Value of Personalized Risk Information in Economic Analysis.
Olchanski, Natalia.
2019
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Better targeting of
medical interventions is ever more important given the aging population in the US, high
prices of new technologies and limited budgets of healthcare payers. Cost-effectiveness
analysis (CEA) assesses the intervention value, typically by comparing average
population health gains to average costs. Because intervention value differs across
individuals, this project aims to ... read moreextend conventional CEA methods to address patient
risk heterogeneity (e.g. risk of the primary outcome), when risk can be predicted on the
basis of pre-treatment characteristics. Because baseline risk is often an important
determinant of an intervention's absolute effects, benefit-harm trade-offs, and costs,
we assessed the potential value of targeting interventions based on individual risk.
This project includes risk-based CEA of (1) a diabetes prevention program for
individuals with pre-diabetes, and (2) duration of dual antiplatelet therapy by bleeding
risk after percutaneous coronary intervention in patients with acute coronary syndrome
(ACS). We assessed how cost-effectiveness varies by risk stratum and how the risk-based
approach may help target patients for intervention. Because the pre-diabetes population
is large, targeting of preventive measures may be necessary to address budget and
capacity limits. Likewise, there is a large population of ACS patients undergoing
interventions, and a need to better target appropriate duration of antiplatelet therapy
to minimize the risks and costs of adverse events. A third paper explores how clinical
risk prediction model performance may influence the results of individualized economic
analysis, and in particular the 'value of misinformation' from miscalibrated
models.
Thesis (Ph.D.)--Tufts University, 2019.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Kent.
Committee: Joshua Cohen, Robin Ruthazer, and David van Klaveren.
Keywords: Health sciences, and Health care management.read less - ID:
- n009wf61s
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- TARC Citation Guide EndNote
