Study Set Content:
Synthesis of results
9-10 Table 1
Risk of bias across studies
9, Supplemental figure 4
Additional analysis
9-10, Table 1, Figure 3, Supplemental Figure 5
is used to evaluate the clinical and economic effects of health care interventions
quantitative modeling
are often used to answer “What if?” questions.
• Models
they are used to represent (or simulate) health care processes or decisions and their impacts under conditions of uncertainty, such as in the absence of actual data or when it is not possible to collect data on all potential conditions, decisions, and outcomes of interest.
modeling
The high cost and long duration of large RCTs and other clinical studies also contribute to the interest in developing alternative methods to collect, integrate, and analyze data to answer questions about the impacts of alternative health care interventions. • Indeed, some advanced types of *()are being used to simulate clinical trials.
modeling
Among the main types of techniques used in quantitative modeling are
–decision analysis (*midterm)–Markov modeling–Monte Carlo simulation
are analytical frameworks that represent disease processes evolving over time and are suited to model progression of chronic disease as this type of model can handle disease recurrence and estimate long-term costs and life years gained/QALYs.
Markov models
Time spent in each disease state for a single model cycle (and transitions between states) is associated with a
coast and a health outcome
uses sampling from random number sequences to assign estimates to parameters with multiple possible values, e.g., certain patient characteristics
Monte Carlo simulation
a large-scale simulation system that models human physiology, disease, and health care systems
Archimedes model
In diabetes, for example, the () model has been used to predict the risk of developing diabetes in individuals, determine the cost-effectiveness of alternative screening strategies to detect new cases of diabetes, and simulate clinical trials of treatments for diabetes.
Archimedes
Models and their results are only () to decision making; they are not statements of scientific, clinical, or economic fact. The report of any modeling study should carefully explain and document the assumptions, data sources, techniques, and software.
aids
Assumptions and estimates of variables used in models should be validated against () data as such data become available, and the models should be modified accordingly
actual
GRADE)
Grading of Recommendations Assessment, Development and Evaluation (Balshem 2011)
Assessing the Quality of a Body of Evidence
Cochrane Collaboration (Higgins 2011)
AHRQ EPCs
US Agency for Healthcare Research and Quality Evidence-based Practice Centers(Berkman 2014)
OCEBM
Oxford Centre for Evidence-Based Medicine
USPSTF
US Preventive Services Task Force 2008)
