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Challenges in Modelling the Cost Effectiveness of Various Interventions for Cardiovascular Disease

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Abstract

Objectives

Decision analytic modelling is essential in performing cost-effectiveness analyses (CEAs) of interventions in cardiovascular disease (CVD). However, modelling inherently poses challenges that need to be dealt with since models always represent a simplification of reality. The aim of this study was to identify and explore the challenges in modelling CVD interventions.

Methods

A document analysis was performed of 40 model-based CEAs of CVD interventions published in high-impact journals. We analysed the systematically selected papers to identify challenges per type of intervention (test, non-drug, drug, disease management programme, and public health intervention), and a questionnaire was sent to the corresponding authors to obtain a more thorough overview. Ideas for possible solutions for the challenges were based on the papers, responses, modelling guidelines, and other sources.

Results

The systematic literature search identified 1,720 potentially relevant articles. Forty authors were identified after screening the most recent 294 papers. Besides the challenge of lack of data, the challenges encountered in the review suggest that it was difficult to obtain a sufficiently valid and accurate cost-effectiveness estimate, mainly due to lack of data or extrapolating from intermediate outcomes. Despite the low response rate of the questionnaire, it confirmed our results.

Conclusions

This combination of a review and a survey showed examples of CVD modelling challenges found in studies published in high-impact journals. Modelling guidelines do not provide sufficient guidance in resolving all challenges. Some of the reported challenges are specific to the type of intervention and disease, while some are independent of intervention and disease.

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Acknowledgments

W.K. Redekop, J.L. Severens and L.T. Burgers have nothing to disclose. L.T. Burgers acts as overall guarantor for the manuscript content. L.T. Burgers, W.K. Redekop and J.L. Severens have all contributed significantly to the planning of the study, performing the document analysis, and drafting and finalizing the manuscript. The current authors acknowledge the authors of the selected papers who responded to the questionnaire: Peter Alperin, Roberta Ara, Rodrigo Refoios Camejo, Peter Denchev, Crystal Smith-Spangler and Rod Taylor. Furthermore, we would like to acknowledge the following researchers who contributed to the challenges list in a pilot version of the questionnaire: Thea van Asselt, Hedwig Blommestein, Leander Buisman, Ron Handels, Tim Kanters and Annemieke Leunis.

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Authors and Affiliations

  1. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands

    Laura T. Burgers, William K. Redekop & Johan L. Severens

  2. Institute for Medical Technology Assessment, Erasmus University Rotterdam, Burgemeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    Laura T. Burgers, William K. Redekop & Johan L. Severens

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  1. Laura T. Burgers
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Correspondence to Johan L. Severens.

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Burgers, L.T., Redekop, W.K. & Severens, J.L. Challenges in Modelling the Cost Effectiveness of Various Interventions for Cardiovascular Disease. PharmacoEconomics 32, 627–637 (2014). https://doi.org/10.1007/s40273-014-0155-9

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