SMDM Programabstracts

09:00 Parallel Short Course 1 SR 107 09:00 Parallel Short Course 2 SR 108 09:00 Parallel Short Course 3 SR109
09:00 Parallel Short Course 3 SR109 09:00 Parallel Short Course 4 SR 001
FOCUSED OPERATIONS MANAGEMENT IN HEALTH HOW-TO-WORKSHOP: REVISE AND IMPROVE YOUR INTRODUCTION TO CLINICAL AND ECONOMIC DECISION- ADVANCED DECISION ANALYSIS: PART 1, THEORY
CARE ORGANISATIONS: DOING MORE WITH THE SAME PRESENTATION FOR THE MEETING ANALYTIC MODELING
SUNDAY, MAY 30, 2010
RESOURCES
(10:30 Coffee Break) (10:30 Coffee Break) (10:30 Coffee Break) (10:30 Coffee Break)
(09:00 – 17:00)
12:00 Lunch
14:00 Parallel Short Course 5 IT 001 14:00 Parallel Short Course 6 IT 101 14:00 Parallel Short Course 7 SR 001
DISCRETE EVENT SIMULATION ADVANCED DECISION ANALYSIS: PART 2, HANDS-ON RECOGNIZING EXTERNAL THREATS TO RATIONAL
DECISION MAKING
(15:30 Coffee Break) (15:30 Coffee Break) (15:30 Coffee Break)
19:00 – 21:00 Get-Together Reception
Mounting of posters for Monday, May 31 poster session
08:30 Registration desk opens at UMIT
10:00 Opening Session Hall A
10:30 Plenary Session:
TOP-RANKED ABSTRACTS Hall A
12:00 Lunch
MONDAY, MAY 31, 2010
13:30 Parallel Session 1 - A Hall A 13:30 Parallel Session 1 - B Hall B

(10:00 – 19:00)
PUBLIC HEALTH DECISION MAKING COST-EFFECTIVENESS ANALYSIS

15:00 Coffee Break and Poster Viewing
15:30 Parallel Workshop 1 Hall B 15:30 Parallel Workshop 2 Hall C 15:30 Parallel Workshop 3 SR 101 15:30 Parallel Workshop 4 SR 001
Modeling approaches for analysing health AGENT BASED MODELING AND THE BENEFITS MARKET ACCESS GOAL & MANAGEMENT OPTIMISATION CURRENT AND FUTURE USE OF
care problems – an introductory overview and REGARDING SIMULATION RESULTS (MAGMO) ANALYSIS AS EVIDENCE-BASED METHOD TO PHARMACOECONOMIC AND PHARMACOTHERAPY
comparison EFFICIENTLY SUPPORT STRATEGIC DECISIONS OUTCOMES RESEARCH DATA IN DECISION MAKING
16:30 Symposium I Hall A
PUBLIC HEALTH DECISION MAKING
18:00 Poster Presentations
19:00 Mounting of Posters for Tuesday, June 1 poster session
20:30 Evening Get Together: REMINISCENCES OF THE “OLD DAYS” OF MEDICAL DECISION MAKING
09:00 Parallel Session 2 – A Hall A 09:00 Parallel Session 2 – B Hall B
METHODS PREFERENCES AND CHOICES
TUESDAY, JUNE 1, 2010
11:00 Parallel Panel Discussion 1 – A Hall A 11:00 Parallel Panel Discussion 1 – B Hall B
(08:00 - 17:00)
KEY PRINCIPLES FOR TECHNOLOGY ASSESSMENT AN EXAMPLE OF A SUCCESSFUL IMPLEMENTATION OF VACCINATION

PROGRAMS: DEBATE AND NEW DIRECTIONS PROGRAMME: THE PUBLIC HEALTH IMPACT OF ROTAVIRUS
VACCINATION
12:00 Lunch
HEALTH SERVICES AND OUTCOMES RESEARCH TRANSLATIONAL RESEARCH AND OTHER TOPICS
15:30 Symposium II Hall A
DECISION MAKING IN PERSONALIZED MEDICINE
17:00 Mounting of Posters for Wednesday, June 2 poster session
19:00 Tour of the Hall Mint Museum, followed by a festive dinner at the Salzlager (optional)
07:00 Mounting of posters for Wednesday, June 2 poster session
WEDNESDAY, JUNE 2, 2010

09:00 Plenary Session Hall A
(08:00 – 13:00)
matching HTA for the requirements of national COHERENCE AND CORRESPONDENCE IN MEDICINE: BRINGING
Health Care systems? Lessons learned: the Bismarck NEW LIGHT TO MEDICAL CONTROVERSIES
system, example of Germany and AUSTRIA
CLINICAL DECISION MAKING AND PATIENT-SHARED DECISION MAKING
12:30 Closing Addresses
13:00 Lunch
SOCIETY FOR MEDICAL DECISION MAKING
SMDM Europe 2010

UMIT – University for Health Sciences
Medical informatics and Technology
Hall in Tyrol, Austria
May 30 – June 2, 2010
PROGRAM
CONFERENCE ORGANIZER
Target Conferences Ltd.
PO Box 29041
Tel Aviv 61290, Israel
Tel: +972 3 5175150
Fax: +972 3 5175155
e-mail: target@targetconf.com
2
TABLE OF CONTENTS
Page
Committees..................................................................................................... 4
Acknowledgements ........................................................................................ 5
General Information ....................................................................................... 6
Social Program .............................................................................................. 7
Scientific Program
- Sunday, May 30 – Short Courses............................................................ 8
- Monday, May 31 ..................................................................................... 9
- Tuesday, June 1 ................................................................................... 14
- Wednesday, June 2 .............................................................................. 19
Poster Presentations ................................................................................... 21
Short Course Descriptions ........................................................................... 30
Abstracts – Oral Presentations .................................................................... 39
Abstracts – Poster Presentations ................................................................. 99
Index .......................................................................................................... 185
Program at a Glance...................................................................... Back Cover
3
ORGANIZING COMMITTEE
Co-Chairs
Uwe Siebert, Austria
Elisabeth Fenwick, UK
Joseph Pliskin, Israel
LOCAL ORGANIZING COMMITTEE
Silke Siebert, UMIT, ONCOTYROL, Austria

Patricia Schirmer, ONCOTYROL, Austria
Elisabeth Havasi, UMIT, Austria
Beate Jahn, UMIT, Austria
Gaby Sroczynski, UMIT, Austria
SCIENTIFIC COMMITTEE
Concha Bielza, Spain

Andrew Briggs, Scotland
Isabelle Durand-Zaleski, France
Gottfried Endel, Austria
Dan Greenberg, Israel
Laszlo Gulacsi, Hungary
Marlene Gyldmark, Switzerland
Ivar Kristiansen, Norway
Iga Lipska, Poland
Andreas Maetzel, Canada
Kathryn McDonald, USA
Mark Roberts, USA
Ingrid Rosian, Austria
Sandy Schwartz, USA
Helmut Sitter, Germany
Sandra Spronk, The Netherlands
Anne Stiggelbout, The Netherlands
Jozef van den Ende, Belgium
4
ACKNOWLEDGEMENTS
The Co-Chairs and Organizing Committee wish to acknowledge the following

companies, institutes and organizations whose generous support has made this
Conference possible:
5
GENERAL INFORMATION
VENUE
UMIT – University for Health Sciences, Medical Informatics and Technology
Eduard Wallnöfer-Zentrum 1
Hall in Tyrol, 6060
Austria
Tel: + 43 8648 3000
Email: public-health@umit.at
LANGUAGE
The Conference will be conducted in English.
REGISTRATION / HOSPITALITY / INFORMATION

A registration desk will operate on the first floor of UMIT – Health and Life
Sciences University, on Saturday, May 29, from 17:00 - 20:30, and during the
following times thereafter:
Sunday, May 30: 08:00 – 17:00
Monday, May 31: 08:30 – 19:00
Tuesday, June 1: 07:00 – 17:00
Wednesday, June 2: 07:00 – 13:00
NAME BADGE
Your name badge is included in the material which you received upon
registration. Please wear your badge to all conference sessions and events.
PROJECTION
Computer projection is available. Please see the technician before the
beginning of your session to load your presentation onto the conference
computer in the relevant Hall.
POSTERS
There will be three poster sessions during the Conference.
Poster presenters should refer to the program to find the poster session and
board number assigned to them. Please use the poster board with the
designated number. Presenters are requested to stand next to their posters
during Poster Viewing times.
Monday, May 31 Poster Session – 18:00

