③180326はじめての費用対効果分析（論文編）

1. はじめての
費用対効果分析

2. Journal club presentation
Cost Effectiveness!!

3. Journal club presentation style
EBM style

4. To begin with…
Which position is

5. Journal club presentation style
EBM style

6. Journal club presentation style
10

7. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

8. 8. Value of the article (Editorial)
9. Similar studies (Correspondence)
10. Impact of the community (Conference Report)

9. Journal club presentation style
7/10

10. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

11. IMRaD format
oriOriginal Article

12. IMRaD
Introduction
Methods
Results
“Why”
“How”
“What”
Discussion “So what?”
and

13. Abstract
Background
Methods
Results
“Why”
“How”
“What”
Conclusion “So what?”

14. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

15. Title
Title Conclusions

16. Title
Title ConclusionsKnowledge

17. Title

18. Title
Incremental Costs and Cost Effectiveness of
Intensive Treatment in Individuals with Type
2 Diabetes Detected by Screening in the
ADDITION-UK Trial: An Update with
Empirical Trial–Based Cost Data

19. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

20. Affiliation
Global LocalVS

22. Affiliation
n Medical Research Council
Epidemiology Unit,
University of Cambridge
School of Clinical
Medicine, Cambridge, UK;
n UK
n Germany

23. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

24. Abstract
Background
Methods
Results
“Why”
“How”
“What”
Conclusion “So what?”

26. Conclusions
The incremental costs of intensive treatment as delivered in
the ADDITION-Cambridge trial were lower than expected.
Given UK willingness-to-pay thresholds in patients with screen-
detected diabetes, intensive treatment is of borderline cost
effectiveness over a time horizon of 20 years and more.

27. Conclusions
The incremental costs of intensive treatment as delivered in
the ADDITION-Cambridge trial were lower than expected.
Given UK willingness-to-pay thresholds in patients with screen-
detected diabetes, intensive treatment is of borderline cost
effectiveness over a time horizon of 20 years and more.

28. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

29. Abstract
Background
Methods
Results
“Why”
“How”
“What”
Conclusion “So what?”

30. Background
What is known?
What is unknown?
Purpose of the study
Original Contribution

31. Background

32. Background

33. Introduction
n Previous research has shown that intensive multifactorial
treatment, including management of cardiovascular risk
factors and glycemic control, reduces the risk of
cardiovascular events and is an effective and cost-effective
intervention for patients with long-standing diabetes.
n There is also solid evidence that tight control of glucose
and blood pressure in newly routinely diagnosed patients
is an effective and cost-effective strategy.
What is known?

34. The pragmatic cluster-randomized Anglo-Danish-Dutch
Study of Intensive Treatment in People with Screen-
Detected Diabetes in Primary Care-Europe trial
ADDITION trial
- studied the effect of intensive multifactorial treatment compared
with routine care on cardiovascular morbidity and mortality in
individuals with type 2 diabetes detected by screening.
- showed a nonstatistically significant relative risk reduction in the
incidence of the composite cardiovascular end point over a time
horizon of 5 years.
What is known?

35. Abstract
There is uncertainty about the cost effectiveness of early
intensive treatment versus routine care in individuals with type 2
diabetes detected by screening.
Introduction
Conversely, little is known about the cost effectiveness of
intensive treatment in individuals with type 2 diabetes detected
by screening who, all else being equal, will typically be at an earlier
stage in the disease.
What is unknown?

36. Abstract
To derive a trial-informed estimate of the incremental
costs of intensive treatment as delivered in the Anglo-
Danish-Dutch Study of Intensive Treatment in People
with Screen-Detected Diabetes in Primary Care-Europe
(ADDITION) trial and to revisit the long-term cost-
effectiveness analysis from the perspective of the UK
National Health Service*.
Purpose of the study
NHS (National Health Service)
NICE**
NHS
NICE HTA(Health Technology Assessment: ) HTA
Original Contribution

37. Introduction
The objective of this study was therefore to estimate the
incremental costs of early intensive treatment as delivered in
ADDITION using empirical data from electronic primary care records.
We then used this new information to update our previous estimate
of the long-term (10–30 years) cost effectiveness analysis of the
ADDITION intervention in the United Kingdom from a National
Health Service (NHS*) perspective, …
NHS (National Health Service)
: NICE*
NHS
Purpose of the study Original Contribution

38. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

39. Clinical Question
PICO

40. PICO
Intervention Observational
Clinical
Endpoint
Surrogate
Endpoint
orI/C
O
P Patients Study Type
or

41. PICO

42. PICO
P: People with type 2 diabetes detected by screening. [ADDITION trial]
O:
Incremental annual costs of intensive treatment over years 1 to 5
after diagnosis [→Incremental Costs in ADDITION-Cambridge]
incremental cost-effectiveness ratios over the 10-, 20-, and 30-year
time horizon [→Long-Term Cost Effectiveness in ADDITION-UK/-Cambridge]
I : early intensive treatment
C: routine care

43. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

44. Results

45. 1.
2.
3.
4.

