Search Results (Author:"Perez-Martin,Jorge", Date:" [2017\-01\-01T00\:00\:00Z TO 2017\-12\-31T00\:00\:00Z] ", isMemberOf:"bibliuned:95") - e-spacio
http://e-spacio.uned.es/fez/
Universidad Nacional de Educación a DistanciaspFez 2.1 RC3http://blogs.law.harvard.edu/tech/rssCost-effectiveness of Pediatric Bilateral Cochlear Implantation in Spain
http://e-spacio.uned.es/fez/view/bibliuned:95-Jperez-001
Objective: To determine the incremental cost-effectiveness of bilateral versus unilateral cochlear implantation for one-year-old children suffering from bilateral sensorineural severe to profound hearing loss from the perspective of the Spanish public health system. Study Design: Cost-utility analysis. Methods: We conducted a general-population survey to estimate the quality of life increase contributed by the second implant. We built a Markov influence diagram and evaluated it for a life-long time horizon with a 3% discount rate in the base case. Results: The incremental cost-effectiveness ratio (ICER) of simultaneous bilateral implantation with respect to unilateral implantation for one-year-old children with severe to profound deafness is €10,323 per quality-adjusted life year (QALY). For sequential bilateral implantation, it rises to €11,733/QALY. Both options are cost-effective for the Spanish health system, whose willingness to pay is estimated at around €30,000/QALY. The probabilistic sensitivity analysis shows that the probability of bilateral implantation being cost-effective reaches 100% for that cost-effectiveness threshold. Conclusions: Bilateral implantation is clearly cost-effective for the population considered. If possible, it should be done simultaneously, i.e., in one surgical operation, because it is as safe and effective as sequential implantation, and saves costs for the system and for users and their families. Sequential implantation is also cost-effective for children who have received the first implant recently, but it is difficult to determine when it ceases to be so because of the lack of detailed data. These results are specific for Spain but the model can easily be adapted to other countries. Level of Evidence: 2C2020-06-11T22:26:51Z
Pérez-Martín, Jorge
og Artaso, Miguel A.
og Díez, Francisco J.
Markov influence diagrams: a graphical tool for cost-effectiveness analysis
http://e-spacio.uned.es/fez/view/bibliuned:95-Jperez-002
Markov influence diagrams (MIDs) are a new type of probabilistic graphical models that extend influence diagrams in the same way as Markov decision trees extend decision trees. They have been designed to build state-transition models, mainly in medicine, and perform cost-effectiveness analysis. Using a causal graph that may contain several variables per cycle, MIDs can model various features of the patient without multiplying the number of states; in particular, they can represent the history of the patient without using tunnel states. OpenMarkov, an open-source tool, allows the decision analyst to build and evaluate MIDs—including cost-effectiveness analysis and several types of deterministic and probabilistic sensitivity analysis—with a graphical user interface, without writing any code. This way, MIDs can be used to easily build and evaluate complex models whose implementation as spreadsheets or decision trees would be cumbersome or unfeasible in practice. Furthermore, many problems that previously required discrete event simulation can be solved with MIDs, i.e., within the paradigm of state-transition models, in which many health economists feel more comfortable.2020-06-17T22:57:50Z
Díez, Francisco J.
og Yebra, Mar
og Bermejo, Iñigo
og Palacios-Alonso, Miguel Angel
og Arias Calleja, Manuel
og Luque, Manuel
og Pérez-Martín, Jorge