Posters should be mounted on Sunday May 30, from 19:00, or on
Monday, May 31, from 08:30. Please ensure that posters are removed by 19:00
on Monday May 31.
Tuesday, June 1 Poster Session – 08:00
Posters should be mounted on Monday May 31, from 19:00, or on
Tuesday, June 1, from 07:00. Please ensure that posters are removed by 17:00
on Tuesday, June 1.
Wednesday, June 2 Poster Session – 08:00
Posters should be mounted on Tuesday June 1, from 17:00, or on
Wednesday, June 2, from 07:00. Please ensure that posters are removed by
13:15 on Wednesday June 2.
Please note that the organizers cannot be held responsible for posters that are
not removed on time.
6
SOCIAL PROGRAM
19:00 GET-TOGETHER RECEPTION (for all registered participants)

At the U Zwei Café, UMIT – Health and Life Sciences University.
20:30 EVENING GET-TOGETHER (for all registered participants)

At the U Zwei Café, UMIT – Health and Life Sciences University.
Reminiscences of the 'Old Days' of Medical Decision Making.
19:00 FESTIVE DINNER (optional)

Champagne Reception and Tour of the Hall Mint Museum,
followed by a festive dinner at the Salzlager.
Please meet in the courtyard of Burg Hasegg Castle and

Mint Tower at 19:00.
Tickets for accompanying persons may be purchased at the registration desk.
7
SCIENTIFIC PROGRAM
________________________________________________________________________
PARALLEL SHORT COURSES

________________________________________________________________________
09:00 – 12:00 Parallel Short Course 1 SR 107
FOCUSED OPERATIONS MANAGEMENT IN HEALTH

CARE ORGANISATIONS: DOING MORE WITH THE
SAME RESOURCES
J. Pliskin, Israel
Parallel Short Course 2 SR 108
HOW-TO-WORKSHOP: REVISE AND IMPROVE YOUR

PRESENTATION FOR THE MEETING
M.G.M. Hunink, The Netherlands
INTRODUCTION TO CLINICAL AND ECONOMIC

DECISION-ANALYTIC MODELING
U. Siebert, Austria
ADVANCED DECISION ANALYSIS: PART 1, THEORY

M.S. Roberts, USA
12:00 Lunch
14:00 – 17:00 Parallel Short Course 5 IT 001
DISCRETE EVENT SIMULATION

B. Jahn, Austria and J. Stahl, USA
Parallel Short Course 6 IT 101
ADVANCED DECISION ANALYSIS:

PART 2, HANDS-ON
M.S. Roberts, USA
RECOGNIZING EXTERNAL THREATS TO RATIONAL

DECISION MAKING
R.M. Poses and W.R. Smith, USA
There will be a coffee break at 10:30 and 15:30
8
SUNDAY, MAY 30, 2010 (continued)
19:00 – 21:00 Get-Together Reception at UMIT


________________________________________________________________________
10:00 – 10:30 Opening Session Hall A

________________________________________________________________________
WELCOME ADDRESS
U. Siebert, Co-Chair, SMDM Europe Meeting 2010, Austria

K.M. McDonald, SMDM President, USA
________________________________________________________________________
10:30 – 12:00 Plenary Session Hall A

________________________________________________________________________
TOP-RANKED ABSTRACTS
Chairpersons: E. Fenwick, UK
K.M. McDonald, USA
10:30 ARE INCREMENTAL BENEFITS FROM NEW TECHNOLOGY

DECREASING? AN ANALYSIS OF QALY GAINS OVER TIME
D. Greenberg, J.T. Cohen, P.J. Neumann, Israel
10:45 IMPUTING QALYS FROM SINGLE TIME POINT HEALTH STATE

DESCRIPTIONS ON THE EQ-5D AND THE SF-6D: A COMPARISON OF
METHODS FOR HEPATITIS A PATIENTS
J. Luyten, C. Marais, N. Hens, K. De Schrijver, P. Beutels, Belgium
11:00 HOSPITAL RANKINGS IN THE NETHERLANDS DO NOT PROVIDE

RELIABLE PATIENT INFORMATION
H. Pons, H.F. Lingsma, E.W. Steyerberg, R. Bal, The Netherlands
11:15 BENZODIAZEPINES RENEWALS: IS THERE A POSSIBILITY FOR

SHARED DECISION?
C. Rat, J.P. Canevet, R. Senand, France
11:30 MULTIDIMENSIONAL OMISSION BIAS IN PARENTS’ VACCINE

DECISION-MAKING
K.F. Brown, J.S. Kroll, M. Ramsay, M. Hudson, J. Green, C. Vincent,
G. Fraser, N. Sevdalis, UK
11:45 ORPHAN DRUGS: DOES SOCIETY VALUE RARITY?

A.S. Desser, D. Gyrd-Hansen, J.A. Olsen, S. Grepperud,
I.S. Kristiansen, Norway
9
MONDAY, MAY 31, 2010 (continued)
12:00 Lunch
________________________________________________________________________
13:30 – 15:00 Parallel Session 1 - A Hall A

________________________________________________________________________
Chairpersons: J.E. Stahl, USA

J. van den Ende, Belgium
13:30 ARE TRANSITION SUPPORT SERVICES FOR LOOKED AFTER

CHILDREN COST EFFECTIVE?
A. Duenas, J. Chilcott, E. Everson-Hock, R. Jones, E. Goyder, UK
13:45 COST-EFFECTIVENESS OF SMOKING CESSATION WITH

VARENICLINE IN PATIENTS WITH CORONARY HEART DISEASE
P. Aidelsburger, J. Wasem, Germany
14:00 MULTI AGENT SIMULATION TECHNIQUES FOR DYNAMIC

SIMULATION OF SOCIAL INTERACTION AND SPREAD OF DISEASES
WITH DIFFERENT SEROTYPES
N. Popper, G. Zauner, F. Breitenecker, G. Endel, Austria
14:15 MODELING THE INTRODUCTION OF PCV7 TO THE CHILDREN

VACCINATION PROGRAM IN AUSTRIA USING MARKOVIAN
PROCESSES
C. Urach, N. Popper, G. Zauner, F. Breitenecker, G. Endel, Austria
14:30 LONG-TERM EFFECTIVENESS AND COST-EFFECTIVENESS OF

PRIMARY HPV SCREENING FOR CERVICAL CANCER IN GERMANY
- A DECISION ANALYSIS
G. Sroczynski, P. Schnell-Inderst, N. Muehlberger, K. Lang,
P. Aidelsburger, J. Wasem, T. Mittendorf, J. Engel, P. Hillemanns,
K.U. Petry, A. Kraemer, U. Siebert, Austria
14:45 DIRECT COST AND NET COSTS OF ROAD TRAFFIC

ENFORCEMENT IN THAILAND
N. Singweratham, J. Podang, Thailand
10
________________________________________________________________________
13:30 – 15:00 Parallel Session 1 - B Hall B

________________________________________________________________________
COST-EFFECTIVENESS ANALYSIS
Chairpersons: S. Spronk, The Netherlands

M.C. Weinstein, USA
13:30 COST-EFFECTIVENESS OF DRUG-ELUTING STENTS VERSUS

BARE-METAL STENTS IN ACUTE MYOCARDIAL INFARCTION:
SUPERIORITY USING BOTH REGISTRY DATA AND TRIAL DATA
T. Wisløff, I.S. Kristiansen, D. Atar, Norway
13:45 ESTIMATING THE FINANCIAL BURDEN OF STROKE IN FRANCE:

A COST-OF-ILLNESS STUDY
K. Chevreul, A. Gouépo, I. Durand-Zaleski, France
14:00 COST-UTILITY ANALYSIS OF DIFFERENT SYSTEMS OF ORGANISED

INPATIENT (STROKE UNIT) CARE
L. Govan, C.J. Weir, P. Langhorne, UK
14:15 ECONOMIC EVALUATION OF OSTEOPOROSIS MANAGEMENT

STRATEGIES: HANDLING UNCERTAINTY PERTAINING TO THE
STRUCTURE OF DECISION-ANALYTIC MODELS
S. Bahrami, K. Alzahouri, F. Guillemin, I. Durand-Zaleski, France
14:30 HERD BEHAVIOR AND HERD IMMUNITY

DOES MAN HAVE PREEMINENCE ABOVE BEAST?
M.J. Cohen, M. Brezis, Israel
14:45 DOES ADJUSTING FOR HEALTH-RELATED QUALITY OF LIFE MATTER

IN COST-EFFECTIVENESS ANALYSES? A COMPARISON OF
COST/LIFE YEAR AND COST/QALY ESTIMATES
D. Greenberg, J.T. Cohen, C-H. Fang, P.J. Neumann, Israel
________________________________________________________________________
15:30 – 16:30 Parallel Workshop 1 Hall B

