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UBC Theses and Dissertations

Economic considerations of patient decision aids : a case study in sleep apnea Trenaman, Michael Logan


Background: Patient decision aids (PtDAs), tools used to facilitate shared decision-making, help improve patient-physician communication and the quality of healthcare decisions. Over 500 PtDAs are available, yet implementation of these tools has been limited. In order for decision-makers to implement new health care interventions such as PtDAs, they require rigorous economic evidence demonstrating that such interventions provide value for money. Objectives: To explore the economic consideration of PtDAs by (1) systematically reviewing PtDA trials that have evaluated economic outcomes, (2) exploring the potential cost-effectiveness of a PtDA for individuals with obstructive sleep apnea (OSA), and (3) describing the development of a an OSA PtDA prototype. Methods: PtDA trials evaluating economic outcomes were systematically reviewed through an electronic search of Medline/PubMed, Embase, CINAHL, and PsycINFO databases. The potential cost-effectiveness of a PtDA for OSA was evaluated through a Markov cohort decision-analytic model, which explored the cost-effectiveness of a PtDA compared to usual care. Finally, an OSA PtDA prototype was developed according to the International Patient Decision Aid Standards (IPDAS) criteria. Results: Our systematic review found that PtDAs will likely increase upfront administration costs, but may decrease short-term costs by reducing the uptake of invasive treatments. Most studies did not comprehensively capture long-term costs and health outcomes appropriately. Through our economic modelling of a PtDA for OSA we found it could be a cost-effective use of resources provided it increases adherence to treatment. However there was considerable uncertainty in this estimate, with expected value of information analysis revealing that additional research is warranted. We developed and tested a prototype OSA PtDA, and found no evidence that users became stuck or experienced errors during usability testing. The majority of users found the PtDA easy to use and worthy of recommending to others. Conclusions: Policy-makers lack sufficient economic evidence to make informed decisions about whether and where to invest in PtDAs. This evidence gap could be a factor contributing to the slow implementation of PtDAs. Using OSA as a case study, this work demonstrates an economic modelling framework that can be used to evaluate the potential cost-effectiveness of PtDAs.

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