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dc.contributor.authorManetti, Stefania
dc.contributor.authorTurchetti, Giuseppe
dc.contributor.authorFusco, Francesco
dc.date.accessioned2020-12-22T19:00:44Z
dc.date.available2020-12-22T19:00:44Z
dc.date.issued2020-10-15
dc.date.submitted2020-02-26
dc.identifier.others12913-020-05768-4
dc.identifier.other5768
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/315470
dc.description.abstractAbstract: Background: Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods: The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results: Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions: Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.
dc.languageen
dc.publisherBioMed Central
dc.rightsAttribution 4.0 International (CC BY 4.0)en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectResearch Article
dc.subjectUtilization, expenditure, economics and financing systems
dc.subjectCost-effectiveness analysis
dc.subjectEarly health technology assessment
dc.subjectValue of information
dc.subjectUncertainty
dc.subjectElicitation
dc.titleDetermining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information
dc.typeArticle
dc.date.updated2020-12-22T19:00:44Z
prism.issueIdentifier1
prism.publicationNameBMC Health Services Research
prism.volume20
dc.identifier.doi10.17863/CAM.62577
dcterms.dateAccepted2020-09-28
rioxxterms.versionofrecord10.1186/s12913-020-05768-4
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.identifier.eissn1472-6963


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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's licence is described as Attribution 4.0 International (CC BY 4.0)