________________________________________________________________________
MODELING APPROACHES FOR ANALYSING HEALTH CARE

PROBLEMS – AN INTRODUCTORY OVERVIEW AND COMPARISON
Speakers:
S. Brailsford, School of Management, University of Southampton,
Southampton, UK
B. Jahn, UMIT - University for Health Sciences, Medical Informatics and
Technology, Hall i.T., Austria
M.S. Roberts, Department of Health Policy and Management, University of
Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
J. Stahl, MGH – Institute for Technology Assessment, Massachusetts
General Hospital, Boston, MA, USA
G. Zauner, dwh Simulation Services, Vienna, Austria
11
________________________________________________________________________
15:30 – 16:30 Parallel Workshop 2 Hall C

________________________________________________________________________
AGENT BASED MODELING AND THE BENEFITS REGARDING

SIMULATION RESULTS
Speakers:
M. Gyimesi, Vienna University of Technology, Institute for Analysis and
Scientific Computing, Vienna, Austria
N. Pfeffer, Main Association of Austrian Social Insurance Institutions,
Vienna, Austria
N. Popper, dwh Simulation Services, Vienna, Austria
________________________________________________________________________
15:30 – 16:30 Parallel Workshop 3 SR 101

________________________________________________________________________
MARKET ACCESS GOAL & MANAGEMENT OPTIMISATION (MAGMO)

ANALYSIS AS EVIDENCE-BASED METHOD TO EFFICIENTLY
SUPPORT STRATEGIC DECISIONS
Speakers:
E. Rogozinska, Arcana Institute, Krakow, Malopolskie, Poland
N.M. Wilk, Arcana Institute, Krakow, Malopolskie, Poland
________________________________________________________________________
15:30 – 16:30 Parallel Workshop 4 SR 001

________________________________________________________________________
CURRENT AND FUTURE USE OF PHARMACOECONOMIC AND

PHARMACOTHERAPY OUTCOMES RESEARCH DATA IN DECISION
MAKING
Speakers:
J. Biskupiak, Department of Pharmacotherapy, University of Utah College
of Pharmacy, Salt Lake City, UT, USA
D.I. Brixner, Department of Pharmacotherapy, University of Utah College of
Pharmacy, Salt Lake City, UT, USA
A-P. Holtorf, BioBridge Strategies, Basel, Switzerland
12
________________________________________________________________________
16:30 – 18:00 Symposium I Hall A

________________________________________________________________________
Moderator: I.S. Kristiansen, Norway
Speakers: Discussants:
J.S. Schwartz, USA. M. Drummond, UK
M. Drummond, UK Y. Mégard, France
Y. Mégard, France J.S. Schwartz, USA
M.C. Weinstein, USA
19:00 Mounting of posters for Tuesday, June 1 poster session
________________________________________________________________________
20:30 – 21:30 Evening Get-Together U Zwei

________________________________________________________________________
REMINISCENCES OF THE "OLD DAYS" OF MEDICAL DECISION MAKING
Moderator: U. Siebert
Co-Chair of SMDM Europe Meeting and Member of the SMDM
Board of Trustees
Professor of Public Health, UMIT, Austria, Adjunct Professor of Health
Policy and Management, Harvard School of Public Health, USA
Invited Guests:
M.C. Weinstein
Past SMDM President and Past Member of SMDM Board of Trustees
Henry J. Kaiser Professor of Health Policy and Management,
Department of Health Policy and Management & Department of
Biostatistics, Harvard School of Public Health, Boston, MA, USA
J. Pliskin
Co-Chair of SMDM Europe Meeting
Sidney Liswood Professor of Health Care Management, Department of
Industrial Engineering and Management & Department of Health Systems
Management, Ben-Gurion University of the Negev, Israel
Adjunct Professor of Health Policy and Management at the Department of
Health Policy and Management at the Harvard School of Public Health,
Boston, MA, USA
J.S. Schwartz
Past SMDM President and Past Member of SMDM Board of Trustees
Professor of Medicine, Health Care Management and Economics,
Department of Health Care Management, University of Pennsylvania,
PA, USA
13
07:00 Mounting of posters for Tuesday, June 1 poster session
________________________________________________________________________
09:00 – 10:30 Parallel Session 2 - A Hall A

________________________________________________________________________
METHODS
Chairpersons: A. Briggs, UK
G. Sroczynski, Austria
09:00 A REVIEW OF MODELING THE MANAGEMENT OF COMPLICATIONS

OR THE PROGRESSION OF DIABETES MELLITUS
L. Renard, I. Borget, Luxembourg
09:15 A POLICY MODEL FOR COPD: USING CONCEPTUAL MODELLING OF

CAUSAL LINKAGES TO GET BEYOND THE MARKOV CHAIN
A.H. Briggs, H. Starkie, N. Roberts, M. Chambers, UK
09:30 ESTIMATING SURVIVAL GAINS – CAN WE RELY ON “END-of-STUDY”

RESULTS?
I.S. Kristiansen, Norway
09:45 THE NUMERACY UNDERSTANDING IN MEDICINE INSTRUMENT

(NUMi): A NEW MEASURE OF HEALTH NUMERACY DEVELOPED
USING ITEM RESPONSE THEORY
M.M. Schapira, M.C. Walker, K.E. Fletcher, P. Ganchow, E. Jacobs,
S. Del Pozo, C. Schauer, USA
10:00 ECONOMIC EVALUATION OF HUMAN LIFE –

A NEW APPROACH BASED ON COMPENSATION FOR PAIN AND
SUFFERING
A. Leiter, M. Thöni, H. Winner, Austria
10:15 DIAGNOSIS OF SPUTUM SMEAR-NEGATIVE PULMONARY

TUBERCULOSIS BY THE TB DIAGNOSTIC COMMITTEE: LOGLINEAR
AND CLASSIFICATION TREE MODELS OF A POSITIVE CHEST X-RAY
READING
C.R.E. Alfonte, Philippines
14
TUESDAY, JUNE 1, 2010 (continued)
________________________________________________________________________
09:00 – 10:30 Parallel Session 2 - B Hall B

________________________________________________________________________
PREFERENCES AND CHOICES
Chairpersons: J. Pliskin, Israel

H. Sitter, Germany
09:00 FRAMING EFFECTS OF MEDICAL BELIEFS IN DECISIONS MAKING

AND CAUSAL JUDGMENTS
S.M. Müller, R. Garcia-Retamero, A. Catena, A. Maldonado, Spain
09:15 RISKY DECISION MAKING WITH GAMBLES AND MEDICAL

TREATMENTS
M.H. Birnbaum, J.P. Bahra, USA
09:30 THE EFFECT OF RISK AVERSION ON TESTING AND TREATMENT

THRESHOLDS IN DIAGNOSTIC TESTING
S. Felder, T. Mayrhofer, Germany
09:45 SELF-ESTIMATION ON FRACTURE RISK AND LENGTH OF LIFE:

ISSUES TO CONSIDER FOR 10-YEAR FRACTURE RISK BASED
DECISION MAKING IN OSTEOPOROSIS
M. Péntek, V. Brodszky, K. Érsek, P. Baji, E. Orlewska, E. Tóth,
C. Horváth, L. Gulácsi, Hungary
10:00 CHOOSING BETWEEN HOSPITALS: THE INFLUENCE OF PATIENT

EXPERIENCES
I.B. de Groot, J. Dijs-Elsinga, W. Otten, J. Kievit,
P.J. Marang-van de Mheen, The Netherlands
10:15 CLINICAL EFFECTIVENESS OF TRIPLE THERAPY IN THE

MANAGEMENT OF COPD
K. Gaebel, G. Blackhouse, P. Hernandez, F. Xie,
D. Robertson, A. McIvor, N. Assasi, R. Goeree, Canada
15
________________________________________________________________________
11:00 – 12:00 Parallel Panel Discussion 1 – A Hall A

________________________________________________________________________
KEY PRINCIPLES FOR TECHNOLOGY ASSESSMENT PROGRAMS:

DEBATE AND NEW DIRECTIONS
Moderator: M. Helfand, Oregon Evidence Based Practice Center, Portland,

OR, USA
Panelists:
M. Drummond, Department of Health Sciences, University of York,
Heslington, York, UK
N. McElwee, U.S. Outcomes Research, Merck & Company, Inc., North
Sumneytown Pike, North Wales, PA, USA
J.S. Schwartz, Department of Health Care Management, University of
Pennsylvania, PA, USA

________________________________________________________________________
11:00 – 12:00 Parallel Panel Discussion 1 - B Hall B

________________________________________________________________________
AN EXAMPLE OF A SUCCESSFUL IMPLEMENTATION OF

VACCINATION PROGRAMME: THE PUBLIC HEALTH IMPACT OF
ROTAVIRUS VACCINATION
Moderator: C. Giaquinto, University of Padua, Padua, Italy
Panelists:
N. Alsayed, Sanofi Pasteur MSD, Lyon, France
M. Toumi, Creativ-Ceutical, Paris, France
12:00 Lunch
16
________________________________________________________________________
13:30 – 14:45 Parallel Session 3 – A Hall A

