Page 72 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

given high likelihood that several key assumptions
cost ineffective; therefore, consider comparison to
will be necessary to generate reference case from
Many existing ICU practices may be ineffective or
Also file (eg, on Internet) intended analysis plan
Multiway sensitivity analyses probably essential
nature of intervention and likely effects on costs
resource use is tracked should be tailored to
best practice rather than standard practice
But, also present “data-rich” case
Second ATS Workshop on Outcomes Research
critical care trials
•
•
•
•
Include costs of other diseases
(too hard to disentangle)
Agree
Agree
Agree
Agree
Agree
Agree
Agree
Agree
(theoretical, pragmatic, user needs, and
Compare to available ratios (user needs)
Sensitivity analysis essential; multiway
If existing practice is suspect, consider
best-available, viable low cost, or “do
Discount costs and effects to present
Use a 3% discount rate (theoretical,
costs and test in sensitivity analysis
sensitivity analysis preferred (user
Journal and technical report (user
Include or exclude other disease
Existing practice (conventional)
Reference case (user needs)
nothing” (conventional)
value (theoretical)
accounting)
pragmatic)
needs)
Determining standard
Not usually done
Not usually done
often difficult
ICU Specific PCEHM Recommendations Comment Position (Rationale) May be instances when provider perspective is • Agree Societal (ethical, pragmatic) useful Require better natural history of ICU conditions • Agree QALYs (pragmatic, conventional) Long-term follow-up and modeling or longer follow-up; other outcomes is rare may be useful depending on perspective Consider modeling reduced efficacy in sensitivity • Agree Best-designed, least biased source analysis (pragmatic) Standard approach to measuring these costs not • Agree Costs to include: health care services; Only hospital costs a
Methodological Considerations in Cost-Effectiveness Analysis
Methodologic Problems Comparing CEAs Different Different out- comes Different costs — Different rates — Not standard
Individual CEA Not defined Data are inadequate or dif- ficult to evaluate Data are inadequate or dif- ficult to evaluate Choice distorts results Inadequate representation of the effect of time Inadequate representation of uncertainty on results —

TABLE 6-1 Aspect Perspective Outcomes (effects) Comparators (stan- dard care) Discounting Uncertainty Reporting

Costs

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