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Chris P Lee; Glenn M Chertow; Stefanos A Zenios |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Medical decision making : an international journal of the Society for Medical Decision Making Volume: 26 ISSN: 0272-989X ISO Abbreviation: Med Decis Making Publication Date: 2006 Sep-Oct |
Date Detail:
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Created Date: 2006-09-25 Completed Date: 2006-12-26 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 8109073 Medline TA: Med Decis Making Country: United States |
Other Details:
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Languages: eng Pagination: 535-49 Citation Subset: IM |
Affiliation:
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Operations and Information Management Department, The Wharton School, University of Pennsylvania, PA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Computer Simulation / statistics & numerical data* Costs and Cost Analysis Demography Female Humans Kidney Failure, Chronic / economics, therapy* Kidney Transplantation / economics, statistics & numerical data Male Middle Aged Models, Statistical* Renal Dialysis / economics, methods* Survival Analysis |
| Grant Support | |
ID/Acronym/Agency:
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R01 DK58411/DK/NIDDK NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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