________________________________________________________________________
HEALTH SERVICES AND OUTCOMES RESEARCH
Chairpersons: R. Goeree, Canada

H. Gothe, Austria
13:30 HOSPITAL MORTALITY OR FOLLOW-UP MORTALITY FOR QUALITY

REPORTING? ANALYSIS OF QUALITY REPORTS COVERING INSURED
FROM LOCAL SICKNESS FUNDS
J. Stausberg, Germany
13:45 IMPACT OF ALTERNATIVE DEFINITIONS OF MEDICATION

COMPLIANCE ON TREATMENT COST FOR MEDI-CAL PATIENTS WITH
SCHIZOPHRENIA
J. Pai, J.M. McCombs, USA
14:00 CHANGES IN QUALITY OF LIFE AND UTILITY IN HEART FAILURE

PATIENTS: A COMPARISON OF TRAJECTORIES
P. Kolm, C.T. Jurkovitz, W.S. Weintraub, USA
14:15 IS QUALITY OF LIFE EVALUATED BY EXPERTS AND BY THE GENERAL

POPULATION IN THE SAME MANNER? IMPACT ON A COST-UTILITY
ANALYSIS
V. Koné, S. Calmus, G. Vidal-Trécan, France
14:30 INDIVIDUAL PATIENT DATA META-ANALYSIS OF COMPLEX

INTERVENTIONS – AN EXAMPLE WITH EARLY MOBILISATION IN
STROKE
L.E. Craig, J. Bernhard, P. Langhorne, O. Wu, UK
________________________________________________________________________
13:30 – 15:00 Parallel Session 3 – B Hall B

________________________________________________________________________
TRANSLATIONAL RESEARCH AND OTHER TOPICS
Chairpersons: M.S. Roberts, USA

M. Gyldmark, Switzerland
13:30 CARE COORDINATION: WHAT WORKS? HARNESSING A VAST

LITERATURE THROUGH A SYSTEMATIC REVIEW OF SYSTEMATIC
REVIEWS
K.M. McDonald, V. Sundaram, C. Smith-Spangler, L. Albin,
D.M. Bravata, D.K. Owens, USA
13:45 HORIZON SCANNING IN ONCOLOGY – EVALUATION OF NEW AND

EMERGING ANTICANCER DRUGS IN AUSTRIA
A. Nachtnebel, S. Geiger-Gritsch, K. Hintringer, Austria
17
________________________________________________________________________
13:30 – 15:00 Parallel Session 3 – B (continued) Hall B

________________________________________________________________________
14:00 FROM 10-YEAR RISK SCORING TO LIFETIME (RISK) BENEFIT IN THE

PREVENTION OF CARDIOVASCULAR DISEASE
A.H. Briggs, K.D. Lawson, J. Lewsey, UK
14:15 DOES COST-EFFECTIVENESS ANALYSIS DISCRIMINATE AGAINST

PATIENTS WITH SHORT LIFE EXPECTANCY? MATTERS OF LOGIC
AND MATTERS OF CONTEXT
M. Paulden, A.J. Culyer, UK
14:30 FUZZY LOGIC APPROACH TO ELABORATION OF MEDICAL

GUIDELINES
K. Pagava, T. Kiseliova, L. Bakashvili, I. Korinteli,
J. Meladze, Georgia
14:45 COVERAGE WITH EVIDENCE DEVELOPMENT AS A SILVER BULLET?

– SOME CAUTIOUS CONSIDERATIONS
P. Storz, D. Bühler, B. Egger, Germany
________________________________________________________________________
15:30 – 17:00 Symposium II Hall A

________________________________________________________________________
Moderator: U. Siebert, Austria
Speakers: M.G. Hansson, Sweden

K. Payne, UK
19:00 Champagne Reception and Tour of the Hall Mint Museum, followed by a
festive dinner at the Salzlager (optional)
18
________________________________________________________________________

________________________________________________________________________
Chairpersons: I.S. Kristiansen, Norway

M.M. Schapira, USA
09:00 VALUING GENETIC TESTS AND SERVICES: THE ROLE OF HEALTH

STATUS
K. Payne, M. McAllister, L. Davies, UK
09:15 COST-EFFECTIVENESS OF THE CHEK2 GENOTYPING AND

PERSONALIZED BREAST CANCER SCREENING IN THE POLISH
HEALTH-CARE SYSTEM
E. Orlewska, J. Lubinski, Poland
09:30 SHOULD WE IMPLEMENT TARGETED ACTIONS TO IMPROVE

ADHERENCE TO THE NATIONAL PROGRAM OF COLORECTAL
CANCER SCREENING?
J. Le Breton, N. Journy, A. Prigent, P. Le Corvoisier, Z. Brixi,
K. Chevreul, France
________________________________________________________________________
10:00 – 11:00 Parallel Panel Discussion 2 - A Hall A

________________________________________________________________________
MATCHING HTA FOR THE REQUIREMENTS OF NATIONAL HEALTH

CARE SYSTEMS? LESSONS LEARNED: THE BISMARCK SYSTEM,
EXAMPLE OF GERMANY AND AUSTRIA
Moderator: A. Ruether, German Institute for Quality and Efficiency in Health

Care, (IQWiG), Cologne, Germany
Panelists:
S-L. Antoine, German Institute for Medical Documentation and Information
(DIMDI), Cologne, Germany
M. Hofmarcher-Holzhacker, Gesundheit Österreich GmbH (GÖG), Vienna,
Austria
I. Rosian-Schikutav, Austrian Health Institute (GÖG, BIQG),Vienna
Austria
19
WEDNESDAY, JUNE 2, 2010 (continued)
________________________________________________________________________
10:00 – 11:00 Parallel Panel Discussion 2 - B Hall B

________________________________________________________________________
COHERENCE AND CORRESPONDENCE IN MEDICINE: BRINGING

NEW LIGHT TO MEDICAL CONTROVERSIES
Moderator: R. Poses, Brown University, Providence, RI, USA
Panelists:
T.G. Tape, University of Nebraska Medical Center College of Medicine,
Omaha, Nebraska, NE, USA
R.S. Wigton, University of Nebraska Medical Center College of Medicine,
________________________________________________________________________

________________________________________________________________________
CLINICAL DECISION MAKING AND PATIENT-SHARED DECISION

MAKING
Chairpersons: M.G.M. Hunink, The Netherlands

J. Hamann, Germany
11:30 PSYCHOMETRIC PROPERTIES OF THE SHARED DECISION-MAKING

QUESTIONNAIRE – PHYSICIAN VERSION (SDM-Q-DOC)
I. Scholl, A. Buchholz, L. Kriston, J. Dirmaier, M. Härter, Germany
11:45 WHY DO SOME PATIENTS WITH SCHIZOPHRENIA WANT TO BE

ENGAGED IN MEDICAL DECISION MAKING AND OTHERS DON’T?
J. Hamann, R. Mendel, W. Kissling, A. Berthele, Germany
12:00 CONSTRUCTING EXPLANATORY PROGNOSTIC PROFILES FROM

CONDITIONAL PROBABILITY TABLES BY CLUSTER-KBM2L ANALYSIS
J.A. Fernandez del Pozo, C. Bielza, P.J.F. Lucas, The Netherlands
12:15 ALGORITHMIC APPROACH TO DIAGNOSTICS OF RARE DISEASES

T. Kiseliova, M. Korinteli, I. Korinteli, K. Pagava, Georgia
________________________________________________________________________
12:30 – 13:00 Closing Addresses Hall A

________________________________________________________________________
CLOSING REMARKS AND AWARDS CEREMONY
E. Fenwick, UK, Co-Chair

J. Pliskin, Israel, Co-Chair
U. Siebert, Austria, Co-Chair
13:00 Lunch
20
________________________________________________________________________
POSTER PRESENTATIONS - MONDAY, MAY 31, 2010

________________________________________________________________________
1. COST-EFFECTIVENESS OF VARENICLINE FOR SMOKING CESSATION IN

PATIENTS WITH DIABETES MELLITUS TYPE 2
P. Aidelsburger, J. Wasem, Germany
2. COST-EFFECTIVENESS OF SMOKING CESSATION WITH VARENICLINE IN

PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
K. Lang, J. Wasem, P. Aidelsburger, Germany
3. HTA IN GERMANY – SUPPORTING HEALTH DECISION-MAKING

S-L. Antoine, Germany
4. COST-EFFECTIVENESS ANALYSIS OF CAPECITABINE FOR THE

ADJUVANT TREATMENT OF COLON CANCER IN ROMANIA
A. Croitoru, P. Curescu, P.C. Radu, B. Pana, S. Baculea, Romania
5. ECONOMIC EVALUATION OF HOSPITAL INFECTION CONTROL

