Alper ATA, Mehmet Ali SUNGUR, Emine Arzu KANIK

Genişletilmiş Baskınlık Durumunda Uygun Yöntem Seçimi için Temel Bir Yaklaşım

Amaç: Maliyet etkililik analizinde, tedavi yöntemleri maliyet ve etkinliğe göre sıralanır ve daha maliyetli fakat daha az etkin olan yöntem baskılanır. Yöntemlerden hiçbirinin kesin olarak baskılanmadığı, ancak bunlardan birinin genişletilmiş baskınlıkta kaldığı modellerde, maliyet-etkin yöntemin seçilmesi karmaşıktır. Bu çalışmanın amacı, genişletilmiş baskınlıkta kalan yöntemin artan maliyet-etkinlik oranı büyüklüğü için, bu tedavinin maliyet etkinliğine karar vermekte kullanılabilecek bir sınıflandırma önermektir. Gereç ve Yöntem: Gerçek verilere dayanan simüle edilmiş veriler ve gerçek verilerle uyumlu varsayımsal veriler kullanılmıştır. Farklı maliyet, etkinlik ve yanıt oranları oluşturularak tüm olasılıklar değerlendirilmeye çalışılmıştır. Genişletilmiş baskınlıkta olan tedavilerin artan maliyet etkinlik oranlarının oransal büyüklükleri incelenmiştir. Her bir model için tanımlayıcı istatistikler ve yanıt oranlarına göre ağırlıklı ortalamalar hesaplanmış ve genişletilmiş baskınlık yüzdesindeki değişim karşılaştırılmıştır. Bulgular: Genişletilmiş baskınlıkta kalan yöntemin artan maliyet-etkinlik oranının büyüklüğü, alternatif yöntemlerin yanıt oranları benzer veya aynı olduğunda karar vermek için oldukça önemli bir faktördür. Yanıt oranları birbirinden farklılaştıkça küçük değişiklikler gözlemlenmiş, ancak genişletilmiş baskınlık oranlarında aşırı bir etkilenme görülmemiştir. Sonuç: Genişletilmiş baskınlıkta kalan tedavi yönteminin artan maliyet-etkinlik oranının oransal büyüklüğünü değerlendirmek ve modeldeki tedavilerin yanıt oranlarının aynı ya da farklı olduğuna bakmaksızın kullanılabilecek çok basit ve pratik bir sınıflandırma önerilmiştir.

A Basic Approach to Select the Appropriate Method in case of Extended Dominance

Objective: In cost-effectiveness analysis, treatment methods are ranked by cost and effectiveness, and a method more costly but less effective, is dominated. In models that none of the methods is absolutely dominated but one of them is extendedly dominated, selecting cost-effective method is complicated. Aim of this study was to propose a classification for magnitude of incremental cost-effectiveness ratio of extendedly dominated method, which can use for deciding about cost-effectiveness of this treatment. Methods: Simulated data based on actual data, and simulated hypothetical data in accordance with actual data were used. All possibilities were tried to consider by generating different costs, effectiveness and response rates. Proportional magnitudes of incremental cost-effectiveness ratios of treatments extendedly dominated were investigated. Descriptive statistics for each model, and weighted means by response rates were calculated and change in percentage of extended dominance were compared. Results: Magnitude of incremental cost-effectiveness ratio of the method extendedly dominated is a quite important factor to decide about it, when response rates of alternative methods are similar or same. Slight changes were observed as the response rates differ from each other, but there was not an extreme impact on proportions of extended dominance. Conclusions: A very simple and practical classification which can be used to assess the proportional magnitude of the incremental cost-effectiveness ratio of extendedly dominated treatment method and be valid regardless of whether response rates of treatments in model are same or different was suggested.

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez