12771 - Types of analysis Simulation rationale x x Each...

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Types of analysis
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Simulation rationale Each patient’s natural history is random, but guided by underlying parameters. With sufficiently large number of patients, Monte Carlo variability can be made as small as possible. In this case, the SPM essentially serves as a “counting machine” to estimate expected outcomes.
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Analysis plan To compare two stroke treatments, set the natural history parameters for the first treatment and run the simulation to obtain expected outcomes. Then, reset the natural history parameters to correspond to the second treatment and rerun the simulation to obtain a second set of expected outcomes. Finally, compare the two sets of outcomes.
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Example To assess the cost-effectiveness of an acute stroke drug for 70-year old males with ischemic stroke… Group Cost Effectiveness Usual care 170,000 3.67 QALY Intervention 180,000 4.17 QALY ICER= 10,000 / .50 = 20,000 $/QALY
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Types of analysis Base case Sensitivity Bootstrapping Stochastic sensitivity ……. .
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Base case analysis 1 SPM run 1 patient type (e.g., 50,000 simulated patients, all with the same characteristics) 1 set of fixed input parameters (e.g., fix the natural history parameters, utilities, cost parameters, efficacy of intervention, etc.)
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Sensitivity analysis 1 patient type Multiple SPM runs Each SPM run applies a separate set of pre-specified parameters. One or more parameters could be changed at a time.
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One-way sensitivity analysis Discount Rate ICER 0% 24,576 3% 21,864 5% 17,987 7% 13,747 As discount rate increases, intervention becomes increasingly cost effective.
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Two-way sensitivity analysis Discount Efficacy ICER 0% 1.30 305,987 5% 1.30 865,483 0% 1.40 5,076 5% 1.40 12,946 Discount rate doesn’t matter, but intervention’s efficacy does: small changes in efficacy imply very different conclusions about cost -effectiveness.
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Bootstrapped analysis 1 patient type 1 SPM run SPM parameters remain the same Resampling of patients (i.e., conceptually, the RCT is repeated a large number of times, and the ICER is estimated for each replication; the variability of the ICER describes the precision of the results)
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This note was uploaded on 02/23/2012 for the course PHARM 290 taught by Professor Staff during the Fall '10 term at Rutgers.

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12771 - Types of analysis Simulation rationale x x Each...

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