Catriona Crossan Health Economics Research Group (HERG), Brunel University

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1 MAPGuid: Modlling of clinical pathways to assss cost-ffctivnss in NICE guidlins: impact on stakholdr viws of th importanc of potntial updat topics Catriona Crossan Halth Economics Rsarch Group (HERG), Brunl Univrsity

2 Disclosur of Intrsts (last 3 yars) Catriona Crossan I crtify that, to th bst of my knowldg, no aspct of my currnt prsonal or profssional situation might rasonably b xpctd to affct significantly my viws on th subjct on which I am prsnting

3 Th MAPGuid projct Fundd by MRC Mthodology Rsarch (G090150) Collaborators: Joann Lord, Marta Trapro-Brtran, Juli Eatock, Catriona Crossan, Simon Taylor (Brunl Univrsity) Sarah Willis, Alc Minrs (LSHTM) Paul Tappndn (ScHARR, Shffild Univrsity) Maggi Wstby, David Wondrling (NCGC, RCP) Ifignia Mavranzouli (NCCMH, UCL) Phil Aldrson, Francis Ruiz, Prashanth Kandaswamy (NICE)

4 What to modl? Gastric ulcr Gastric ulcr Gastric ulcr Stop NSAIDs, if usd 1 Stop NSAIDs, if usd 1 Stop NSAIDs, if usd 1 3 H. pylori positiv ulcr, associatd with NSAID us Tst for H. pylori H. pylori 2 ngativ H. pylori positiv ulcr not, associatd with NSAID us Full-dos PPI for 1 or 2 months Fulldos PPI for 2 months Eradication thrapy Fulldos PPI for 2 months Eradication thrapy 3 H. pylori positiv ulcr, associatd with NSAID us Tst for H. pylori H. pylori 2 ngativ H. pylori positiv ulcr not, associatd with NSAID us Full-dos PPI for 1 or 2 months Fulldos PPI for 2 months Eradication thrapy 3 H. pylori positiv ulcr, associatd with NSAID us Tst for H. pylori H. pylori 2 ngativ H. pylori positiv ulcr not, associatd with NSAID us Full-dos PPI for 1 or 2 months H. pylori positiv Endoscopy and H. pylori tst Ulcr not H. hald, pylori ngativ Ulcr hald, H. pylori ngativ Low-dos tratmnt as 5 rquird Priodic rviw 6 Hal d Endoscop y Not hald H. pylori positiv Endoscopy and H. pylori tst Ulcr not H. hald, pylori ngativ Ulcr hald, H. pylori ngativ Low-dos tratmnt as 5 rquird Priodic rviw 6 Hal d Endoscop y Not hald H. pylori positiv Endoscopy and H. pylori tst Ulcr not H. hald, pylori ngativ Ulcr hald, H. pylori ngativ Low-dos tratmnt as 5 rquird Priodic rviw 6 Hal d Endoscop y Not hald Rfr to spcialist scondary car Rturn to slf car Rfr to spcialist scondary car Rfr to spcialist scondary car Rturn to slf car Rfr to spcialist scondary car Rfr to spcialist scondary car Rturn to slf car Rfr to spcialist scondary car Slctd qustions Sub-sctions of pathway Whol pathway

5 Aim of MAPGUIDE Projct To invstigat th fasibility of modlling th pathways rcommndd in NICE clinical guidlins to stimat associatd patint flows, halth outcoms and costs AND Us th modls as a basis for assssing th incrmntal costffctivnss of possibl variations in th car pathway for two NICE clinical guidlins Atrial Fibrillation (CG36) and Prostat Cancr (CG58)

6 Mthods- Th projct plan Dvlop Bas Cas Modl of Currnt Guidlin pathways Collat a list of potntial updat topics from NICE documnts Survy xprts (stakholdrs) for opinions r updat topics Modl updat topics Prsnt Rsults to xprts and r-survy

