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Using the Payoff Time in Decision-Analytic Models: A Case Study for Using Statins in Primary Prevention.

Alexander Thompson1, Bruce Guthrie2, Katherine Payne1

  • 1Manchester Centre for Health Economics, University of Manchester, Manchester, UK (AT, KP).

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|April 26, 2017
PubMed
Summary

Payoff time estimates when intervention benefits exceed costs, aiding decisions on treatments with delayed benefits and immediate harms. This study demonstrates its application in decision-analytic models for cardiovascular risk and statin use.

Keywords:
cardiovascularcost-effectivenessdecision-analytic modellingdirect treatment disutilitypayoff time

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Area of Science:

  • Health economics
  • Decision analysis
  • Pharmacoeconomics

Background:

  • Payoff time quantifies the breakeven point for health interventions with upfront harms and deferred benefits.
  • It is crucial for benefit-harm assessments in clinical decision-making.
  • This study aimed to expand payoff time's application within decision-analytic models.

Purpose of the Study:

  • To demonstrate the application of payoff time in a decision-analytic model.
  • To evaluate payoff time for statin interventions across varying cardiovascular risks and treatment disutilities.
  • To provide insights for healthcare decision-making regarding interventions with deferred benefits.

Main Methods:

  • Developed three patient vignettes with 10-year cardiovascular risks (10%, 15%, 20%).
  • Adapted a Markov model to incorporate direct treatment disutility (DTD) levels (0.005, 0.01, 0.015) for statin use.
  • Calculated payoff times, both inclusive and exclusive of healthcare costs, for each scenario.

Main Results:

  • For 10% cardiovascular risk and low DTD, payoff time was 8.5 years (excluding costs) and 16 years (including costs).
  • Increasing cardiovascular risk shortened payoff time; higher DTD lengthened it, sometimes resulting in net harm.
  • Payoff time varied significantly based on baseline risk and treatment disutility.

Conclusions:

  • Payoff time is readily applicable to existing decision-analytic models.
  • It complements existing measures for guiding healthcare decisions.
  • This method aids in evaluating interventions with delayed benefits and upfront harms.