46. (CEA)
(CUA)
Tornado Diagram
Scattered Plot
(CEAC)
(CER)
(ICER)
(dominant)
LY
QALY
QOL

47. Outcome Incremental Costs in ADDITION-Cambridge

48. Outcome Incremental Costs in ADDITION-Cambridge

49. Study Population
No substantial differences were observed between the UK sample (n=1024) and the
weighted Cambridge subsample from which empirical cost data were available (n=173).

50. Outcome
A detailed analysis of the cost pattern over time showed that the cost difference
varied considerably between the observation years
Incremental Costs in ADDITION-Cambridge
←Abstract→

51. The primary
care cost
components

52. Significant cost differences between the intensive treatment arm and the routine
care arm were observed only for glucose-lowering and lipid-lowering drugs.
The primary care cost components

53. (CER)
(ICER)
(dominant)
LY
QALY
QOL
(CEA)
(CUA)
Tornado Diagram
Scattered Plot
(CEAC)

54. Long-Term Cost Effectiveness in ADDITION-UK/-CambridgeOutcome

55. Crude accumulated QALYs and costs over the 10-, 20-, and 30-year time
horizon for ADDITION-UK and ADDITION-Cambridge.
Long-Term Cost Effectiveness in ADDITION-UK/-CambridgeOutcome

56. (CER)
(ICER)
(dominant)
LY
QALY
QOL
(CEA)
(CUA)
Tornado Diagram
Scattered Plot
(CEAC)

57. Adjusted incremental QALYs, costs, and ICERs for
ADDITION-UK and ADDITION-Cambridge.
Long-Term Cost Effectiveness in ADDITION-UK/-CambridgeOutcome

58. (CEA)
(CUA)
Tornado Diagram
Scattered Plot
(CEAC)
(CER)
(ICER)
(dominant)
LY
QALY
QOL

59. Scatterplot of the 10-, 20-, and 30-year QALY and cost pairs
Long-Term Cost Effectiveness in ADDITION-UK/-Cambridge
ICER
(QALY)
Outcome

60. Scatterplot of the 10-, 20-, and 30-year QALY and cost pairs
Long-Term Cost Effectiveness in ADDITION-UK/-Cambridge
ICER
(QALY)
Outcome

61. Scatterplot of the 10-, 20-, and 30-year QALY and cost pairs
Long-Term Cost Effectiveness in ADDITION-UK/-Cambridge
ICER
(QALY)
Outcome

62. (Cost-effectiveness acceptability curve: CEAC)
Long-Term Cost Effectiveness in ADDITION-UK/-CambridgeOutcome

63. (Cost-effectiveness acceptability curve: CEAC)
Long-Term Cost Effectiveness in ADDITION-UK/-CambridgeOutcome

64. 1.
2.
3.
4.

65. (CEA)
(CUA)
Tornado Diagram
Scattered Plot
(CEAC)
(CER)
(ICER)
(dominant)
LY
QALY
QOL

66. 1. Title
2. Author Affiliation
3. Conclusion
4. Original contribution of the article (Background)
5. PICO (Methods)
6. Result (ratios, 95%CI)
7. Discussion (Interpretation & Generalizability)

67. 費用対効果分析結果の解釈における注意点
Ø
Ø
Ø ICER
Ø
Ø
Ø
Ø

68. IMRaD
Introduction
Methods
Results
“Why”
“How”
“What”
Discussion “So what?”
and

69. STEP
Put a number on each paragraph.
Underline the topic sentences.
Circle the verbs of the topic sentence

70. STEP
Put a number on each paragraph.
Underline the topic sentences.
Circle the verbs of the topic sentence

71. Paragraphs
Topic Paragraph
Supporting Paragraph
Concluding Paragraph

72. Sentences
Topic Sentence
Supporting Sentence
Concluding Sentence
Topic Sentence
Supporting Sentence
Concluding Sentence
Topic Sentence
Supporting Sentence
Concluding Sentence

73. STEP
Put a number on each paragraph.
Underline the topic sentences.
Circle the verbs of the topic sentence

74. STEP
Put a number on each paragraph.
Underline the topic sentences.
Circle the verbs of the topic sentence

75. Discussion
Summary of Main Findings
Interpretation
Generalization
Conclusions

76. Discussion
Summary of Main Findings
Interpretation
Generalization
Conclusions
Read in summary
Read in summary

77. What type?
Interpretation
Generalization
Interpretation
Generalization
Interpretation
Interpretation
Generalization
Generalization

78. InterpretationSummary of Main Findings

79. InterpretationSummary of Main Findings

80. Generalization

81. Generalization

82. Generalization

83. Generalization

84. Generalization

85. Generalization

86. Generalization

87. Generalization

88. Generalization

89. Conclusions

90. 費用対効果分析結果の解釈における注意点
Ø
Ø
Ø ICER
Ø
Ø
Ø
Ø

91. Journal club presentation
reference

92. Journal club presentation
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