MDM Policy and Practice最新文献

{"title":"Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context.","authors":"Jodi Gray, Tilenka R Thynne, Vaughn Eaton, Rebecca Larcombe, Mahsa Tantiongco, Jonathan Karnon","doi":"10.1177/23814683231226335","DOIUrl":"10.1177/23814683231226335","url":null,"abstract":"<p><p><b>Background.</b> Local health services make limited use of economic evaluation to inform decisions to fund new health service interventions. One barrier is the relevance of published intervention effects to the local setting, given these effects can strongly reflect the original evaluation context. Expert elicitation methods provide a structured approach to explicitly and transparently adjust published effect estimates, which can then be used in local-level economic evaluations to increase their local relevance. Expert elicitation was used to adjust published effect estimates for 2 interventions targeting the prevention of inpatient hypoglycemia. <b>Methods.</b> Elicitation was undertaken with 6 clinical experts. They were systematically presented with information regarding potential differences in patient characteristics and quality of care between the published study and local contexts, and regarding the design and application of the published study. The experts then assessed the intervention effects and provided estimates of the most realistic, most pessimistic, and most optimistic intervention effect sizes in the local context. <b>Results.</b> The experts estimated both interventions would be less effective in the local setting compared with the published effect estimates. For one intervention, the experts expected the lower complexity of admitted patients in the local setting would reduce the intervention's effectiveness. For the other intervention, the reduced effect was largely driven by differences in the scope of implementation (hospital-wide in the local setting compared with targeted implementation in the evaluation). <b>Conclusions.</b> The pragmatic elicitation methods reported in this article provide a feasible and acceptable approach to assess and adjust published intervention effects to better reflect expected effects in the local context. Further development and application of these methods is proposed to facilitate the use of local-level economic evaluation.</p><p><strong>Highlights: </strong>Local health services make limited use of economic evaluation to inform their decisions on the funding of new health service interventions. One barrier to use is the relevance of published intervention evaluations to the local setting.Expert elicitation methods provide a structured way to consider differences between the evaluation and local settings and to explicitly and transparently adjust published effect estimates for use in local economic evaluations.The pragmatic elicitation methods reported in this article offer a feasible and acceptable approach to adjusting published intervention effects to better reflect the effects expected in the local context. This increases the relevance of economic evaluations for local decision makers.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683231226335"},"PeriodicalIF":1.9,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10812103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Time-Series Analysis and Expert Judgment in Modeling and Forecasting Blood Donation Trends in Zimbabwe.","authors":"Coster Chideme, Delson Chikobvu","doi":"10.1177/23814683231222483","DOIUrl":"10.1177/23814683231222483","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Blood cannot be artificially manufactured, and there is currently no substitute for human blood. The supply of blood in transfusion facilities requires constant and timely collection of blood from donors. Modeling and forecasting trends in blood collections are critical for determining both the current and future capacity requirements and appropriate models of adequate blood provision. &lt;b&gt;Objectives.&lt;/b&gt; The objective of this study is to determine blood collection or donation patterns and develop time-series models that can be updated and refined in predicting future blood donations in Zimbabwe when given the historical data. &lt;b&gt;Materials and Methods.&lt;/b&gt; Monthly blood donation data for the period 2009 to 2019 were collected retrospectively from the National Blood Service Zimbabwe database. Time-series models (i.e., the Seasonal Autoregressive Integrated Moving Average [SARIMA] and Error, Trend and Seasonal [ETS]) models were applied and compared. The models were chosen because of their ability to handle the seasonality and other time-series components evident in the blood donation data. Expert opinions and experience were used in selecting the models and in making inferences in the analysis. &lt;b&gt;Results.