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Decision-Analytic Models to Simulate Health Outcomes and Costs in Heart Failure: A Systematic Review

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Author Info

  • Alexander Goehler

    (Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany)

  • Benjamin P. Geisler

    (Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria)

  • Jennifer M. Manne

    (Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA)

  • Beate Jahn

    (Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria)

  • Annette Conrads-Frank

    (Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria)

  • Petra Schnell-Inderst

    (Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria)

  • G. Scott. Gazelle

    (Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA)

  • Uwe Siebert

    (Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems, and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA)

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    Abstract

    Chronic heart failure (CHF) is a critical public health issue with increasing effect on the healthcare budgets of developed countries. Various decision-analytic modelling approaches exist to estimate the cost effectiveness of health technologies for CHF. We sought to systematically identify these models and describe their structures. We performed a systematic literature review in MEDLINE/PreMEDLINE, EMBASE, EconLit and the Cost-Effectiveness Analysis Registry using a combination of search terms for CHF and decision-analytic models. The inclusion criterion required 'use of a mathematical model evaluating both costs and health consequences for CHF management strategies'. Studies that were only economic evaluations alongside a clinical trial or that were purely descriptive studies were excluded. We identified 34 modelling studies investigating different interventions including screening (n - 1), diagnostics (n - 1), pharmaceuticals (n - 15), devices (n - 13), disease management programmes (n - 3) and cardiac transplantation (n - 1) in CHF. The identified models primarily focused on middle-aged to elderly patients with stable but progressed heart failure with systolic left ventricular dysfunction. Modelling approaches varied substantially and included 27 Markov models, three discrete-event simulation models and four mathematical equation sets models; 19 studies reported QALYs. Three models were externally validated. In addition to a detailed description of study characteristics, the model structure and output, the manuscript also contains a synthesis and critical appraisal for each of the modelling approaches. Well designed decision models are available for the evaluation of different CHF health technologies. Most models depend on New York Heart Association (NYHA) classes or number of hospitalizations as proxy for disease severity and progression. As the diagnostics and biomarkers evolve, there is the hope for better intermediate endpoints for modelling disease progression as those that are currently in use all have limitations.

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    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

    Volume (Year): 29 (2011)
    Issue (Month): 9 ()
    Pages: 753-769

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    Handle: RePEc:wkh:phecon:v:29:y:2011:i:9:p:753-769

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    Web page: http://pharmacoeconomics.adisonline.com/

    Related research

    Keywords: Cost-effectiveness; Heart-failure; Modelling.;

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    Cited by:
    1. Joerg Schroettner & Alexander Lassnig, 2013. "Simulation model for cost estimation of integrated care concepts of heart failure patients," Health Economics Review, Springer, vol. 3(1), pages 1-11, December.

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