INTERVENTIONS : DESIGN ISSUES IN THE EVALUATION ALONGSIDE THE
MOSAR CLINICAL TRIALS
S. Bahrami, M. Padget, I. Durand-Zaleski, France
6. CAREFUL COMPARISON OF THE USE OF DEPRESSION-RELATED

MEDICATIONS AFTER INITATION TO SCREENING FOR PROSTATE
CANCER: USEFUL FOR DECISION MODELS?
N. Booth, T. Tammela, A. Auvinen, P. Rissanen, Finland
7. IS PET/CT IMAGING FOR PATIENTS WITH RECURRENT COLORECTAL

CANCER COST-EFFECTIVE? A PRE-TRIAL ECONOMIC MODEL
K.A. Boyd, E. Fenwick, J. Brush, M. Dunlop, F. Crawford, F. Chappell,
H. McIntosh, M. Dozier, J. Glanville, A. Renehan, D. Weller, Scotland, UK
8. THE VALUE OF PET/CT IMAGING FOR STAGING IN PATIENTS WITH

PRIMARY COLORECTAL CANCER: A PRE-TRIAL ECONOMIC MODEL FOR
COST-EFFECTIVENESS ANALYSIS
H. McIntosh, M. Dozier, J. Glanville, A. Renehan, D. Weller, Scotland, UK
9. EARLY IMPACT AND COST-EFFECTIVENESS OF A VACCINATION

AGAINST HERPES ZOSTER AND POSTHERPETIC NEURALGIA
ESTIMATED FOR VARIOUS AGE COHORTS IN THE UK
M. Martin, M. Papageorgiou, X. Bresse, UK, France
10. HOW DO PARENTS PRIORITISE INFORMATION IN VACCINE DECISIONS?

A MULTIFACTORIAL EXPERIMENTAL MODEL
K.F. Brown, J.S. Kroll, M. Ramsay, M. Hudson, J. Green, C. Vincent, G. Fraser,
N. Sevdalis, UK
11. THE UK MMR CATCH-UP CAMPAIGN 2008-9: EVALUATION IN TWO

LONDON PRIMARY CARE TRUSTS
K.F. Brown, R. Shanley, N. Cowley, J. van Wijgerden, P. Toff, J.S. Kroll,
M. Ramsay, M. Hudson, J. Green, C. Vincent, G. Fraser, N. Sevdalis, UK
21
________________________________________________________________________
POSTER PRESENTATIONS - MONDAY, MAY 31, 2010 (continued)

________________________________________________________________________
12. EVALUATION OF DISEASE MANAGEMENT PROGRAMMES IN FRANCE:

METHODES, PRACTICE AND PERSPECTIVES
K. Chevreul, M. Brunn, I. Durand-Zaleski, France
13. THE COST-EFFECTIVENESS OF BASELINE MRI VERSUS CT IN PATIENTS

WITH CLINICAL SYMPTOMS STRONGLY SUGGESTIVE OF STROKE—A
DECISION ANALYSIS
K. Burton, Canada
14. IMPACT OF CONSUMER DIRECTED HEALTH PLANS ON HEALTHCARE

UTILIZATION AND COSTS
T.M. Waters, C.F. Chang, D.M. Mirvis, W.T. Cecil, P. Kasteridis, USA
15. THE COST OF SCHIZOPHRENIA: AN INTERNATIONAL NON SYSTEMATIC

LITERATURE REVIEW
I. Durand-Zaleski, N. Charrier, A. Bourmaud, A.Gouepo, K. Chevreul, France
16. BEYOND COST EFFECTIVENESS ANALYSIS: THE ORGANIZATIONAL

IMPACT OF TECHNOLOGICAL CHANGE IN HEALTH CARE. APPLICATION
TO INNOVATIONS IN COLORECTAL CANCER SCREENING
P. Chauvin, D. Heresbach, J-M. Josselin, J. Grolier, France
17. THE EFFECTS OF ABSOLUTE RISKS, RELATIVE RISKS, FREQUENCIES,

AND PROBABILITIES ON DECISION QUALITY
J. Covey, UK
18. DECISIONS BY MIDWIVES TO TRANSFER SLOW PROGRESS IN LABOUR

CASES TO OBSTETRIC CARE: A VIGNETTE STUDY TO EXPLAIN
VARIATION IN TRANSFER RATES
L. Dalgleish, H. Cheyne, C. Niven, UK
19. FACTORS DETERMINING FUTURE HOSPITAL CHOICE OF SURGICAL

PATIENTS: EXPLORATORY FACTOR ANALYSIS
P.J. Marang-van de Mheen, Y. Peeters, J. Dijs-Elsinga, I.B. de Groot,
J. Kievit, The Netherlands
20. HOSPITAL PERFORMANCE DATA IN THE PUBLIC DOMAIN: DO PATIENTS

COMPARE HOSPITALS?
I.B. de Groot, J. Dijs-Elsinga, W. Otten, J. Kievit, P.J. Marang-van de Mheen,
The Netherlands
21. VACCINE EFFECTIVENESS (VE) – VACCINATION IMPACT.

DEFINITION, SIMILARITIES AND DIFFERENCES. THE EXAMPLE OF
ROTAVIRUS (RV) VACCINATION
T. Derrough, G. Dominiak-Felden, France
22. ARE DIET AND EXERCISE INTERVENTIONS COST EFFECTIVE IN THE

WEIGHT MANAGEMENT AFTER CHILDBIRTH?
A. Duenas, A. Radwin, J. Chilcott, J. Messina, F. Campbell, E. Goyder, UK
22
________________________________________________________________________
POSTER PRESENTATIONS - MONDAY, MAY 31, 2010 (continued)

________________________________________________________________________
23. COSTING AN INNOVATIVE DIAGNOSTIC TEST IN HEPATITIS B AND C

(FIBROSCAN®) AND PREDICTING THE IMPACT OF ITS REIMBURSEMENT
K. Chevreul, A. Gouepo, P. Perez, J. Asselineau, F. Degos,
I. Durand-Zaleski, France
24. COST EFFECTIVENESS OF A FULL PUBLIC REIMBURSEMENT OF

SMOKING CESSATION TREATMENTS IN FRANCE
E. Chan, K. Chevreul, I. Durand-Zaleski, France
25. CPG-RECOMMENDATIONS: A VALID BASE FOR DECISION-MAKING? NEW

METHODS FOR THE ASSESSMENT OF CPG CONTENT
M. Eikermann, N. Holzmann, A. Ruether, Germany
26. DEVELOPMENT OF A DYNAMIC MODEL STRUCTURE FOR COMPARING

AMBULATORY REIMBURSEMENT SYSTEMS
F. Breitenecker, P. Einzinger, G. Endel, M. Gyimesi, L. Meier, N. Pfeffer,
N. Popper, A. Weisser, Austria
27. MOBILE MEDICAL RECORD – A LIFE SAVING TOOL

N. Friedman, A. Goldberg, Israel
28. QUANTIFYING THE AVOIDABLE COST BURDEN OF PREECLAMPSIA – A

COMPARATIVE CASE STUDY
N. Hadker, E. Shaw-Caffrey, J. Gartemann, W. van der Helm, S. Garg,
J. Creeden, USA, Switzerland
29. MOBILE PHONE USE FOR CONTACTING EMERGENCY SERVICES IN LIFE

THREATENING CIRCUMSTANCES: A RECORD LINKAGE STUDY
O. Wu, A. Briggs, T. Kemp, A. Gray, K. MacIntyre, J. Rowley, K. Willett, UK
23
________________________________________________________________________
POSTER PRESENTATIONS - TUESDAY, JUNE 1, 2010

________________________________________________________________________
1. EVALUATING THE EFFECT OF FRAME AND LEXICAL VALENCE ON

COLON-CANCER SCREENING UPTAKE
T. Gavaruzzi, L. Lotto, Italy
2. DEVELOPMENT OF A COMPUTER –ADAPTIVE VERSION OF

ONCOLOGICAL PATIENT-REPORTED OUTCOME MEASURES
J.M. Giesinger, G. Kemmler, E.M. Gamper, A. Oberguggenberger,
B. Holzner, Austria
3. DEVELOPMENT OF A TYPOLOGY OF DECISIONS IN MEDICAL

ENCOUNTERS
P. Gulbrandsen, Norway
4. EXPLAINING RISK REDUCTIONS TO PATIENTS: DO PHYSICIANS USE

NUMBERS?
P.A. Halvorsen, O.G. Aasland, I.S. Kristiansen, Norway
5. HOW SHOULD PATIENTS BEHAVE TO FACILITATE SHARED DECISION

MAKING – THE DOCTORS’ VIEW
J. Hamann, R. Mendel, W. Kissling, E. Knipfer, H.H. Eckstein, Germany
6. POPULATION GROWTH IMPACT ASSESSMENT (PGIA), THE NEGLECTED

