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Paul McNamee, Alessandra Vanoli, Debbie Hutchings, Ian McKeith, John Bond

Quantifying uncertainty in long-term care costs following introduction of new drug therapy: the importance of model choice. Paul McNamee, Alessandra Vanoli, Debbie Hutchings, Ian McKeith, John Bond. In the next 25 minutes. Aims, methods and results of the paper

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Paul McNamee, Alessandra Vanoli, Debbie Hutchings, Ian McKeith, John Bond

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  1. Quantifying uncertainty in long-term care costs following introduction of new drug therapy: the importance of model choice Paul McNamee, Alessandra Vanoli, Debbie Hutchings, Ian McKeith, John Bond

  2. In the next 25 minutes... • Aims, methods and results of the paper • Conclusions and points for discussion

  3. Aims of the paper • To compare two approaches in modelling the net NHS costs of drug treatment for Alzheimer’s Disease • Application of deterministic and probabilistic modelling methods to estimate costs and explore uncertainty about likely “budget impact” to the NHS over 10 years • Apply these methods to 3 different policies (ALL, NG1, NG2)

  4. Some background • AD affects a large and growing number of older people • Drugs are effective at slowing disease progression • Uncertainty over whether they are ‘cost-effective’ • NICE recommends assessment of “budget impact” for NHS, but only partially done for AD drugs in 2001 • Recent guidance (March 05) - treatment should no longer be prescribed for new patients

  5. Methods -1 • Simulate cost impact for AD population (England and Wales) • ONS population data • MRC ageing study for AD prevalence rates • Systematic review of effects of treatment on cognition • Long term prognosis from observational studies • OLS and GLM regression models estimate cost effect of changes in disease progression

  6. Ordinary least squares (OLS) Identity link Normal (Gaussian) distribution Generalized Linear Model (GLM) Log link Gamma or Negative Binomial Distribution Methods – 2 Regression models N=371 dependent variable: weekly cost Constant term allowed. independent variables: sex, age, ADL, MMSE

  7. Estimated incremental cost impact over 10 yrs 2002/03 prices £m

  8. Estimated incremental 10 yr cost per patient 2002/03 prices £ (% diff from OLS estimate)

  9. Conclusions • Drug treatment for AD likely to lead to additional costs to the NHS • Choice of modelling method makes a difference to magnitude of estimates

  10. Discussion points • A GLM framework for probabilistic analysis more likely to produce outliers • Lack of evidence on long term effects • Estimates based on 10 year old observations of costs of care • Estimates assume full adoption for different NICE policy decisions – but how realistic? • How important is the “budget impact” question to local and national decision-makers?

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