【体外膜肺ECMO精品课件】 Economic evaluations alongside clinical trials what they contribute, how they are performed and their limitations.pptVIP

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2018-03-14 发布于天津
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【体外膜肺ECMO精品课件】 Economic evaluations alongside clinical trials what they contribute, how they are performed and their limitations.ppt

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Mean net benefits of neonatal ECMO Mean net benefits = Rc.?E - ?C Rc Life year gained Disability-free life year gained Mean net benefit 95% CI Mean net benefit 95% CI 0 -20,130 (-26,027, -13,522) -19,949 (-25,997, -13,375) 10,000 -5,299 (-14,475, 3,750) -11,387 (-20,394, -244) 20,000 9,532 (-6,691, 25,351) -2,825 (-18,377, 13,804) 30,000 24,362 (1,474, 47,314) 5,737 (-16,245, 29,393) 40,000 39,193 (8,926, 69,513) 14,299 (-14,863, 44,781) 50,000 54,024 (15,496, 91,567) 22,861 (-13,246, 60,319) Are trial-based economic evaluations sufficient? Under the right circumstances, Yes Like clinical evidence, economic evidence can stand alone or be synthesised Requirements: reasonable comparators, adopts final outcomes, collects data on a sufficiently broad set of services, adequately powered, sufficiently long follow-up, representative patient population Problems: Use of inappropriate statistical tests, lack of power, failure to handle missing data, lack of intention-to-treat analysis, follow-up too short, lack of transferability Was the ECMO trial-based economic evaluation sufficient? Reasonable comparator ? Representative patient population ? Intention to treat analysis ? Adequately powered ? Appropriate perspective ? Sufficiently long follow-up x Adopts final outcomes ? Appropriate statistical tests ? Handled missing data ? Longer-term cost-effectiveness Simple decision-analytic model Assumptions: restricted to first 18 years of life survivors to 7 years survive to 18 years disability status at age 7 does not vary excess annual costs during years 4-7 continue during years 8-18 ? ICER: ￡7344 per life year gained ￡11802 per disability-free life year gained Vehicles for economic evaluation Prospective collection of data alongside randomised controlled trials Least subject to bias, control over instruments, low incremental cost. May need to supplement. Prospective collection of data alongside non