Examining the Heterogeneity and Cost Effectiveness of a Complex Intervention by Segmentation of Patients with Chronic Obstructive Pulmonary Disease

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

1 Citation (Scopus)
97 Downloads (Pure)

Resumé

Objectives: To examine the heterogeneity in cost-effectiveness analyses of patient-tailored complex interventions. Methods: Latent class analysis (LCA) was performed on data from a randomized controlled trial evaluating a patient-tailored case management strategy for patients suffering from chronic obstructive pulmonary disease (COPD). LCA was conducted on detailed process variables representing service variation in the intervention group. Features of the identified latent classes were compared for consistency with baseline demographic, clinical, and economic characteristics for each class. Classes for the control group, corresponding to the identified latent classes for the intervention group, were identified using multinomial logistic regression. Cost-utility analyses were then conducted at the class level, and uncertainty surrounding the point estimates was assessed by probabilistic sensitivity analysis. Results: The LCA identified three distinct classes: the psychologically care class, the extensive COPD care class, and the limited COPD care class. Patient baseline characteristics were in line with the features identified in the LCA. Evaluation of cost-effectiveness revealed highly disparate results, and case management for only the extensive COPD care class appeared cost-effective with an incremental cost-effectiveness ratio of £26,986 per quality-adjusted life-year gained using the threshold value set by the National Institute of Health and Care Excellence. Conclusions: Findings indicate that researchers evaluating patient-tailored complex interventions need to address both supply-side variation and demand-side heterogeneity to link findings with outcome. The article specifically proposes the use of LCA because it is believed to have the potential to enable more appropriate targeting of complex care strategies.

OriginalsprogEngelsk
TidsskriftValue in Health
Vol/bind21
Udgave nummer2
Sider (fra-til)239-247
Antal sider9
ISSN1098-3015
DOI
StatusUdgivet - feb. 2018

Fingerprint

Chronic Obstructive Pulmonary Disease
Cost-Benefit Analysis
Case Management
Quality-Adjusted Life Years
National Institutes of Health (U.S.)
Uncertainty
Randomized Controlled Trials
Logistic Models
Economics
Research Personnel
Demography
Delivery of Health Care
Costs and Cost Analysis
Control Groups

Emneord

    Citer dette

    @article{397b0798ec3547d2b72c7ac4b7533a8e,
    title = "Examining the Heterogeneity and Cost Effectiveness of a Complex Intervention by Segmentation of Patients with Chronic Obstructive Pulmonary Disease",
    abstract = "Objectives: To examine the heterogeneity in cost-effectiveness analyses of patient-tailored complex interventions. Methods: Latent class analysis (LCA) was performed on data from a randomized controlled trial evaluating a patient-tailored case management strategy for patients suffering from chronic obstructive pulmonary disease (COPD). LCA was conducted on detailed process variables representing service variation in the intervention group. Features of the identified latent classes were compared for consistency with baseline demographic, clinical, and economic characteristics for each class. Classes for the control group, corresponding to the identified latent classes for the intervention group, were identified using multinomial logistic regression. Cost-utility analyses were then conducted at the class level, and uncertainty surrounding the point estimates was assessed by probabilistic sensitivity analysis. Results: The LCA identified three distinct classes: the psychologically care class, the extensive COPD care class, and the limited COPD care class. Patient baseline characteristics were in line with the features identified in the LCA. Evaluation of cost-effectiveness revealed highly disparate results, and case management for only the extensive COPD care class appeared cost-effective with an incremental cost-effectiveness ratio of £26,986 per quality-adjusted life-year gained using the threshold value set by the National Institute of Health and Care Excellence. Conclusions: Findings indicate that researchers evaluating patient-tailored complex interventions need to address both supply-side variation and demand-side heterogeneity to link findings with outcome. The article specifically proposes the use of LCA because it is believed to have the potential to enable more appropriate targeting of complex care strategies.",
    keywords = "case management, chronic obstructive pulmonary disease, complex interventions, economic evaluation, heterogeneity, latent class analysis, variability",
    author = "S{\o}rensen, {Sabrina Storgaard} and Jensen, {Morten Berg} and Pedersen, {Kjeld M{\o}ller} and Ehlers, {Lars Holger}",
    year = "2018",
    month = "2",
    doi = "10.1016/j.jval.2017.08.001",
    language = "English",
    volume = "21",
    pages = "239--247",
    journal = "Value in Health",
    issn = "1098-3015",
    publisher = "Elsevier",
    number = "2",