&lt;/b&gt; Time-series plots of blood donations showed seasonal patterns, with significant drops in blood donations in months associated with Zimbabwe's school holidays (April, August, and December) and public holidays. During these holidays, there is a reduced number of school donors, while at about the same time, there is increasing blood demand as a result of road accidents. Model identification procedures established the &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;SARIMA&lt;/mi&gt;&lt;mspace&gt;&lt;/mspace&gt;&lt;mrow&gt;&lt;mo&gt;(&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;mo&gt;,&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;mo&gt;,&lt;/mo&gt;&lt;mn&gt;2&lt;/mn&gt;&lt;mo&gt;)&lt;/mo&gt;&lt;/mrow&gt;&lt;msub&gt;&lt;mrow&gt;&lt;mo&gt;(&lt;/mo&gt;&lt;mn&gt;0&lt;/mn&gt;&lt;mo&gt;,&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;mo&gt;,&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;mo&gt;)&lt;/mo&gt;&lt;/mrow&gt;&lt;mrow&gt;&lt;mn&gt;12&lt;/mn&gt;&lt;/mrow&gt;&lt;/msub&gt;&lt;/mrow&gt;&lt;/math&gt; model as the appropriate model for forecasting total blood donation in Zimbabwe. The results and forecasts show an upward trend in blood donations. According to the accuracy measures used, the SARIMA model outperforms the ETS model. &lt;b&gt;Conclusions.&lt;/b&gt; Expert knowledge in the blood donation process, coupled with statistical models, can help explain trends exhibited in blood donation data in Zimbabwe. These findings help the blood authorities plan for blood donor campaign drives. The findings are key indicators of where to allocate more resources toward blood donation and when to collect more blood units. The increasing blood donation projections ensure a stable blood bank inventory in the near future.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;A SARIMA model can be used to predict the flow of blood donations in Zimbabwe.The seasonal blood donation pattern peaks in the months of March, June/July, and September.The donations troughs are in the months of April, August, December, and January. These are the months coinciding with school holidays in Zimbabwe.Both t","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683231222483"},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Treatment Preferences for Patients with Tricuspid Regurgitation.","authors":"Vijay Iyer, Nadeen N Faza, Michael Pfeiffer, Mark Kozak, Brandon Peterson, Mortiz Wyler von Ballmoos, Sarah Mollenkopf, Melissa Mancilla, Diandra Latibeaudiere-Gardner, Michael J Reardon","doi":"10.1177/23814683231225667","DOIUrl":"10.1177/23814683231225667","url":null,"abstract":"<p><p><b>Background.</b> Tricuspid regurgitation (TR) is a high-prevalence disease associated with poor quality of life and mortality. This quantitative patient preference study aims to identify TR patients' perspectives on risk-benefit tradeoffs. <b>Methods.</b> A discrete-choice experiment was developed to explore TR treatment risk-benefit tradeoffs. Attributes (levels) tested were treatment (procedure, medical management), reintervention risk (0%, 1%, 5%, 10%), medications over 2 y (none, reduce, same, increase), shortness of breath (none/mild, moderate, severe), and swelling (never, 3× per week, daily). A mixed logit regression model estimated preferences and calculated predicted probabilities. Relative attribute importance was calculated. Subgroup analyses were performed. <b>Results.</b> An online survey was completed by 150 TR patients. Shortness of breath was the most important attribute and accounted for 65.8% of treatment decision making. The average patients' predicted probability of preferring a \"procedure-like\" profile over a \"medical management-like\" profile was 99.7%. This decreased to 78.9% for a level change from severe to moderate in shortness of breath in the \"medical management-like\" profile. Subgroup analysis confirmed that patients older than 64 y had a stronger preference to avoid severe shortness of breath compared with younger patients (<i>P</i> < 0.02), as did severe or worse TR patients relative to moderate. New York Heart Association class I/II patients more strongly preferred to avoid procedural reintervention risk relative to class III/IV patients (<i>P</i> < 0.03). <b>Conclusion.</b> TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated. This risk tolerance is higher for older and more symptomatic patients. These results emphasize the appropriateness of developing TR therapies and the importance of addressing symptom burden.</p><p><strong>Highlights: </strong>This study provides quantitative patient preference data from clinically confirmed tricuspid regurgitation (TR) patients to understand their treatment preferences.Using a targeted literature search and patient, physician, and Food and Drug Administration feedback, a cross-sectional survey with a discrete-choice experiment that focused on 5 of the most important attributes to TR patients was developed and administered online.TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated, and this risk tolerance is higher for older and more symptomatic patients.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683231225667"},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding and Bridging Gaps in the Use of Evidence from Modeling for Evidence-Based Policy Making in Nigeria's Health System.","authors":"Chinyere Mbachu, Prince Agwu, Felix Obi, Obinna Onwujekwe","doi":"10.1177/23814683231225658","DOIUrl":"10.1177/23814683231225658","url":null,"abstract":"<p><p><b>Background.</b> Modeled evidence is a proven useful tool for decision makers in making evidence-based policies and plans that will ensure the best possible health system outcomes. Thus, we sought to understand constraints to the use of models in making decisions in Nigeria's health system and how such constraints can be addressed. <b>Method.</b> We adopted a mixed-methods study for the research and relied on the evidence to policy and Knowledge-to-Action (KTA) frameworks to guide the conceptualization of the study. An online survey was administered to 34 key individuals in health organizations that recognize modeling, which was followed by in-depth interviews with 24 of the 34 key informants. Analysis was done using descriptive analytic methods and thematic arrangements of narratives. <b>Results.</b> Overall, the data revealed poor use of modeled evidence in decision making within the health sector, despite reporting that modeled evidence and modelers are available in Nigeria. However, the disease control agency in Nigeria was reported to be an exception. The complexity of models was a top concern. Thus, suggestions were made to improve communication of models in ways that are easily comprehensible and to improve overall research culture within Nigeria's health sector. <b>Conclusion.</b> Modeled evidence plays a crucial role in evidence-based health decisions. Therefore, it is imperative to strengthen and sustain in-country capacity to value, produce, interpret, and use modeled evidence for decision making in health. To overcome limitations in the usage of modeled evidence, decision makers, modelers/researchers, and knowledge brokers should forge viable relationships that regard and promote evidence translation.</p><p><strong>Highlights: </strong>Despite the use of modeling by Nigeria's disease control agency in containing the COVID-19 pandemic, modeling remains poorly used in the country's overall health sector.Although policy makers recognize the importance of evidence in making decisions, there are still pertinent concerns about the poor research culture of policy-making institutions and communication gaps that exist between researchers/modelers and policy makers.Nigeria's health system can be strengthened by improving the value and usage of scientific evidence generation through conscious efforts to institutionalize research culture in the health sector and bridge gaps between researchers/modelers and decision makers.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683231225658"},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informed Random Forest to Model Associations of Epidemiological Priors, Government Policies, and Public Mobility.","authors":"Tsaone Swaabow Thapelo, Dimane Mpoeleng, Gregory Hillhouse","doi":"10.1177/23814683231218716","DOIUrl":"10.1177/23814683231218716","url":null,"abstract":"<p><p><b>Background.</b> Infectious diseases constitute a significant concern worldwide due to their increasing prevalence, associated health risks, and the socioeconomic costs. Machine learning (ML) models and epidemic models formulated using deterministic differential equations are the most dominant tools for analyzing and modeling the transmission of infectious diseases. However, ML models can be inconsistent in extracting the dynamics of a disease in the presence of data drifts. Likewise, the capability of epidemic models is constrained to parameter dimensions and estimation. We aimed at creating a framework of informed ML that integrates a random forest (RF) with an adapted susceptible infectious recovered (SIR) model to account for accuracy and consistency in stochasticity within the dynamics of coronavirus disease 2019 (COVID-19). <b>Methods.</b> An adapted SIR model was used to inform a default RF on predicting new COVID-19 cases (NCCs) at given intervals. We validated the performance of the informed RF (IRF) using real data. We used Botswana's pharmaceutical interventions (PIs) and non-PIs (NPIs) adopted between February 2020 and August 2022. The discrepancy between predictions and observations is modeled using loss functions, which are minimized, interpreted, and used to assess the IRF. <b>Results.</b> The findings on the real data have revealed the effectiveness of the default RF in modeling and predicting NCCs. The use of the effective reproductive rate to inform the RF yielded an excellent predictive power (84%) compared with 75% by the default RF. <b>Conclusion.</b> This research has potential to inform policy and decision makers in developing systems to evaluate interventions for infectious diseases.</p><p><strong>Highlights: </strong>This framework is initiated by incorporating model outputs from an epidemic model to a machine learning model.An informed random forest (RF) is instantiated to model government and public responses to the COVID-19 pandemic.This framework does not require data transformations, and the epidemic model is shown to boost the RF's performance.This is a baseline knowledge-informed learning framework for assessing public health interventions in Botswana.