MILLENNIUM DEVELOPMENT GOAL
A. Hamedanizadeh, Norway
7. THE USE OF PROXY OUTCOME MEASUREMENTS: A REVIEW AND A

CASE STUDY
B. Hanson, Switzerland
8. ADAPTIVE CONJOINT ANALYSIS AS A DECISION AID FOR

DYSFUNCTIONAL UTERINE BLEEDING
L.M. Hess, A. Litwiller, K. Kasper, J. Stutsman, J. Byron, L. Learman, USA
9. DEVELOPMENT OF A FLAG SYSTEM FOR THE COMPUTERIZED

DETECTION OF CANCER PATIENTS WITH ADDITIONAL TREATMENT
NEEDS BY MEANS OF THE “COMPUTER BASED HEALTH EVALUATION
SYSTEM” (CHES)
B. Holzner, G. Kemmler, J. Giesinger, E. Gamper, A. Oberguggenberger,
A. Zabernigg, B. Sperner-Unterweger, Austria
10. GEOGRAPHIC DISTRIBUTION OF CCU BEDS IN IRAN

A.A. Kiadaliri, H. Safari, R. Hosseinpour, Sweden, Iran
11. DETERMINING THE TECHNICAL EFFICIENCY OF HOSPITALS USING DATA

ENVELOPMENT ANALYSIS: A NATIONAL-WIDE STUDY ON
GOVERMENTAL HOSPITALS IN IRAN
B. Najafi, A.A. Kiadaliri, Iran, Sweden
24
________________________________________________________________________
POSTER PRESENTATIONS - TUESDAY, JUNE 1, 2010 (continued)

________________________________________________________________________
12. MOTIVATION TO UNDERGO PSA TEST AND WILLINGNESS TO PAY OF

SCREENING FOR PROSTATE CANCER
N. Koinuma, M. Ito, Japan
13. A DISCRETE EVENT SIMULATION APPROACH IN MODELING THE HEALTH

AND ECONOMIC IMPACT OF HPV VACCINATION AND CERVICAL CANCER
SCREENING
P. Quon, D. Vanness, P. Hillemanns, N. Largeron, V. Rémy, USA, Germany,
France
14. COMPARISON OF TWO DATA COLLECTION PROCESSES IN CLINICAL

TRIALS: ELECTRONIC AND PAPER CASE REPORT FORMS
C. Alberti, A. Le Jeannic, I. Durand-Zaleski, France
15. DECISION MAKING ON PARTICIPATION IN A RANDOMIZED CONTROLLED

TRIAL IN TRAUMATIC BRAIN INJURY: THE VALIDITY OF DEFERRED
PROXY CONSENT
H.F. Lingsma, B. Roozenbeek, E.W. Steyerberg, A.I.R. Maas,
E.J.O. Kompanje, The Netherlands, Belgium
16. COST OF EARLY RHEUMATOID PATIENTS BY TYPE OF TREATMENT: IS IT

WORTH PRESCRIBING EXPENSIVE NEW DRUGS EARLIER IN THE
HISTORY OF THE DISEASE?
K. Chevreul, S. Lucier, M. De Rosa, F. Guillemin, I. Durand-Zaleski, B. Fautrel,
France
17. PATIENT AUTONOMY AND EDUCATION IN MEDICAL KNOWLEDGE

D. Lukas, Germany
18. ETHICAL DIMENSIONS IN THE DEMAND AND THE SUPPLY OF VACCINES

J. Luyten, P. Beutels, Belgium
19. DEVELOPING A FLEXIBLE DECISION SUPPORT SYSTEM FOR MEDICAL

APPLICATIONS BASED ON A NEURO-FUZZY APPROACH
M. Gyimesi, J. Mayerhofer, M. Wastian, A. Zimmermann, Austria
20. IMPACT OF EXENATIDE, PEN INSULIN AND VIAL INSULIN ON PATIENT

OUTCOMES IN A DIABETES POPULATION IN THE UNITED STATES: A
RETROSPECTIVE DATABASE ANALYSIS OF PERSISTENCE AND
FIRST-YEAR COSTS
N. Rashid, J.M. McCombs, S.A. Foster, L.A. Miller, USA
21. WATCHFULLY WAITING: MEDICAL INTERVENTION AS AN OPTIMAL

INVESTMENT DECISION
E. Meyer, R. Rees, Germany
22. MODELING VARIOUS VACCINATION STRATEGIES AGAINST

STREPTOCOCCUS PNEUMONIAE
F. Breitenecker, G. Endel, F. Miksch, N. Popper, C. Urach, G. Zauner, Austria
25
________________________________________________________________________
POSTER PRESENTATIONS - TUESDAY, JUNE 1, 2010 (continued)

________________________________________________________________________
23. MODELING OF HOUSEHOLDS IN AN AGENT BASED POPULATION MODEL

AND RESULTS FOR EPIDEMICS
F. Breitenecker, M. Götzinger, F. Miksch, N. Popper, I. Schiller-Frühwirt,
C. Urach, D. Wetter, G. Zauner, Austria
24. DOC, WHAT WOULD YOU DO IF YOU WERE ME?

ON SELF-OTHER DISCREPANCIES IN DECISION MAKING ABOUT HEALTH
R. Garcia-Retamero, S. Müller, Y. Okan, Germany, Spain
25. DOES VISUAL REPRESENTATION OF STATISTICAL INFORMATION

IMPROVE DIAGNOSTIC INFERENCES?
R. Garcia-Retamero, U. Hoffrage, S. Müller, Y. Okan, Spain, Switzerland
26. ARE MEDICAL DECISIONS SHAPED BY THE MEDIA? AN INTERCULTURAL

COMPARISON ON THE VACCINATION AGAINST CERVICAL CANCER (VPH)
S. Müller, R. Garcia-Retamero, N. Bodemer, Y. Okan, A. Neumeyer-Gromen,
Spain, Germany
27. CLINICAL BENEFIT AND COST-EFFECTIVENESS OF SCREENING

STRATEGIES FOR CARDIOVASCULAR DISEASES AMONG HIV-INFECTED
PATIENTS IN THE DEVELOPED WORLD
J. Nolte, T. Neumann, U. Siebert, P. Schnell-Inderst, N. Muehlberger,
A. Neumann, E.F. Halpern, G.S. Gazelle, J. Wasem, A. Goehler, USA,
Germany, Austria
28. GUIDELINES FOR CARRYING OUT LEGAL REGULATIONS FOR PRIORITY

SETTING IN NORWAY
E. Nygaard, B. Guldvog, H.P. Aarseth, Norway
26
________________________________________________________________________
POSTER PRESENTATIONS - WEDNESDAY, JUNE 2, 2010

________________________________________________________________________
1. GRAPH COMPREHENSION IN MEDICAL CONTEXTS: AN EYE-TRACKING

STUDY
Y. Okan, M. Galesic, R. Garcia-Retamero, Spain, Germany
2. FRAMING EFFECTS IN THE COMMUNICATION OF TREATMENT RISK

REDUCTION
Y. Okan, R. Garcia-Retamero, A. Maldonado, Spain, Germany
3. GUIDELINES FOR THE USE OF BIOLOGIC DRUGS IN RHEUMATOID

ARTHRITIS AND ITS RATIONAL BASIS IN SELECTED CENTRAL AND
EASTERN EUROPEAN COUNTRIES
E. Orlewska, I. Ancuta, B. Anic, C. Codrenau, N. Damjanov, P. Djukic,
L. Gulácsi, R. Ionescu, L. Marinchev, T. Peets, M. Pentek, S. Praprotnik,
R. Rashkov, J. Skoupa, W. Tlustochowicz, M. Tlustochowicz, M. Tomsic,
T. Veldi, J. Vojinovic, P. Wiland, Poland, Romania, Croatia, Serbia, Hungary,
Bulgaria, Estonia, Slovenia, Czech Republic
4. PRIORITY PREFERENCES CONCERNING MEDICAL TREATMENT IN

ONCOLOGY BY DIFFERENT STAKEHOLDER GROUPS: AN EXPLORATORY
STUDY
M. Otten, M. Schreier, A. Diederich, Germany
5. DIFFERENCE-IN-DIFFERENCES AND ORDINARY LEAST SQUARES

METHODS: A STUDY OF THE COVERAGE GAP IN THE MEDICARE PART D
PROGRAM ON STATIN MEDICATION ADHERENCE
J. Pai, F. Zeng, J.M. McCombs, B.V. Patel, R.J. Sanchez, USA
6. DECISION-MAKING IN EMERGENCY MEDICINE: DOES COMPUTER

MEDIATED COMMUNICATION FACILITATES A SHARED SITUATION
AWARENESS?
G. Pravettoni, C. Lucchiari, G. Vago, Italy
7. THE ECONOMIC BURDEN OF MENTAL ILLNESS IN FRANCE

