| Title |
Decision uncertainty and value of further research: a case-study in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms
|
|---|---|
| Published in |
Cost Effectiveness and Resource Allocation, April 2018
|
| DOI | 10.1186/s12962-018-0098-7 |
| Pubmed ID | |
| Authors |
Oriana Ciani, David Epstein, Claire Rothery, Rod S. Taylor, Mark Sculpher |
| Abstract |
Fenestrated endovascular aneurysm repair (fEVAR) is a new approach for complex abdominal aortic aneurysms, limited to a few specialist centers, with limited evidence base. We developed a cost-effectiveness decision model of fEVAR compared to open surgical repair (OSR) to investigate the likely direction of costs and benefits and inform further research projects on this technology. A systematic review with meta-analysis and a four-state Markov model were used to estimate the cost-effectiveness of fEVAR versus OSR. We used a recent coverage with evidence development framework to characterize the main sources of uncertainty and inform decisions about the type of further research that would be most worthwhile and feasible. Seven observational comparative studies were identified, of which four presented odds ratios adjusted for confounders. The odds ratios for operative mortality varied widely between studies. Assuming a central estimate of the odds ratio of 0.54 (95% CI 0.05-6.24), the decision model estimated that the incremental cost per quality adjusted life year (QALY) was £74,580/QALY with a probability of 9 and 16% of being cost-effective at standard cost-effectiveness thresholds of £20,000/QALY and £30,000/QALY, respectively. The Expected Value of Perfect Information over 10 years at a threshold of £20,000/QALY was £11.2 million. Operative mortality contributed to most of the uncertainty in the decision model. In the case of "maturing technologies", decision modelling indicates the likely direction of costs and benefits and guides the development of further research projects. In our analysis of fEVAR versus OSR, decision uncertainty, particularly around operative mortality, might be effectively resolved by a short-term RCT, or possibly a well-conducted comparative observational study. Decision makers may consider that a conditional coverage decision is warranted with assessments required to make this type of recommendation depending on local priorities and circumstances. |
X Demographics
The data shown below were collected from the profiles of 7 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 2 | 29% |
| Italy | 2 | 29% |
| Pakistan | 1 | 14% |
| Unknown | 2 | 29% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 86% |
| Scientists | 1 | 14% |
Mendeley readers
The data shown below were compiled from readership statistics for 42 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 42 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 6 | 14% |
| Student > Bachelor | 5 | 12% |
| Student > Master | 4 | 10% |
| Student > Ph. D. Student | 2 | 5% |
| Lecturer > Senior Lecturer | 2 | 5% |
| Other | 10 | 24% |
| Unknown | 13 | 31% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 12 | 29% |
| Economics, Econometrics and Finance | 3 | 7% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 5% |
| Business, Management and Accounting | 2 | 5% |
| Computer Science | 1 | 2% |
| Other | 5 | 12% |
| Unknown | 17 | 40% |
Attention Score in Context
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 April 2018.
All research outputs
#6,285,277
of 23,043,346 outputs
Outputs from Cost Effectiveness and Resource Allocation
#194
of 431 outputs
Outputs of similar age
#100,419
of 296,868 outputs
Outputs of similar age from Cost Effectiveness and Resource Allocation
#10
of 11 outputs
Altmetric has tracked 23,043,346 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 431 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.1. This one has gotten more attention than average, scoring higher than 54% of its peers.
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We're also able to compare this research output to 11 others from the same source and published within six weeks on either side of this one. This one is in the 9th percentile – i.e., 9% of its contemporaries scored the same or lower than it.