Jason Shafrin, Jaehong Kim, Jacob Fajnor, Kyi-Sin Than, Elizabeth S Mearns, Stacey L Kowal, Thomas Majda, Jakub P Hlávka
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Treatment value was measured as risk-aversion and severity-adjusted net monetary benefit (NMB), defined as (1) risk-adjusted health gains (generalized risk-adjusted quality-adjusted life-years [GRA-QALYs]) monetized by (2) risk-aversion and severity-adjusted willingness to pay less (3) incremental costs. Risk-neutral results (traditional cost-effectiveness analysis [TCEA]) were compared.</p><p><strong>Results: </strong>Incorporating risk preferences and disease severity increased the value of health benefits. Incremental health gains from using the hypothetical treatment (vs standard of care) were valued more when accounting for risk preferences with GRACE (1.358 GRA-QALYs vs 1.199 QALY). Willingness to pay for these health gains was higher when computed under GRACE compared with TCEA ($109 656 per GRA-QALY vs $100 000 per QALY). Overall, NMB increased by 11.6% (risk-aversion and severity-adjusted NMB = $278 324 vs TCEA NMB = $249 311) using GRACE versus TCEA. Results were sensitive to risk-aversion estimates and the functional form of patient utility.</p><p><strong>Conclusions: </strong>In the first application of GRACE within neurology, GRACE increased the health economic value of a hypothetical neurology treatment, suggesting that TCEA may undervalue treatments for mobility-related neurological impairments.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Generalized Risk-Adjusted Cost-Effectiveness Economic Model for Measuring the Value of Interventions That Delay Mobility Impairment Across Neurological Conditions.\",\"authors\":\"Jason Shafrin, Jaehong Kim, Jacob Fajnor, Kyi-Sin Than, Elizabeth S Mearns, Stacey L Kowal, Thomas Majda, Jakub P Hlávka\",\"doi\":\"10.1016/j.jval.2025.08.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To quantify how incorporating patient risk preferences and severity adjustments affect the value of a hypothetical treatment for mobility impairments caused by neurological conditions.</p><p><strong>Methods: </strong>A 5-state Markov model was developed to measure the health economic value of a hypothetical treatment delaying the progression of mobility impairments by 30.7% versus standard of care for patients who were 45-year-old, minimally impaired, and had received a diagnosis of a neurological condition. A generalized and risk-adjusted cost-effectiveness (GRACE) model was implemented using relative risk aversion estimates from a US general population survey. Treatment value was measured as risk-aversion and severity-adjusted net monetary benefit (NMB), defined as (1) risk-adjusted health gains (generalized risk-adjusted quality-adjusted life-years [GRA-QALYs]) monetized by (2) risk-aversion and severity-adjusted willingness to pay less (3) incremental costs. Risk-neutral results (traditional cost-effectiveness analysis [TCEA]) were compared.</p><p><strong>Results: </strong>Incorporating risk preferences and disease severity increased the value of health benefits. Incremental health gains from using the hypothetical treatment (vs standard of care) were valued more when accounting for risk preferences with GRACE (1.358 GRA-QALYs vs 1.199 QALY). Willingness to pay for these health gains was higher when computed under GRACE compared with TCEA ($109 656 per GRA-QALY vs $100 000 per QALY). 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引用次数: 0
摘要
目的：量化纳入患者风险偏好和严重程度调整如何影响神经系统疾病引起的活动障碍的假设治疗价值。方法：建立了一个五状态马尔可夫模型来衡量一种假设的治疗方法的健康经济价值，这种治疗方法比标准护理（SoC）延迟30.7%的运动障碍进展，诊断为神经系统疾病的45岁轻度损伤患者。使用来自美国普通人群调查的相对风险厌恶（RRA）估计，实现了广义和风险调整成本效益（GRACE）模型。治疗价值以风险厌恶和严重程度调整后的净货币效益（RASA-NMB）来衡量，定义为：(i)风险调整后的健康收益（GRA-QALYs）货币化（ii）风险厌恶和严重程度调整后的支付意愿（RASA-WTP）减去（iii）增量成本。风险中性结果（传统成本效益分析（TCEA））进行比较。结果：纳入风险偏好和疾病严重程度增加了健康益处的价值。当考虑GRACE的风险偏好时，使用假设治疗（vs. SoC）的增量健康收益更有价值（1.358 gra -QALY vs. 1.199 QALY）。与TCEA相比，GRACE下计算这些健康收益的支付意愿更高（每个GRA-QALY为109,656美元，每个QALY为100,000美元）。总体而言，使用GRACE与TCEA相比，净货币效益增加了11.6% （RASA-NMB = 278,324美元，而传统CEA NMB = 249,311美元）。结果对风险规避估计和患者效用的功能形式敏感。结论：在GRACE在神经病学中的首次应用中，GRACE增加了一种假设的神经病学治疗的健康经济价值，这表明TCEA可能低估了运动相关神经损伤的治疗价值。
A Generalized Risk-Adjusted Cost-Effectiveness Economic Model for Measuring the Value of Interventions That Delay Mobility Impairment Across Neurological Conditions.
Objectives: To quantify how incorporating patient risk preferences and severity adjustments affect the value of a hypothetical treatment for mobility impairments caused by neurological conditions.
Methods: A 5-state Markov model was developed to measure the health economic value of a hypothetical treatment delaying the progression of mobility impairments by 30.7% versus standard of care for patients who were 45-year-old, minimally impaired, and had received a diagnosis of a neurological condition. A generalized and risk-adjusted cost-effectiveness (GRACE) model was implemented using relative risk aversion estimates from a US general population survey. Treatment value was measured as risk-aversion and severity-adjusted net monetary benefit (NMB), defined as (1) risk-adjusted health gains (generalized risk-adjusted quality-adjusted life-years [GRA-QALYs]) monetized by (2) risk-aversion and severity-adjusted willingness to pay less (3) incremental costs. Risk-neutral results (traditional cost-effectiveness analysis [TCEA]) were compared.
Results: Incorporating risk preferences and disease severity increased the value of health benefits. Incremental health gains from using the hypothetical treatment (vs standard of care) were valued more when accounting for risk preferences with GRACE (1.358 GRA-QALYs vs 1.199 QALY). Willingness to pay for these health gains was higher when computed under GRACE compared with TCEA ($109 656 per GRA-QALY vs $100 000 per QALY). Overall, NMB increased by 11.6% (risk-aversion and severity-adjusted NMB = $278 324 vs TCEA NMB = $249 311) using GRACE versus TCEA. Results were sensitive to risk-aversion estimates and the functional form of patient utility.
Conclusions: In the first application of GRACE within neurology, GRACE increased the health economic value of a hypothetical neurology treatment, suggesting that TCEA may undervalue treatments for mobility-related neurological impairments.
期刊介绍：
Value in Health contains original research articles for pharmacoeconomics, health economics, and outcomes research (clinical, economic, and patient-reported outcomes/preference-based research), as well as conceptual and health policy articles that provide valuable information for health care decision-makers as well as the research community. As the official journal of ISPOR, Value in Health provides a forum for researchers, as well as health care decision-makers to translate outcomes research into health care decisions.
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