Cost Effectiveness of Characterised Chondrocyte Implantation for Treatment of Cartilage Defects of the Knee in the UK

Elvidge, Jamie; Bullement, Ash; Hatswell, Anthony J.

doi:10.1007/s40273-016-0423-y

Cited by 19 publications

(23 citation statements)

References 26 publications

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“…These GLMs were calculated from individual patient data and no details were provided on their covariates or coefficients; as such, it was not possible to replicate the published results. Within the paper reported by Elvidge et al [40]), the reporting of the model structure and parameter inputs was generally clear, however the model structure diagram did not exactly match the implemented model, a finding which was determined through subsequent personal communication with the authors. As a consequence of this ambiguity, the replication of the Elvidge et al model was abandoned.…”

Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 95%

“…In order to assess the feasibility of comprehensive model replication, we undertook a small pilot study in which we attempted to fully reproduce five recent economic analyses published in Pharmacoeconomics between August and November 2016 [40][41][42][43][44]. For each study, the feasibility of replicating the analyses was explored through consideration of published information relating to model structure, assumptions and model parameter values (see Table 1) within the full study publication and any supplementary material available online, but excluding information reported in other papers or reports.…”

Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 99%

“…Across the five case studies, our model replication efforts were met with limited success: two models were fully replicated (Versteegh [44] and Tappenden et al [41]), two models were unequivocally not replicable (Oddershede et al [43] and Davies et al [42]), and one model was potentially replicable although the replication process failed in this instance (Elvidge et al [40]). In the two instances whereby the models were reproduced, there were discrepancies between the replicated model results and those reported within the study publications.…”

Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 99%

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Replicating Health Economic Models: Firm Foundations or a House of Cards?

2017

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Health economic evaluation is a framework for the comparative analysis of the incremental health gains and costs associated with competing decision alternatives. The process of developing health economic models is usually complex, financially expensive and time consuming. For these reasons, model development is sometimes based on previous model-based analyses: this endeavour is usually referred to as model replication. Such model replication activity may involve the comprehensive reproduction of an existing model or "borrowing" all or part of a previously developed model structure. Generally speaking, the replication of an existing model may require substantially less effort than developing a new de novo model by bypassing, or undertaking in only a perfunctory manner, certain aspects of model development such as the development of a complete conceptual model and/or comprehensive literature searching for model parameters. A further motivation for model replication may be to draw on the credibility or prestige of previous analyses which have been published and/or used to inform decisionmaking. The acceptability and appropriateness of replicating models depends on the decision-making context: there exists a trade-off between the "savings" afforded by model replication and the potential "costs" associated with reduced model credibility due to the omission of certain stages of model development. This paper provides an overview of the different levels of, and motivations for, replicating health economic models, and discusses the advantages, disadvantages and caveats associated with this type of modelling activity. Irrespective of whether replicated models should be considered appropriate or not, complete replicability is generally accepted as a desirable property of health economic models, as reflected in critical appraisal checklists and good practice guidelines. To this end, the feasibility of comprehensive model replication is explored empirically across a small number of recent case studies.Recommendations are put forward for improving reporting standards to enhance comprehensive model replicability. Key points for decision makers Model replicability is generally perceived to be an indicator of the quality of published models. Model replication is associated with both advantages and disadvantages. Replication may be quicker and less expensive than developing a de novo model, however model authors should be aware that these "savings" may impact upon the credibility of the model. Our pilot study indicates that even amongst a very small sample of studies, the majority of the models considered could not be fully replicated.

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Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 95%

Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 99%

Section: Feasibility Of Comprehensive Model Replication -A Pilot Studymentioning

confidence: 99%

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Replicating Health Economic Models: Firm Foundations or a House of Cards?

2017

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“…Previous published studies comparing costs following MF and ACI have not analysed only high evidence studies with a minimum follow-up of 5 years, nor taken into account all the costs related to the procedure. Most notably, the costs of physiotherapy following the procedures are sparse [ 21 , 22 ], whereas indirect costs to the society related to sick leave are almost absent [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up

Aae

Randsborg

Lurås

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeFocal cartilage defects in the knee may have devastating effect on the knee joint, where two of the main surgical treatment options are microfracture and autologous chondrocyte implantation. Comparative studies have failed to establish which method yields the best clinical results. A cost-effectiveness analysis of microfracture and autologous chondrocyte implantation would contribute to the clinical decision process.MethodsA PubMed search identifying level I and level II studies with 5 year follow-up was performed. With the data from these studies, decision trees with associated service provision and costs connected to the two different techniques were designed. In addition to hospital costs, we included costs connected to physiotherapy following surgery. To paint a broader cost picture, we also included indirect costs to the society due to productivity loss caused by work absence.ResultsFour high-quality studies, with a follow-up of 5 years, met the inclusion criteria. A total of 319 patients were included, 170 undergoing microfracture and 149 autologous chondrocyte implantation. The re-operation rate was 23 (13.5%) following microfracture, and 18 (12.1%) for autologous chondrocyte implantation. Both groups achieved substantially better clinical scores at 5 years compared to baseline. Microfracture was more cost-effective when comparing all clinical scores.ConclusionMicrofracture is associated with both lower costs and lower cost per point increase in patient reported outcome measures. There is a need of well-designed, high-quality randomized controlled trials before reliable conclusions regarding cost-effectiveness in the long run is possible.Level of evidenceIII.

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“…To illustrate the importance of using probabilistic analysis, a PSA was conducted using 250,000 simulations in a published model [6] this large number is assumed to give close approximations of Incremental Cost Effectiveness Ratio (ICER). Whilst the deterministic ICER was £25,961, the probabilistic estimate was £20,684 showing the difference that can occur between the two in nonlinear models.…”

Section: Probabilistic Sensitivity Analysis In Health Economicsmentioning

confidence: 99%

Probabilistic Sensitivity Analysis in Cost-Effectiveness Models: Determining Model Convergence in Cohort Models

et al. 2018

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Probabilistic sensitivity analysis (PSA) demonstrates the parameter uncertainty in a decision problem. The technique involves sampling parameters from their respective distributions (rather than simply using mean/median parameter values). Guidance in the literature, and from health technology assessment bodies, on the number of simulations that should be performed suggests a 'sufficient number', or until 'convergence', which is seldom defined. The objective of this tutorial is to describe possible outcomes from PSA, discuss appropriate levels of accuracy, and present guidance by which an analyst can determine if a sufficient number of simulations have been conducted, such that results are considered to have converged. The proposed approach considers the variance of the outcomes of interest in cost-effectiveness analysis as a function of the number of simulations. A worked example of the technique is presented using results from a published model, with recommendations made on best practice. While the technique presented remains essentially arbitrary, it does give a mechanism for assessing the level of simulation error, and thus represents an advance over current practice of a round number of simulations with no assessment of model convergence.

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Cost Effectiveness of Characterised Chondrocyte Implantation for Treatment of Cartilage Defects of the Knee in the UK

Abstract: Chondrocyte implantation is estimated to provide substantial patient benefits over a lifetime horizon, with a considerable increase in QALYs. Despite the increase in costs, the procedure is cost effective at standard thresholds used in the UK.

Cited by 19 publications

References 26 publications

Replicating Health Economic Models: Firm Foundations or a House of Cards?

Replicating Health Economic Models: Firm Foundations or a House of Cards?

Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up

Probabilistic Sensitivity Analysis in Cost-Effectiveness Models: Determining Model Convergence in Cohort Models

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