A convenient approximation of life expectancy (the “DEALE”)

Beck, J. Robert; Pauker, Stephen G.; Gottlieb, Jonathan E.; Klein, Karen Oerter; Kassirer, Jerome P.

doi:10.1016/0002-9343(82)90787-2

Cited by 402 publications

(179 citation statements)

References 12 publications

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“…Outcomes were expressed both as overall life expectancy (LE) and as quality-adjusted life expectancy (QALE), using a declining exponential approximation of the 'DEALE' (25). Population-based mortality rates were derived from tables of vital statistics.…”

Section: Effectivenessmentioning

confidence: 99%

Managing toxic thyroid adenoma: a cost-effectiveness analysis

2002

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Objective: To examine the cost-effectiveness of therapeutic strategies for patients with toxic thyroid adenoma. Design: A decision analytic model was used to examine strategies, including thyroid lobectomy after a 3-month course of antithyroid drugs (ATDs), radioactive iodine (RAI), and lifelong ATDs followed by either RAI (ATD-RAI) or surgery (ATD-surgery) in patients suffering severe drug reactions. Methods: Outcomes were measured in quality-adjusted life years. Data on the prevalence of co-incident thyroid cancer, complications and treatment efficacies were derived from a systematic review of the literature (1966 -2000). Costs were examined from the health care system perspective. Costs and effectiveness were examined at their present values. Discounting (3% per year), variations of major cost components, and every variable for which disagreements exist among studies or expert opinion were examined by sensitivity analyses. Results: For a 40-year-old woman, surgery was both the most effective and the least costly strategy (e1391),while ATD-RAI cost the most (e5760). RAI was more effective than surgery if surgical mortality exceeded 0.6% (base-case 0.001%). RAI become less costly for women of more than 72 years (more than 66 in discounted analyses). For women of 85, ATD-RAI may be more effective than RAI and have an inexpensive marginal cost-effectiveness ratio (e4975) if lifelong follow-up results in no decrement in quality of life. Conclusions: Age, surgical mortality, therapeutic costs and patient preference must all be considered in choosing an appropriate therapy.

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Section: Effectivenessmentioning

confidence: 99%

Managing toxic thyroid adenoma: a cost-effectiveness analysis

2002

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“…35,36 Agespecific death rates were used. 34 An exponential function is used to estimate mortality using the DEALE.…”

Section: Effectiveness and Natural Historymentioning

confidence: 99%

“…The DEALE provides an approximation of the LE of a patient when annual mortality is constant. 35,36 This approximation of LE has been applied in another costeffective study in the liver transplant setting. 37 …”

Section: Effectiveness and Natural Historymentioning

confidence: 99%

Is it cost-effective to treat recurrent hepatitis C infection in orthotopic liver transplantation patients?

