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The use of best practice guidelines and the effect of alternative model structures in results of cost-effectiveness : an analysis with emphasis in cardiovascular disease

The growing use of decision analytic modelling (DAM) to aid decision making in healthcare has triggered the need for increased scrutiny of the methods used and the assessment of compliance with these methods. The assessment of structural uncertainty surrounding the choice of model structure and model external validity represent some of most frequent challenges faced by researchers. This thesis used systematic reviews and two case studies focused on the self-management of hypertension in patients at high risk and thrombolysis in acute stroke to critically examine all available guidelines and statements of good practice and the adherence of current research to good practice guidelines. Two case studies were developed to assess structural uncertainty surrounding the choice of model structure and the impact of the exclusion of secondary events. The results here indicate that DAM guidelines lack practicality due to the extensive amount of information available and their complexity; furthermore, researchers are failing to identifY and correctly assess model structural uncertainty. This thesis makes an important contribution to current knowledge by developing and proposing the use of a practical five-dimension framework to improve the current standards of reporting results of DAM and by illustrating, through case studies, the assessment of structural uncertainty arising from the choice of model structure via scenario analysis and the use of extensive sensitivity analysis.
Date January 2017
CreatorsPeƱaloza-Ramos, Maria Cristina
PublisherUniversity of Birmingham
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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