For any given illness or condition requiring medical care, there will usually be a number of different treatments available. These will often include multiple medications, some reasonably new and others with a longer history.
In some cases, the choice of treatment may be confined to identifying the most effective medication versus "watchful waiting/doing nothing." Often, however, the alternatives may also include medical devices, behavioral interventions, or surgical procedures.
How does the prescribing physician choose among these options? How does one determine – in the context of a particular patient – the comparative effectiveness and safety of the competing treatments?
In the United States, for example, pharmaceuticals must be approved by the Food and Drug Administration before they can be marketed. That approval process is rigorous and includes multiple stages of lengthy, expensive clinical trials in which the effectiveness and safety of the new drug are measured, usually against a placebo.
Thus, the fact that there may be 2, 3, or even more drugs on the market approved by the FDA for treating the same condition establishes only that each of these medications is likely to be preferable to no treatment at all in a controlled treatment setting. It says nothing about the relative risks and benefits of competing treatments in realistic usage scenarios. Physicians are left to negotiate the scientific literature, in which consensus about the right treatment may or may not occur.
Comparative Effectiveness Models
TreeAge Pro is used worldwide to build and analyze comparative effectiveness models, helping clinicians choose the optimal treatment for a particular situation. Specialists work together to systematically review the diverse sources of evidence on potentially useful therapies, drawing on the experience of thousands or millions of patients and subjects from different studies. TreeAge models are then used to link the evidence to the decision problem, and rank the options available to clinician and patient based on comparative effectiveness.
This is not, what some detractors of evidence-based medicine have termed, "a one-size-fits-all approach." TreeAge Pro models are supremely flexible and accommodate inclusion and identification of all patient- or subgroup-specific factors which, the evidence shows, may influence treatment ranking. In the shift towards an increasingly evidence-based clinical practice, TreeAge Pro models incorporate the best scientific evidence along with the patient’s preferences, medical history, and risk characteristics.
Not only are comparative effectiveness models built in TreeAge Pro far less costly than clinical trials, but the models can also be continually updated to include new drugs or procedures, and can evolve as additional evidence on effectiveness and safety becomes available.
Comparative effectiveness models built in TreeAge Pro can, but need not, include cost information. Moreover, a model initially built solely to analyze comparative effectiveness can be converted into a cost-effectiveness model simply by adding the requisite cost data. In most cases, there would be no need to modify the model’s structure.
A cost-effectiveness model built in TreeAge Pro can then be analyzed on the basis of comparative effectiveness alone, cost alone, or cost-effectiveness. Switching between analysis perspectives requires only a simple change in the model's calculation preferences.
In TreeAge Pro, models are easily contructed utilizing graphical tree components. With mouse-clicks you specify decision point, chance nodes, Markov states, probabilities, etc. You then choose the desired analysis, and TreeAge Pro automatically enters the correct algorithms and creates customizable charts and graphs relevant to the analysis being performed. In addition, our team
will help you get your comparative effectiveness models up and running quickly. For more information or questions please contact us:
Elsewhere in This Section
> Decision Analysis and Decision Trees
> Markov Models - State Transition Models
> Discrete Event Simulation Models
> Monte Carlo Simulation
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how TreeAge Pro users are using decision analysis. >