Publicación: Análisis de coste-efectividad en OpenMarkov. Aplicación al implante coclear bilateral pediátrico en España
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2015-10-05
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info:eu-repo/semantics/openAccess
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Universidad Nacional de Educación a Distancia (España). Escuela Técnica Superior de Ingeniería Informática. Departamento de Inteligencia Artificial.
Resumen
El uso de implantes cocleares es, a día de hoy la terapia más efectiva para el tratamiento de la sordera severa y profunda. Diferentes estudios han demostrado que el implante coclear unilateral es coste-efectivo en niños y en adultos. Investigaciones recientes indican que el implante coclear bilateral (un implante en cada oído) es coste-efectivo en niños, pero el grado de incertidumbre sigue siendo elevado. El objetivo de este estudio consiste en determinar con la mayor precisión posible si el implante coclear bilateral pediátrico es coste-efectivo. Con este fin se ha construido un modelo gráfico probabilista que representa los sucesos que pueden producirse a lo largo de la vida del usuario, su impacto en la calidad de vida y los costes asociados, distinguiendo los costes que cubre el sistema nacional de sanidad de los que en España asumen los usuarios y sus familias. La construcción y la evaluación del modelo se han realizado con la herramienta de software libre OpenMarkov, desarrollada en Centro de Investigación sobre Sistemas Inteligentes de Ayuda a la Decisión (CISIAD) de la UNED, para lo cual se han añadido nuevas funcionalidades y se han extendido algunas de las ya existentes. Varios estudios han estimado que la disposición a pagar (también conocida como “umbral de coste-efectividad”) implícitamente utilizada por el sistema de sanidad español si sitúa entre entre 30.000 y 35.000 € por año de vida ajustado en calidad (AVAC). Según los resultados de nuestro modelo, la razón de coste-efectividad incremental (RCEI) del implante simultáneo frente al unilateral para niños de un año de edad es de 12.133 €/AVAC, lo cual implica que conviene poner dos implantes todos los que los necesitan. El análisis de sensibilidad confirma esta conclusión, pues para un umbral de 30.000 €/AVAC la probabilidad de que esta intervención sea coste-efectivo alcanza el 98 %. Incluso en el caso de que el sistema nacional de salud asumiera los costes que en nuestro país cubren actualmente las familias,la intervención seguiría siendo coste-efectiva, con una RCEI de 17.263 €/AVAC y una probabilidad del 94 %. La implantación debe hacerse de forma simultánea, es decir, en una sola operación quirúrgica, porque la implantación secuencial tiene la misma efectividad pero mayor coste para el sistema sanitario y para la familia. Nuestro modelo no es capaz de estimar la RCEI para niños mayores de un año porque la efectividad depende de muchos factores, principalmente de la edad actual, cuándo apareció la sordera, cuándo fue diagnosticada y, en su caso, cuándo se realizó el primer implante. Este modelo estará disponible públicamente para que otros investigadores puedan reproducir los resultados y adaptarlo a otros contextos. En particular, sería interesante analizar la RCEI en adultos y en otros países.
Cochlear implantation is nowsadays the most effective therapy for the treatment of severe to profound deafness. Different studies have found that unilateral cochlear implantation is cost-effective in both children and adults. Recent research has shown that bilateral cochlear implantation (an implant in each ear) is cost-effective in children, but the degree of uncertainty is still high. The goal of this study is to determine as precisely as possible whether pediatric bilateral cochlear implantation is cost-effective. In order to accomplish it, we have built a probabilistic graphical model that represents the events that may occur during the life of a cochlear implant user, their impact on quality of life and their associated costs, distinguishing those covered by the national health system from those that in Spain are covered by users and their families. We have built and evaluated the model with the open source software OpenMarkov, developed by the Research Centre for Intelligent Decision-Support Systems (CISIAD) at UNED, and for this purpose we have created new functionalities and extended some of those already existing. Several studies have estimated that the willingness to pay (also called “cost-effectiveness threshold”) implicitly used by the Spanish health system lies between 30.000 and 35.000 € per quality-adjusted life year (QALY). According to the results of our model, the incremental cost-effectiveness ratio of simultaneous bilateral implantation with respect to unilateral implantation for one-year-old children is 12.133 €/QALY), which implies that all those needing two implants should receive them. The sensitivity analysis confirms this conclusion, since for a threshold of 30.000 €/AVAC the probability that bilateral implantation is cost-effective reaches 98 %. Even if the national health system covered the costs that in our country are currently paid by users and their families, the intervention would still be cost-effective, with an ICER of 17.263 €/QALY and a probability of 94 %. Implantation should be done simultaneously, i.e., in one surgery, because sequential implantation has the same effectiveness but is more expensive. Our model is not able to estimate the ICER for children older than one year because the effectiveness depends on many factors, mainly on the current age, the age at the onset of deafness, when it was diagnosed and, if the child already has an implant, when he/she received it. Our model will be publicly available so that other researchers can reproduce the results and adapt it to other contexts. In particular, it would be interesting to analyse the ICER for adults and in other countries.
Cochlear implantation is nowsadays the most effective therapy for the treatment of severe to profound deafness. Different studies have found that unilateral cochlear implantation is cost-effective in both children and adults. Recent research has shown that bilateral cochlear implantation (an implant in each ear) is cost-effective in children, but the degree of uncertainty is still high. The goal of this study is to determine as precisely as possible whether pediatric bilateral cochlear implantation is cost-effective. In order to accomplish it, we have built a probabilistic graphical model that represents the events that may occur during the life of a cochlear implant user, their impact on quality of life and their associated costs, distinguishing those covered by the national health system from those that in Spain are covered by users and their families. We have built and evaluated the model with the open source software OpenMarkov, developed by the Research Centre for Intelligent Decision-Support Systems (CISIAD) at UNED, and for this purpose we have created new functionalities and extended some of those already existing. Several studies have estimated that the willingness to pay (also called “cost-effectiveness threshold”) implicitly used by the Spanish health system lies between 30.000 and 35.000 € per quality-adjusted life year (QALY). According to the results of our model, the incremental cost-effectiveness ratio of simultaneous bilateral implantation with respect to unilateral implantation for one-year-old children is 12.133 €/QALY), which implies that all those needing two implants should receive them. The sensitivity analysis confirms this conclusion, since for a threshold of 30.000 €/AVAC the probability that bilateral implantation is cost-effective reaches 98 %. Even if the national health system covered the costs that in our country are currently paid by users and their families, the intervention would still be cost-effective, with an ICER of 17.263 €/QALY and a probability of 94 %. Implantation should be done simultaneously, i.e., in one surgery, because sequential implantation has the same effectiveness but is more expensive. Our model is not able to estimate the ICER for children older than one year because the effectiveness depends on many factors, mainly on the current age, the age at the onset of deafness, when it was diagnosed and, if the child already has an implant, when he/she received it. Our model will be publicly available so that other researchers can reproduce the results and adapt it to other contexts. In particular, it would be interesting to analyse the ICER for adults and in other countries.
Descripción
Categorías UNESCO
Palabras clave
implante coclear bilateral, análisis de coste-efectividad, análisis de sensibilidad, modelos gráficos probabilistas, diagramas de influencia, Modelos de Markov, bilateral cochlear implantation, cost-effectiveness analysis, sensitivity analysis, probabilistic graphical models, influence diagrams, Markov models
Citación
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Facultades y escuelas::E.T.S. de Ingeniería Informática
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Inteligencia Artificial