gms | German Medical Science

Kongress Medizin und Gesellschaft 2007

17. bis 21.09.2007, Augsburg

The impact of limited resources on health economic evaluation. An Discrete-Event-Simulation for drug-eluting and bare-metal stent

Meeting Abstract

  • Beate Jahn - Department für medizinische Statistik Informatik und Gesundheitsökonomie, Innsbruck
  • Gord Blackhouse - Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada, Hamilton, Canada
  • James Bowen - Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada, Hamilton, Canada
  • Robert Hopkins - Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada, Hamilton, Canada
  • Jean-Eric Tarride - Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada, Hamilton Canada
  • Karl-Peter Pfeiffer - Department for Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Austria, Innsbruck
  • Engelbert Theurl - Department of Public Finance, Leopold-Franzens-University of Innsbruck, Austria, Innsbruck
  • Ron Goeree - Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada., Hamilton, Canada

Kongress Medizin und Gesellschaft 2007. Augsburg, 17.-21.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gmds176

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2007/07gmds176.shtml

Veröffentlicht: 6. September 2007

© 2007 Jahn et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Resource limitations are a highly relevant problem in health care. However, in decision analytic models (e.g. for the comparison of treatment alternatives) resources or capacities (e.g. number of beds, daily interventions) are not modelled explicitly. Therefore, a delay in the treatment process and other impacts of limited capacities are not sufficiently accounted for in the model outcomes (health effects, long-term costs). Furthermore, the benefits of new treatment alternatives which free up resources might be underestimated. In the study an innovative modelling alternative is applied to illustrate the effects of limited capacities on cost-effectiveness results.

Methods: Discrete-Event-Simulation is well established for analysing complex service systems such as airports but it is rarely applied for cost-effectiveness analysis in health care. Drug-eluting stents (des) are a newly developed treatment alternative for coronary artery disease. They showed promising reductions of repeated interventions compared to bare-metal stents (bms) (e.g. for diabetics patients). However, prices of the new stents remain high and cost-effectiveness is questioned. Therefore, treatment strategies were evaluated. These strategies define the stent type which is provided depending on the risk factors of each patient. Simulation was run assuming a limited and unlimited number of daily stent interventions.

Results: Long-term costs and effects of the strategies, utilization factors and budgetary information were estimated. It is shown that capacity limitations for cardiovascular intervention change the ranking of efficient treatment strategies in such a way that certain strategies become dominated. These dominated strategies should not be taken into consideration by decision makers.

Conclusion: The outcome indicates that neglect of limited capacities can result in wrong cost-effectiveness results. Therefore, capacities should be explicitly included in decision analytic models if there is evidence of scarcity. Discrete-Event-Simulation provides a unique feature to account for capacity constraints and a wide range of multiple perspective outcome analyses.