7 Mthods - Not possibl to carry out Aftr Survy du to Tim Constraints complxity of modl- longr modlling tim quicknss of guidlin updat procss

8 AF Modl Illustration Atrial Fibrillation modl Dvlopd by Juli Eatock Dpartmnt of Information Systms and Computing & Marta Trapro-Brtran & Joann Lord Halth Economics Rsarch Group (HERG)

9 Simul8 modl Discrt vnt simulation (DES) Draws individuals from THIN databas (AF/non AF) Estimats risks of major outcoms (arrhythmia, strok, blds, tc.) Runs through car pathway to dtrmin what tsts and tratmnts thy would rciv Estimats tim to nxt vnt Tratmnt rviw Follows individuals to dath

10 Survy Dvlopmnt Survy Dsign- Dvlopd using Survy Monky Qustion 1: Rat topics according to how important thy ar to updat within a guidlin (using Likrt Scal) Qustion 2: Rank topics according to which is most important to updat within a guidlin (scal 1-8) Fr Txt Commnts usd to sk additional information Information shts providd on ach topic

11 AF Survy Topics Topic 1: Anti-arrhythmic drugs as PCV Topic 2: Tratmnt for maintaining SR aftr cardiovrsion Topic 3: Risk Stratification for strok & mbolism Topic : Risk Stratification for blding risk Topic 5:Apixaban, Rivaroxaban or Dabigatran vs warfarin Topic 6: Rhythm vrsus rat control stratgis for AF subgroups Topic 7: Prophylaxis for prvntion of post-oprativ AF Topic 8: Cathtr Ablation

12 Survy Rsults- Rspons Rat Qustion 1- Nam, Company & Addrss 32 rspondnts (rspons rat of 19%) Qustion 2-Rat topics on Likrt Scal (Not, Somwhat, No Opinion,, Vry ) 25 answrd, 7 skippd Qustion 3- Rank topics in ordr of importanc of bing updatd (scal of 1-9) 23 answrd, 9 skippd Additional: Qustion/Spac for commnts 13 commnts rcivd

13 Survy Rsults Organisation Affiliation Organisational Affiliation of Rspondnt s (n=25) 16% Information 8% Spc Soc 12% Charitis % Halth Srvics Sctor 20% Industry

14 Survy Rsults- Distribution of Answrs Topic 5 (Apixaban, rivaroxaban or Dabigatran txilat) ratd as th most important to updat. Also rankd most important Qustion 1 (Rating) Qustion 2 (Ranking) Not Somwhat No Opinion Vry

15 Survy Rsults- Distribution of Answrs Topic (Risk Stratification for blding risk) ratd 2 nd most important. Rankd th most important Qustion 1 (Rating) Qustion 2 (Ranking) Not Somwhat No Opinion Vry

16 Survy Rsults- Distribution of Answrs Topic 3 (Risk Stratification for strok & mbolism) ratd 3rd most important. Rankd 2 nd most important Qustion 1 (Rating) 12 Qustion 2 (Ranking) Not Somwhat No Opinion Vry

17 Survy Rsults- Distribution of Answrs Topic 8 (Cathtr Ablation) ratd th most important. Rankd 3rd most important Qustion 1 (Rating) 12 Qustion 2 (Ranking) Not Somwhat No Opinion Vry

18 Conclusion-Is Whol Pathway Modlling Fasibl? Whol pathway modlling is possibl Estimat patint flows, halth & budgt impacts + cost-ffctivnss Can captur systmic ffcts of srvic chang upstram and downstram impacts And us th sam modl to answr many qustions But Don t undrstimat th input ndd (clinical and analytical xprtis, data, tim, ) It may not b fasibl within NICE ral tim clinical guidlins procss

19 Currnt work in progrss Bas Cas Modl is complt Updat topics currntly bing addd Fasibl to modl all bar 1 topic- Prophylaxis for th prvntion of post-oprativ AF Plan to compar th rsults with stakholdrs opinions from th 1st survy

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