K. Chevreul, A. Prigent, A. Bourmaud, M. Leboyer, I. Durand-Zaleski, France
8. PRACTICE INNOVATIONS IN PSYCHIATRY: ESTIMATION OF OUTPUTS

USING PATIENTS’ QUALITY OF LIFE
A. Prigent, S. Simon, K. Chevreul, France
9. EFFECTIVENESS OF SHORT MESSAGING SERVICE OF CRITICALLY

APPRAISED TOPIC CONCLUSIONS AS A CONTINUING MEDICAL
EDUCATION STRATEGY
G.Z. Racaza, L.M. Palileo, A.L. Dans, R.N. Delgado, The Philippines
10. POTENTIAL NUMBER OF FATAL AND NON FATAL INJURIES AVOIDED

THANKS TO THE INTRODUCTION OF THE 50 MG/100 ML BAC LAW IN
ENGLAND AND WALES
R. Rafia, A. Brennan, A. Killoran, UK
11. RELATIVE IMPORTANCE OF EQ-5D DIMENSIONS IN EXPERIENCED AND

HYPOTHETICAL HEALTH VALUATIONS
K. Rand-Hendriksen, L.A. Augestad, I.S. Kristiansen, K.Stavem, Norway
27
________________________________________________________________________
POSTER PRESENTATIONS - WEDNESDAY, JUNE 2, 2010 (continued)

________________________________________________________________________
12. SYSTEMATIC ASSESSMENT OF DECISION MODELS IN CHRONIC

MYELOID LEUKEMIA
U. Rochau, R. Schwarzer, G. Sroczynski, B. Jahn, D. Wolf, G. Gastl,
U. Siebert, Austria, USA
13. DO FAMILY DOCTORS AND THEIR PATIENTS DISCUSS THE TREATMENT

OPTIONS? A STUDY ON BEHAVIORS ASSESSMENT AND PATIENT
PERCEPTION
R. Ruiz-Moral, L.A. Pérula de Torres, L. Peralta Munguía, A. Alba Dios,
M. Martínez, M.T. Carrión, Spain
14. COMPARISION OF PATIENTS’ AND PHYSICIANS’ VIEWS ON THE

DECISION MAKING PROCESS IN MEDICAL ENCOUNTERS
I. Scholl, L. Kriston, J. Dirmaier, M. Härter, Germany
15. SYSTEMATIC CLINICAL PRACTICE GUIDELINE ANALYSES TO ASSIST

POLITICAL DECISION-MAKERS IN THEIR DECISION-MAKING
U. Siering, M. Eikermann, C. Bartel, W. Hoffmann, N. Holzmann, A. Ruether,
Germany
16. COMPARING DIFFERENT HEALTH STATUS VALUATION METHODS: HOW

CAN WE TEST WHETHER COVARIATES IMPACT THE STRUCTURAL
RELATIONSHIP?
B. Stollenwerk, R. Leidl, R. Stark, H.H. König, R. Holle, Germany
17. WILL TIME TELL? – FEASIBLITY OF A NEW APPROACH FOR ASSESSING

THE VALUE OF FURTHER RESEARCH IN A MULTI-TREATMENT,
INFORMATION VALUE ORIENTED AND INFORMATION ACCRUING
ENVIROMENT
P. Storz, Germany
18. JUDGEMENT STRATEGIES IN THE DIAGNOSIS OF POSSIBLE PNEUMONIA

T.G. Tape, B. Mirivosky, D. Nickol, R.S. Wigton, USA
19. FACTORIAL SURVEY OF PROFESSIONAL JUDGEMENTS ON

RECOGNISING AND REPORTING ELDER ABUSE
B.J. Taylor, C. Killick, Northern Ireland, UK
20. DISTANCE DEPENDENCE ON THE WILLINGNESS OF PATIENTS TO

PARTICIPATE IN AMBULATORY HEART REHABILITATION PROGRAMS
C. Urach, F. Miksch, N. Popper, G. Zauner, F. Breitenecker, I. Wilbacher,
Germany
21. DEALING WITH HEALTH CARE DATA OF THE AUSTRIAN SOCIAL

SECURITYSYSTEM
F. Breitenecker, F. Miksch, N. Popper, C. Urach, A. Weisser, Austria
22. BIASES IN SECOND-OPINION CONSULTATIONS

G. Vashitz, N. Davidovitch, J. Pliskin, Israel
28
________________________________________________________________________
POSTER PRESENTATIONS - WEDNESDAY, JUNE 2, 2010 (continued)

________________________________________________________________________
23. FAILURE TO ACCUMULATE PERCEIVED CARDIOVASCULAR RISKS AND

DENIAL OF SOLIDARITY: A VIGNETTE STUDY AMONG THE AUSTRIAN
PUBLIC
W. Wiedermann, O. Kada, J. Rehm, U. Frick, Austria, Canada, Germany
24. HOW DO COMMUNITY PRACTITIONERS DIAGNOSE AND TREAT ACUTE

RESPIRATORY INFECTIONS ? A CASE WHERE CUE INTERACTIONS
MATTER
R.S. Wigton, C.A. Darr, K.K. Corbett, D. Nickol, R. Gonzales, USA, Canada
25. CONTROVERSIAL PRIORITY PREFERENCES OF DIFFERENT SOCIAL

STATUS GROUPS
J. Winkelhage, A. Diederich, M. Schreier, Germany
26. METHODOLOGICAL PROBLEMS IN CAUSAL INTERPRETATION OF

RETROSPECTIVE DATABASE ANALYSIS – FINDING FACTORS OF
TEMPORARY WORK DISABILITY IN THE SWISS INFLAMMATORY BOWEL
DISEASE STUDY
J. Wurm, R. Matteucci Gothe, M. Arvandi, M. Sagmeister, U. Siebert, Austria,
Switzerland, USA
27. PROSTATA SPECIFIC ANTIGEN DOUBLING TIME AND TUMOR

DETECTION
PROBABILITY MODELS USING MATHEMATICAL CONCEPTS
N. Popper, G. Zauner, F. Breitenecker, A. Ponholzer, Austria
29
PARALLEL SHORT COURSES
MORNING COURSES
Parallel Short Course 1:
FOCUSED OPERATIONS MANAGEMENT IN HEALTH CARE

ORGANISATIONS: DOING MORE WITH THE SAME RESOURCES
J. Pliskin, Israel
Course Description:
How can a hospital successfully reduce the response time in the Emergency
Department by 40% and at the same time increase the clinical quality, all this
using existing resources? How can one increase the throughput of the
Operating Room by 20% using the same resources? Why do performance
measures sometimes undermine value creation? How can the removal of
inexpensive bottlenecks easily increase throughput, reduce response time and
increase quality? Why adding more personnel and making more capital
investment are not usually the answer for the improvement of healthcare
organizations?
These topics and more are the theme of the short course on managing
healthcare organizations. The main theme of the course is that one can do
much more with the same resources in terms of throughput, response time and
quality by using simple practical tools and techniques. It provides a system view
and touches upon issues of performance measures, operations management,
quality, and above all, value creation and value enhancement.
The course includes the use of methods such as the Seven Focusing Steps of
the Theory Constraints (TOC) that yields fast improvement in systems such as
operating rooms and emergency departments. The course demonstrates how
simple tools like the Focusing Table, the Focusing Matrix, the Complete Kit
concept, working in Small Batches, Specific Contribution and Pareto Analysis
can increase throughput, reduce response time and create value in the
healthcare industry.
30
HOW-TO-WORKSHOP: REVISE AND IMPROVE YOUR PRESENTATION

FOR THE MEETING
M.G.M. Hunink, The Netherlands
Course Description:
After a brief Introduction two participants will have the opportunity to give their
presentation which will be followed by commentary with tips and tricks for
improving their presentation. Everyone will then have the chance to work on
their own presentation while the teachers will walk around to help them. Another
two participants will have the opportunity to present which will again be followed
by commentary and points for improvement. We will rap up with a list of take-
home points.
Participants are expected to come with a laptop and a prepared presentation.
31
INTRODUCTION TO CLINICAL AND ECONOMIC DECISION-ANALYTIC

