Modelling: one tool in the decision-making toolkit

Editorial comment on the Viewpoint - Should prioritising health interventions be informed by modelling studies? The case of cancer control in Aotearoa New Zealand, published by Wilson. N, et al VIEWPOINT Vol 134 No 1531: 12 March 202

Scenario analysis: cost of trastuzumab decreases by 30%.

<p>Scenario analysis: cost of trastuzumab decreases by 30%.</p

One-way sensitivity analysis: tornado plot for pooled subtypes for the age group 50–54 y.

<p>One-way sensitivity analysis: tornado plot for pooled subtypes for the age group 50–54 y.</p

Overall survival.

<p>Curves indicate model outputs. Diamond and triangle markers indicate reported 10-y OS from the N9831 and B-31 trials [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002067#pmed.1002067.ref006" target="_blank">6</a>].</p

Scenario analyses: cost-effectiveness plane for the age group 50–54 y.

<p>GDP, gross domestic product.</p

Health states in the Markov model.

<p>CHF, congestive heart failure.</p

Base-case incremental QALYs^DW and costs (2011 New Zealand dollars) per woman treated and ICERs (2011 New Zealand dollars), by age group and subtype.

<p>Base-case incremental QALYs^DW and costs (2011 New Zealand dollars) per woman treated and ICERs (2011 New Zealand dollars), by age group and subtype.</p

Cost-effectiveness acceptability curves.

<p>Cost-effectiveness acceptability curves.</p

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs

<div><p>Background</p><p>There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.</p><p>Methods and findings</p><p>A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, <i>Injury Prevention</i>) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial.</p><p>In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95$663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and$832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori.</p><p>Conclusions</p><p>This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.</p></div

Intervention costs by population group offered the home safety assessment and modification (HSAM) intervention (age-group and injurious fall history).

<p>Intervention costs by population group offered the home safety assessment and modification (HSAM) intervention (age-group and injurious fall history).</p