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231218716"},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective.","authors":"Padam Kanta Dahal, Lal Rawal, Zanfina Ademi, Rashidul Alam Mahumud, Grish Paudel, Corneel Vandelanotte","doi":"10.1177/23814683231216938","DOIUrl":"https://doi.org/10.1177/23814683231216938","url":null,"abstract":"<p><p><b>Background.</b> This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. <b>Methods.</b> This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D (<i>N</i> = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. <b>Results.</b> Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. <b>Conclusion.</b> T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses.</p><p><strong>Highlights: </strong>More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes.Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities.The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231216938"},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10725113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study.","authors":"Alistair Thorpe, Rebecca K Delaney, Nelangi M Pinto, Elissa M Ozanne, Mandy L Pershing, Lisa M Hansen, Linda M Lambert, Angela Fagerlin","doi":"10.1177/23814683231204551","DOIUrl":"10.1177/23814683231204551","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. &lt;b&gt;Purpose.&lt;/b&gt; To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. &lt;b&gt;Methods.&lt;/b&gt; We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. &lt;b&gt;Results.&lt;/b&gt; Our sample included 23 parents (average Age&lt;sub&gt;[years]&lt;/sub&gt;: 27 ± 4, range = 21-37). Most were women (&lt;i&gt;n&lt;/i&gt; = 18), non-Hispanic White (&lt;i&gt;n&lt;/i&gt; = 20), and married (&lt;i&gt;n&lt;/i&gt; = 21). Most parents chose surgery (&lt;i&gt;n&lt;/i&gt; = 16), with 11 children surviving to the time of the survey; remaining parents (&lt;i&gt;n&lt;/i&gt; = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (&lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 1.51, &lt;i&gt;s&lt;/i&gt; = 0.75 v. &lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 0.74, &lt;i&gt;s&lt;/i&gt; = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (&lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 91.86, &lt;i&gt;s&lt;/i&gt; = 22.96 v. &lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 63.38, &lt;i&gt;s&lt;/i&gt; = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (&lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 1.64, &lt;i&gt;s&lt;/i&gt; = 0.95 v. &lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 0.65, &lt;i&gt;s&lt;/i&gt; = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (&lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 26.43, &lt;i&gt;s&lt;/i&gt; = 8.02 v. &lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 5.00, &lt;i&gt;s&lt;/i&gt; = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (&lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 20.98, &lt;i&gt;s&lt;/i&gt; = 10.00 v. &lt;math&gt;&lt;mrow&gt;&lt;mover&gt;&lt;mrow&gt;&lt;mi&gt;x&lt;/mi&gt;&lt;/mrow&gt;&lt;mo&gt;¯&lt;/mo&gt;&lt;/mover&gt;&lt;/mrow&gt;&lt;/math&gt; = 3.44, &lt;i&gt;s&lt;/i&gt; = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. &lt;b&gt;Conclusions.&lt;/b&gt; The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;&lt;b&gt;","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231204551"},"PeriodicalIF":1.9,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands.","authors":"Jieyi Li,&nbsp;Marco Viceconti,&nbsp;Xinshan Li,&nbsp;Pinaki Bhattacharya,&nbsp;David M J Naimark,&nbsp;Anwar Osseyran","doi":"10.1177/23814683231202993","DOIUrl":"https://doi.org/10.1177/23814683231202993","url":null,"abstract":"<p><p><b>Objective.</b> To conduct cost-utility analyses for Computed Tomography To Strength (CT2S), a novel osteoporosis screening service, compared with dual-energy X-ray absorptiometry (DXA), treat all without screening, and no screening methods for Dutch postmenopausal women referred to fracture liaison service (FLS). CT2S uses CT scans to generate femur models and simulate sideways fall scenarios for bone strength assessment. <b>Methods.</b> Early health technology assessment (HTA) was adopted to evaluate CT2S as a novel osteoporosis screening tool for secondary fracture prevention. We constructed a 2-dimensional simulation model considering 4 strategies (no screening, treat all without screening, DXA, CT2S) together with screening intervals (5 y, 2 y), treatments (oral alendronate, zoledronic acid), and discount rate scenarios among Dutch women in 3 age groups (60s, 70s, and 80s). Strategy comparisons were based on incremental cost-effectiveness ratios (ICERs), considering an ICER below €20,000 per QALY gained as cost-effective in the Netherlands. <b>Results.</b> Under the base-case scenario, CT2S versus DXA had estimated ICERs of €41,200 and €14,083 per QALY gained for the 60s and 70s age groups, respectively. For the 80s age group, CT2S was more effective and less costly than DXA. Changing treatment from weekly oral alendronate to annual zoledronic acid substantially decreased CT2S versus DXA ICERs across all age groups. Setting the screening interval to 2 y increased CT2S versus DXA ICERs to €100,333, €55,571, and €15,750 per QALY gained for the 60s, 70s, and 80s age groups, respectively. In all simulated populations and scenarios, CT2S was cost-effective (in some cases dominant) compared with the treat all strategy and cost-saving (more effective and less costly) compared with no screening. <b>Conclusion.