SRS Newsletter
June 2012
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Medical Decision Modeling: The Facts

Mark Dekutoski, MD
Education Committee Co-Chair

Mark Dekutoski, MD

The Education Committee has chosen to highlight the efforts of the Scoliosis Research Society Board of Directors (BOD) in enhancing the spine community’s understanding of the societal impact of spine disease, interventions and payer relations.  In collaboration with Covance Services, the SRS BOD has directed an effort to educate the spine community on Medical Decision Modeling in an effort to afford a common language and communication tool for providers to advocate to payers regarding interventions that enhance the quality of life for our patient community. 

Much akin to the methods in “Difficult Conversations: How to Discuss What Matters Most” (D.Stone/Penguin) the methods and concepts in Medical Decision Modeling evoke engagement in a common language, engaging shared interests in patient welfare and demonstrating prudent economic evaluation. With maturation of Medical Decision Modeling the goal is to help mold interactions and insurance carrier decisions into informed, relevant and patient focused policy.

What is Medical Decision Modeling?

  • A Medical Decision Model is a tool for evaluating the clinical AND economic impact of interventions for a given clinical condition.
  • Models simulate reality in a simple, straightforward manner.

Why are Medical Decision Models Useful?

  • Aid decision-making by evaluating and communicating the clinical-economic impact of alternative medical technologies and practice patterns (i.e., weighs the benefits versus costs)
  • Allow integration of numerous data sources into a single analysis
  • Enable simulation and investigation of outcomes beyond the timeframe for which data may exist
  • Allow for evaluation of “What if…” scenarios
  • Allow for evaluation of the impact of uncertainty on results and conclusions

There are Three Major Types of Medical Decision Models
1.  Cost-of-Illness Models

  • Used to estimate costs only (e.g., What is the economic burden of adult degenerative scoliosis in the United States?)
  • Does not consider effectiveness of interventions per se
  • Does not compare interventions

2.  Budget Impact Models

  • Used to estimate costs only (e.g., What is the cost of covering a specific intervention in the population of interest?)
  • Compares two or more alternative treatments
  • Assumes equivalent effectiveness of interventions

3.  Cost-Effectiveness and Cost-Utility Models

  • Used to compare the relative costs and outcomes (effects) of two or more alternative interventions (often new intervention vs. standard of care)
  • Costs and effects are expressed in different units
  • Results most commonly expressed as incremental cost per quality-adjusted life-year (QALY) gained

When and why are these models used? Who is the end user?

1. Cost-of-Illness Models

  • Establish burden of illness and unmet need

2. Budget Impact Models

  • Estimate the economic impact to a payer (cost per member per month, and annually for beneficiaries) of covering an intervention (e.g., procedure)
  • Models can be customized for a specific health plan and are particularly influential to payers

3. Cost-Effectiveness and Cost-Utility Models

  • Identify the additional costs associated with a unit increase in effectiveness
  • Allows comparison across interventions and conditions to prioritize allocation of scarce resources
  • Publications presenting the methods and findings of cost-effectiveness and cost-utility models influential to payers (particularly in Europe) and providers

Committee Co-Chairs: Mark B. Dekutoski, MD; John R. Dimar, MD Committee Members: Joseph H. Perra, MD; Daniel J. Sucato, MD, MS; Brian Hsu, MD; Adam L. Wollowick, MD; Lukas P. Zebala, MD; Eric T. Jones, MD; Glenn R. Rechtine, II, MD; Paul D. Sponseller, MD; Lori A. Karol, MD; Daniel W. Green, MS, MD, FACS; Sigurd H. Berven, MD; John C. France, MD; Kit M. Song, MD, MHA.