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Cost-Effectiveness and Heterogeneity: Using Finite Mixtures of Disease Activity Models to Identify and Analyze Phenotypes

In English

Författare

Summary, in English

Heterogeneity in patient populations is an important issue in health economic evaluations, as the cost-effectiveness of an intervention can vary between patient subgroups, and an intervention which is not cost-effective in the overall population may be cost-effective in particular subgroups. Identifying such subgroups is of interest in the allocation of healthcare resources. Our aim was to develop a method for cost-effectiveness analysis in heterogeneous chronic diseases, by identifying subgroups (phenotypes) directly relevant to the cost-effectiveness of an intervention, and by enabling cost-effectiveness analyses of the intervention in each of these phenotypes. We identified phenotypes based on healthcare resource utilization, using finite mixtures of underlying disease activity models: first, an explicit disease activity model, and secondly, a model of aggregated disease activity. They differed with regards to time-dependence, level of detail, and what interventions they could evaluate. We used them for cost-effectiveness analyses of two hypothetical interventions. Allowing for different phenotypes improved model fit, and was a key step towards dealing with heterogeneity. The cost-effectiveness of the interventions varied substantially between phenotypes. Using underlying disease activity models for identifying phenotypes as well as cost-effectiveness analysis appears both feasible and useful in that they guide the decision to introduce an intervention.

Avdelning/ar

Publiceringsår

2015

Språk

Engelska

Publikation/Tidskrift/Serie

Working Paper / Department of Economics, School of Economics and Management, Lund University

Issue

5

Dokumenttyp

Working paper

Förlag

Department of Economics, Lund University

Ämne

  • Health Care Service and Management, Health Policy and Services and Health Economy
  • Clinical Medicine

Nyckelord

  • Cost-effectiveness
  • Disease heterogeneity
  • Phenotypes
  • Latent classes
  • Disease activity model
  • Crohn's disease

Status

Published

Projekt

  • Disease activity models of Inflammatory Bowel Diseases

Forskningsgrupp

  • Health Economics
  • Chronic Inflammatory and Degenerative Diseases Research Unit
  • Gastroenterology