</b> CT2S was estimated to be potentially cost-effective in the 70s and 80s age groups considering the willingness-to-pay threshold of the Netherlands. This early HTA suggests CT2S as a potential novel osteoporosis screening tool for secondary fracture prevention.</p><p><strong>Highlights: </strong>For postmenopausal Dutch women who have been referred to the FLS, direct access to CT2S may be cost-effective compared with DXA for age groups 70s and 80s, when considering the ICER threshold of the Netherlands. This study positions CT2S as a potential novel osteoporosis-screening tool for secondary fracture prevention in the clinical setting.A shorter screening interval of 2 y increases the effectiveness of both screening strategies, but the ICER of CT2S compared with DXA also increased substantially, which made CT2S no longer cost-effective for the 70s age group; however, it remains cost-effective for individuals in their 80s.Annual zoledronic acid treatment with better adherence may contribute to a lower cost-effectiveness ratio when comparing CT2S to DXA screening and the treat all strategies for all age groups.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231202993"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing an Online Patient Decision Aid about Upper Extremity Reconstructive Surgery for Cervical Spinal Cord Injury: Pilot Testing Knowledge, Decisional Conflict, and Acceptability.","authors":"William Moritz, Amanda M Westman, Mary C Politi, Dod Working Group, Ida K Fox","doi":"10.1177/23814683231199721","DOIUrl":"10.1177/23814683231199721","url":null,"abstract":"<p><p><b>Background.</b> While nerve and tendon transfer surgery can restore upper extremity function and independence after midcervical spinal cord injury, few individuals (∼14%) undergo surgery. There is limited information regarding these complex and time-sensitive treatment options. Patient decision aids (PtDAs) convey complex health information and help individuals make informed, preference-consistent choices. The purpose of this study is to evaluate a newly created PtDA for people with spinal cord injury who are considering options to optimize upper extremity function. <b>Methods.</b> The PtDA was developed by our multidisciplinary group based on clinical evidence and the Ottawa Decision Support Framework. A prospective pilot study enrolled adults with midcervical spinal cord injury to evaluate the PtDA. Participants completed surveys about knowledge and decisional conflict before and after viewing the PtDA. Acceptability measures and suggestions for further improvement were also solicited. <b>Results.</b> Forty-two individuals were enrolled and completed study procedures. Participants had a 20% increase in knowledge after using the PtDA (<i>P</i> < 0.001). The number of participants experiencing decisional conflict decreased after viewing the PtDA (33 v. 18, <i>P</i> = 0.001). Acceptability was high. To improve the PtDA, participants suggested adding details about specific surgeries and outcomes. <b>Limitations.</b> Due to the COVID-19 pandemic, we used an entirely virtual study methodology and recruited participants from national networks and organizations. Most participants were older than the general population with a new spinal cord injury and may have different injury causes than typical surgical candidates. <b>Conclusions.</b> A de novo PtDA improved knowledge of treatment options and reduced decisional conflict about reconstructive surgery among people with cervical spinal cord injury. Future work should explore PtDA use for improving knowledge and decisional conflict in the nonresearch, clinical setting.</p><p><strong>Highlights: </strong>People with cervical spinal cord injury prioritize gaining upper extremity function after injury, but few individuals receive information about treatment options.A newly created patient decision aid (PtDA) provides information about recovery after spinal cord injury and the role of traditional tendon and newer nerve transfer surgery to improve upper extremity upper extremity function.The PtDA improved knowledge and decreased decisional conflict in this pilot study.Future work should focus on studying dissemination and implementation of the ptDA into clinical practice.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231199721"},"PeriodicalIF":1.9,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/65/10.1177_23814683231199721.PMC10583528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to \"Involvement in Chemotherapy Decision Making among Patients with Stage II and III Colon Cancer\".","authors":"","doi":"10.1177/23814683231206277","DOIUrl":"10.1177/23814683231206277","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/23814683231163189.].</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"8 2","pages":"23814683231206277"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/66/10.1177_23814683231206277.PMC10571682.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}