Saab

Han

et al. 2002

Liver Transplantation

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Hepatitis C virus (HCV) recurs in the allograft almost universally after orthotopic liver transplantation (OLT), with a variable course ranging from mild hepatitis to frank cirrhosis. The uncertain prognosis after OLT has lead to widely increased use of antiviral therapy in the post-OLT setting. We compared two scenarios (antiviral therapy versus no antiviral therapy) using a Markov-based decision analytic model to simulate costs and health outcomes for recurrent HCV in three age and sex cohorts of post-OLT patients. Efficacy outcomes included total costs, cases of cirrhosis prevented, cases of death prevented, lifeyears gained, and cost per life-year saved. One-way sensitivity analyses were performed for sustained viral response; annual drug cost, discount rate, compliance, cirrhosis rate, decompensation rate, and cost of dying. Two-way sensitivity analyses were performed to compare effects of (1) changing sustained viral response and antiviral therapy costs, and (2) changing the sustained viral response and cirrhosis rate. The incremental cost-effectiveness ratio for the reference patient cohort of 1,000 men aged 55 years was $29,100 per life-year saved. The model was sensitive to drug costs, cirrhosis rate, and sustained viral response. The two-way sensitivity analysis showed that antiviral therapy remained cost-effective even if drug costs increased, as long as these increases were associated with higher sustained viral responses. The costeffectiveness ratio also was sensitive to age and sex of cohort. The decision to treat HCV after OLT with antiviral therapy usually is based on many considerations. O rthotopic liver transplantation (OLT) is definitive therapy for patients with decompensated liver disease. Whereas the 1-year survival rate in patients with decompensated liver disease is between 50% and 70%, OLT increases survival to almost 90%. 1-4 Hepatitis C virus (HCV) is one of the leading causes of cirrhosis in patients undergoing OLT in the United States. It now accounts for the majority of liver transplantations in the United States. 5 As the population of individuals infected with HCV several decades ago begin to develop liver disease, the number and relative proportion of patients who undergo OLT for HCV is likely to increase further. 6 HCV recurrence is almost universal after OLT.After 5 years, approximately 75% of transplant recipients have recurrent HCV. 7 Recurrence does not appear to affect short-term survival. The 5-year survival rate of patients who undergo OLT for HCV is similar to that of patients who undergo OLT for other causes of decompensated liver disease. 1,[8][9][10] However, HCV recurrence may have an adverse impact on long-term survival after OLT. Between 8% and 31% of patients who undergo OLT for HCV develop cirrhosis in 5 to 7 years. 8,9,[11][12][13][14][15][16] Thus, the clinical impact of HCV may not be seen for almost a decade after OLT. However, a subgroup of individuals who undergo OLT for HCV have an accelerated course and develop decompensation within several months of OLT...

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“…The declining exponential approximation to life expectancy (DEALE) model uses an additive function of risk factors. 63,64 The implications of the choice of an additive versus a multiplicative assumption can be striking. 9,10,47,[65][66][67][68] When practical, sensitivity analysis should be used to evaluate different assumptions about parameter form.…”

Section: Specification Of Survival Parameters and Modeling Patientmentioning

confidence: 99%

Assessing the effectiveness of health interventions for cost-effectiveness analysis

Mandelblatt¹,

Fryback²,

Weinstein³

et al. 1997

J Gen Intern Med

101

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C ost-effectiveness analysis (CEA) is an analytic tool in which the costs and effects of an intervention designed to prevent, diagnose, or treat disease are calculated and compared with an alternative strategy to achieve the same goals. The results of a CEA are presented as a ratio of costs to effects, where the effects are health outcomes such as cases of disease prevented, years of life gained, or qualityadjusted life years gained, rather than monetary measures, as in cost-benefit analysis. Conducting a CEA requires a framework for portraying the cascade of events that occur as a consequence of the decision to intervene, for describing the probability that each event will occur, for accounting how long each event will last, and describing how much each event costs and is valued by the population or individuals targeted by the intervention. Mathematical models are well suited to these purposes.The purpose of this article is to provide an overview of modeling to estimate net effectiveness in a CEA (the difference in effectiveness between an intervention and the alternative to which it is being compared). Many of the principles described for estimating effectiveness apply equally to determining costs in a CEA. The main difference is that health events are weighted by costs in the numerator of the cost-effectiveness ratio, while they are often weighted by preference values in the denominator. Preference values, or utilities, reflect the fact that individuals or populations with similar ability (or disability) to function may regard that level of functioning differently. When preferences are incorporated into CEAs, the results are generally expressed as costs per quality-adjusted life years. 1,2 A discussion of measurement of costs and valuing outcomes is beyond the scope of this article; for further information on these, and other components of a CEA, the reader is referred elsewhere. [3][4][5] Following some definitions of terms, this article is organized into two sections describing the process of estimating effectiveness in a CEA: the first presents a review of the sources of event probabilities, and the second describes the use of modeling to estimate effectiveness. DEFINITIONSEffectiveness, which reflects the impact of an intervention of health in real practice settings, should be distin-

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A convenient approximation of life expectancy (the “DEALE”)

Cited by 402 publications

References 12 publications

Managing toxic thyroid adenoma: a cost-effectiveness analysis

Managing toxic thyroid adenoma: a cost-effectiveness analysis

Is it cost-effective to treat recurrent hepatitis C infection in orthotopic liver transplantation patients?

Assessing the effectiveness of health interventions for cost-effectiveness analysis

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