    }

    TY - JOUR

    T1 - Examining the Heterogeneity and Cost Effectiveness of a Complex Intervention by Segmentation of Patients with Chronic Obstructive Pulmonary Disease

    AU - Sørensen, Sabrina Storgaard

    AU - Jensen, Morten Berg

    AU - Pedersen, Kjeld Møller

    AU - Ehlers, Lars Holger

    PY - 2018/2

    Y1 - 2018/2

    N2 - Objectives: To examine the heterogeneity in cost-effectiveness analyses of patient-tailored complex interventions. Methods: Latent class analysis (LCA) was performed on data from a randomized controlled trial evaluating a patient-tailored case management strategy for patients suffering from chronic obstructive pulmonary disease (COPD). LCA was conducted on detailed process variables representing service variation in the intervention group. Features of the identified latent classes were compared for consistency with baseline demographic, clinical, and economic characteristics for each class. Classes for the control group, corresponding to the identified latent classes for the intervention group, were identified using multinomial logistic regression. Cost-utility analyses were then conducted at the class level, and uncertainty surrounding the point estimates was assessed by probabilistic sensitivity analysis. Results: The LCA identified three distinct classes: the psychologically care class, the extensive COPD care class, and the limited COPD care class. Patient baseline characteristics were in line with the features identified in the LCA. Evaluation of cost-effectiveness revealed highly disparate results, and case management for only the extensive COPD care class appeared cost-effective with an incremental cost-effectiveness ratio of £26,986 per quality-adjusted life-year gained using the threshold value set by the National Institute of Health and Care Excellence. Conclusions: Findings indicate that researchers evaluating patient-tailored complex interventions need to address both supply-side variation and demand-side heterogeneity to link findings with outcome. The article specifically proposes the use of LCA because it is believed to have the potential to enable more appropriate targeting of complex care strategies.

    AB - Objectives: To examine the heterogeneity in cost-effectiveness analyses of patient-tailored complex interventions. Methods: Latent class analysis (LCA) was performed on data from a randomized controlled trial evaluating a patient-tailored case management strategy for patients suffering from chronic obstructive pulmonary disease (COPD). LCA was conducted on detailed process variables representing service variation in the intervention group. Features of the identified latent classes were compared for consistency with baseline demographic, clinical, and economic characteristics for each class. Classes for the control group, corresponding to the identified latent classes for the intervention group, were identified using multinomial logistic regression. Cost-utility analyses were then conducted at the class level, and uncertainty surrounding the point estimates was assessed by probabilistic sensitivity analysis. Results: The LCA identified three distinct classes: the psychologically care class, the extensive COPD care class, and the limited COPD care class. Patient baseline characteristics were in line with the features identified in the LCA. Evaluation of cost-effectiveness revealed highly disparate results, and case management for only the extensive COPD care class appeared cost-effective with an incremental cost-effectiveness ratio of £26,986 per quality-adjusted life-year gained using the threshold value set by the National Institute of Health and Care Excellence. Conclusions: Findings indicate that researchers evaluating patient-tailored complex interventions need to address both supply-side variation and demand-side heterogeneity to link findings with outcome. The article specifically proposes the use of LCA because it is believed to have the potential to enable more appropriate targeting of complex care strategies.

    KW - case management

    KW - chronic obstructive pulmonary disease

    KW - complex interventions

    KW - economic evaluation

    KW - heterogeneity

    KW - latent class analysis

    KW - variability

    UR - http://www.scopus.com/inward/record.url?scp=85029148391&partnerID=8YFLogxK

    U2 - 10.1016/j.jval.2017.08.001

    DO - 10.1016/j.jval.2017.08.001

    M3 - Journal article

    VL - 21

    SP - 239

    EP - 247

    JO - Value in Health

    JF - Value in Health

    SN - 1098-3015

    IS - 2

    ER -