A Comprehensive Probabilistic-Micro-Simulation Model to Assess Cost-Effectiveness

用于评估成本效益的综合概率微观模拟模型

• 批准号: 7866693
• 负责人: ANIRBAN BASU
• 金额: $ 23.7万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-23 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7866693
• 关键词: Accounting; Address; Adverse effects; Affect; Algorithms; Antipsychotic Agents; Attention; Behavior; Biological; Caring; Chronic; Clinical Trials; Clozapine; Cognition; Complex; Consensus; Costs and Benefits; Credentialing; Decision Modeling; Delusions; Development; Diabetes Mellitus; Disease; Economics; Ensure; Evaluation; Expenditure; Face; Family member; Funding; Future; Generations; Goals; Growth; Guidelines; Hallucinations; Health Care Costs; Healthcare; Impaired cognition; Inpatients; Intervention; Investments; Lead; Length; Life; Literature; Malignant Neoplasms; Measures; Medical; Mental disorders; Mentored Research Scientist Development Award; Methods; Modeling; Moods; National Institute of Mental Health; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacological Treatment; Physicians; Policies; Policy Maker; Population; Prevalence; Principal Investigator; Probability; Process; Psychiatrist; Publishing; Randomized; Reporting; Research; Research Priority; Resource Allocation; Resources; Risk; Role; Schizophrenia; Science; Series; Severities; Social Welfare; Societies; Specific qualifier value; Symptoms; Syndrome; Tardive Dyskinesia; Technology Assessment; Time; Treatment outcome; Uncertainty; Vulnerable Populations; Woman; Work; alternative treatment; atypical antipsychotic; base; cardiovascular risk factor; case-based; comparative effectiveness; cost; cost effectiveness; effective intervention; evidence base; improved; innovation; insight; men; models and simulation; programs; psychologic; statistics; treatment effect

DESCRIPTION (provided by applicant): Schizophrenia affects about 1.3% of the population and yet is responsible for US$28 billion in annual health care costs. The burden of schizophrenia to the patients, their family members and to the society is large. Antipsychotic drugs are the first line of treatment of schizophrenia and have helped some patients with this disease to lead productive and fulfilling lives. With the advent of the second-generation of antipsychotic drugs, which are typically much more expensive than first generation antipsychotics, the growth in medical expenditures among these patients have risen steadily, calling into question the marginal value of the newer second-generation antipsychotic drugs (atypicals) over the older generation neuroleptics. There is also ambiguous evidence on whether pharmaceutical expenditures can offset the expensive inpatient care for these patients. Consequently, controversies are growing regarding the use of these newer and more expensive drugs, especially when some of them have recently documented evidence of increasing cardiovascular risks in this already vulnerable population. This debate is further fueled by the recently published results from the NIMH funded CATIE study that reported equivalence of continuation rates between patient randomized to receiving first-generation versus atypical antipsychotic drugs. In the presence of such controversy, there remain crucial questions to be answered. These questions span a variety of policies, both present and future, influence a wide range of stake-holders, and primarily focus on the comparative effectiveness, costs and cost-effectiveness of the atypicals versus the neuroleptics. They can only be answered with careful research on evaluating treatment options in schizophrenia and identifying research priorities in this field. This proposal attempts to address these questions using innovative methods in economics, statistics and decision sciences. In this work, we propose to develop and apply a comprehensive probabilistic micro-simulation model in schizophrenia to provide information about population level costs, effectiveness and cost-effectiveness of pharmacological treatments and treatment algorithms. The work proposed here is important methodologically and clinically. The methodological advancements that are proposed will have major applications for technology assessment in many domains in health care and hope to provide valuable insights for their potential application in many other contexts. Clinically, our findings have the potential to have important implications for the treatment of schizophrenia by providing physicians and their patients with rich information on the distribution of outcomes of treatments that can help guide them in making more informed treatment choices. Furthermore, the proposed value of information analyses will direct future research and resources in this field by identifying research priorities on those parameters where more precise estimates would be most valuable. Controversies are growing regarding the use of second generation versus the first generation antipsychotics by patients with schizophrenia in the face of rising costs and ambiguous evidence on the benefits of the newer drugs. Frequent switching between alternative drugs indicates that no one drug may be optimal for a patient. Enormous uncertainties in current estimates of treatment effect imply that the value of future research in this filed may be substantial. In order to address these questions, the proposed work aims to develop a comprehensive micro-simulation model to assess the costs, effectiveness, cost-effectiveness of alternative pharmacological treatment algorithms in schizophrenia and to conduct value of information and value of future research analyses in this field.

描述（由申请人提供）：精神分裂症影响约1.3％的人口，但负责每年280亿美元的医疗保健费用。精神分裂症对患者，家人和社会的负担很大。抗精神病药是精神分裂症的第一道治疗方法，并帮助一些患有这种疾病的患者过着生产和充实的生活。随着第二代抗精神病药的出现，通常比第一代抗精神病药贵得多，这些患者的医疗支出的增长稳步上升，质疑新的第二代抗精神病药（异型药）的边际价值比老年代的神经毒剂相比。关于药物支出是否可以抵消这些患者昂贵的住院护理，也有模棱两可的证据。因此，关于使用这些更新颖，更昂贵的药物的使用正在越来越多，尤其是当其中一些人最近记录了这一脆弱人群中心血管风险增加的证据时。 NIMH资助的CATIE研究的最近发表的结果进一步推动了这一辩论，该研究报告了随机接受第一代与非典型抗精神病药的患者之间延续率的等效性。在存在此类争议的情况下，仍有重要的问题要回答。这些问题涵盖了各种政策，包括当前和未来，都会影响各种各样的利益持有人，并主要关注非典型人与神经恋爱的比较有效性，成本和成本效益。只能通过仔细研究评估精神分裂症的治疗方案并确定该领域的研究优先事项的仔细研究。该提案试图使用经济学，统计和决策科学方面的创新方法来解决这些问题。在这项工作中，我们建议在精神分裂症中开发和应用全面的概率微模拟模型，以提供有关药理治疗和治疗算法的人口水平成本，有效性和成本效益的信息。这里提出的工作在方法论和临床上都是重要的。提出的方法学进步将在许多其他领域的许多领域中在许多领域的技术评估中都有主要的应用，并希望在许多其他情况下为其潜在应用提供宝贵的见解。从临床上讲，我们的发现有可能通过为医生及其患者提供有关治疗结果分布的丰富信息，从而对精神分裂症的治疗产生重要影响，这可以帮助他们指导他们做出更明智的治疗选择。此外，信息分析的拟议价值将通过确定最有价值的估计值最有价值的参数的研究优先级来指导该领域的未来研究和资源。关于第二代与第一代抗精神病药的使用以及精神分裂症患者的使用，面对成本上升和关于新药物的益处的模棱两可的证据，争议越来越大。替代药物之间的频繁切换表明，没有一种药物最适合患者。当前的治疗效果估计中，巨大的不确定性表明，未来研究的价值可能是重要的。为了解决这些问题，拟议的工作旨在开发全面的微模拟模型，以评估精神分裂症中替代药理治疗算法的成本，有效性，成本效益，并在该领域进行信息和未来研究分析的价值和价值。