MODELING
U. Siebert, Austria
Objectives:
By the end of this course, participants will
1. Understand the key concepts and goals of decision analysis,
2. Know the basic methods of decision tree analysis and Markov modeling and
be able to choose the appropriate model type for a given research question
3. Understand why and when decision-analytic modeling should be used in
clinical and economic evaluation, and
4. Be able to critically judge the conclusions derived from a model and know the
strengths and limitations and of modeling
Course Description:
Decision making is an essential part of health care. It involves choosing an
action after weighing the risks, benefits, and costs of the options available to the
individual patient or the patient population. While all decisions in health care are
made under conditions of uncertainty, the degree of uncertainty depends on the
availability, validity, and generalizability of clinical and economic data. Decision-
analytic modeling is a systematic approach to decision making under uncertainty
that is used widely in clinical decision making, economic evaluation, and health
technology assessment of preventive, diagnostic or therapeutic procedures. It
involves combining evidence for different outcomes and from different sources.
Outcome parameters may include disease progression, treatment
efficacy/effectiveness, safety, quality of life, and costs. Sources may include
epidemiological studies on the natural history of the disease, randomized clinical
trials, observational studies, pharmacoepidemiologic studies, quality of life
surveys, and resource utilization studies, and others.
This half day course provides an introduction into decision-analytic modeling as

a tool for medical decision making and economic evaluation. The course
consists of lectures and interactive group exercises and discussions. During the
course, participants will develop a basic understanding of:
• Key concepts, definitions and goals of decision analysis
• Creating the structure of a model
• Measuring health effects and costs
• Application of modeling techniques such as decision trees and Markov
models
• Perform sensitivity analysis
Based on practical examples, participants will be guided through the main
modeling steps. Examples from the published literature will be discussed to
understand the application of modeling techniques to specific research
questions. Guidelines for good practice in decision modeling will be presented
that help to assess the quality and validity of decision models. Ethical
implications, strengths and limitations of decision analysis will be briefly
discussed at the end of the course.
The intended audience includes researchers from all substance matter fields, as
well as statisticians, epidemiologists, health economists, decision scientists, and
others interested in decision-analytic modeling.
No previous knowledge of is required. No laptop is needed. Please bring a
simple pocket calculator!
32
ADVANCED DECISION ANALYSIS: PART 1, THEORY

M.S. Roberts, USA
Course Description:
The purpose of this course is to introduce the participant to the development
and analysis of more complex decision models. The course will start with a brief
review of standard decision analysis, the addition of cost and quality to life to
outcomes, and then progress to the use of Markov processes to develop more
clinically realistic representations of time-varying processes. Advanced forms of
sensitivity analysis will be presented, and a brief introduction to advanced
methods such as Monte Carlo micro-simulation, discrete event simulation and
agent based models will be presented. As a prerequisite, participants should
have a basic knowledge of decision trees and their analysis.
33
AFTERNOON COURSES
DISCRETE EVENT SIMULATION

B. Jahn, Austria and J. Stahl, USA
Goals:
By the end of this course, participants will
1. Understand the key concepts of DES and know the element of a DES model,
2. Understand basics of Queue theory and its application
3. Understand why and when DES should be applied and which are the
strengths and limitations of DES.
Course Description:
This half day course provides an introduction into Discrete Event Simulation
(DES) as a tool for clinical and economic decision analysis as well as for
management optimization. The course consists of lectures and interactive
hands-on activities.
Whereas DES has been successfully applied in industrial engineering since

1960s, it is today more and more used in the field of health care. Applications
include health care management (e.g., management of ambulance services,
optimization of emergency departments), health technology assessments (e.g.,
in cancer and other diseases requiring organ transplantations) as well as
pharmacoeconomics.
In a DES, a system is modelled where state changes occur at a discrete set of

points in time. These state changes are called events. Examples for events are
admission to hospital, change in dose, adverse event, etc. The simulation allows
modelling on the individual (e.g., patient) level. In addition , resources (e.g.,
facilities, staff) can be modelled explicitly and interdependencies between
patients (e.g., competition for resources) can be incorporated in the model.
Real-world scenarios of patient pathways or other real systems as well as
conceptual systems can be analysed, compared for their effectiveness and cost-
effectiveness, and optimized.
During the course, participants will develop a basic understanding of the key
concepts of DES including Entities, Attributes, Events, Resources and Queues.
It starts with an introduction to simulation models and modelling. Based on
practical examples participants will be guided through the main modeling steps.
The course will combine lectures and hands-on activities. Basic concepts of
input modelling, verification and validation and output analysis will be covered.
Models will be constructed using ARENATM or other software.
The intended audience includes researchers from all substance matter fields, as
well as statisticians, epidemiologists, decision analysts, and others interested in
decision modeling.
The exercises will be in the computer lab (no laptop required). No previous
knowledge of is required for these exercises.
The course has been developed in cooperation with James Stahl and Uwe
Siebert.
34
ADVANCED DECISION ANALYSIS: PART 2, HANDS-ON

M.S. Roberts, USA
Course Description:
The afternoon session will be primarily tutorial-based, and will have participants
work through the development of a decision analysis model about the cost
effectiveness of HIV screening. Participants will start by developing a simple
tree; add costs and utilities, expand the outcomes to be represented as Markov
processes, and conduct several types of sensitivity analysis, including one- and
two-way and probabilistic sensitive analysis. If there is time, participants will
develop CE acceptability curves and use the model to conduct value of
information analysis. All participants will need to have a laptop computer, and to
have TreeAge software (available at: http://www.treeage.com/) on their
computer. There is a free demonstration version of the software that is sufficient
for all of the components of the tutorial. The morning course or equivalent
experience in building decision models is a prerequisite.
35
RECOGNIZING EXTERNAL THREATS TO RATIONAL DECISION MAKING

R.M. Poses, USA and W.R. Smith, USA
Course Description:
Many models of rational medical decision making require consideration of all
plausible decision alternatives and their important benefits and harms,
determining the probabilities of these outcomes and the values (utilities) patients
place on them, and finally the combination of the probabilities and utilities to
indicate the best decision. Evidence-based medicine suggests that ideally, the
selection of the decision alternatives and the outcomes to be considered, and
the assessment of the probabilities of these outcomes ought to come from
understanding of the clinical and biopsychosocial context, and critical review of
the best available evidence from the clinical research literature. However, there
is increasing awareness that those with vested interests have attempted to
unduly influence decision making for their private gain.
After a brief introduction, we will review an example of how widely accepted,

apparently unbiased, evidence-based guidelines for the treatment of a common
outpatient problem may have been distorted by suppression and manipulation of
evidence. Then we will discuss how stages of rational medical decision making
may be unduly influenced by tactics designed to further vested interests. The
stages include choice of decision alternatives to consider, choice of outcomes to
consider, and assessment of outcome probabilities. Tactics include specific
manipulations of the design, implementation, analysis, and dissemination of
clinical studies, and outright suppression. We will also discuss how stealth
marketing, special politically correct pleadings, suppression and manipulation of
research, perverse bureaucratic and financial incentives, and intimidation and
coercion may be used to influence decision making. We will conclude with group
discussion about how to defend medical decision making and evidence-based
medicine from willful attempts at abuse in pursuit of private gain.
36
ABSTRACTS
ORAL PRESENTATIONS
37
38
ARE INCREMENTAL BENEFITS FROM NEW TECHNOLOGY
DECREASING? AN ANALYSIS OF QALY GAINS OVER TIME
D. Greenberg1,2, J.T. Cohen2, P.J. Neumann2
1
Department of Health Systems Management, Ben-Gurion University of the
Negev, Beer Sheba, Israel, 2Center for the Evaluation of Value and Risk in
Health, Tufts Medical Center, Boston, MA, USA
Objectives: As medical care advances, new and innovative interventions

may offer more limited benefits compared with existing standard of care,
which already include important background technologies (e.g., statins,
effective chemotherapy). We analyze changes in incremental QALY gains
over time, as reflected in cost-utility analyses (CUAs).
Methods: We used the Tufts Medical Center Registry of original CUAs
(years 1995 to 2009) (www.cearegistry.org) (N= 2120) to determine
incremental QALYs gained for each intervention. Using linear regression,
we analyzed changes in incremental QALYs gained by CUA publication
year. As each CUA may report multiple incremental cost-effectiveness
ratios (ICER), our primary analysis is restricted to studies reporting a single
ratio. A secondary analysis included all ICERs. Because the distribution of
QALY gains is skewed, we log transformed these gains before conducting
the regression.
Results: The 781 interventions included in our primary analysis, had a
geometric mean (median) gain of 0.09 (0.11) QALYs. Multivariate analysis
indicates incremental QALY gains decrease by 11% annually (P < 0.0001).
Factors in our regression explained a limited proportion of the variation
(R2= 12%). Declines in QALYs gained were more profound in interventions
for diabetes and cancer. The set of all 3240 ICERs had a geometric mean
(median) gain of 0.07 (0.09) QALYs, with gains decreasing by 7% annually
(p<0.0001). Variation explained was again limited (R2 = 8%).
Conclusions: Our analysis suggests that the incremental benefits of new
health interventions are decreasing over time, although this change is small
compared to differences in QALY gains across studies published in the
same year.
39
IMPUTING QALYS FROM SINGLE TIME POINT HEALTH STATE
DESCRIPTIONS ON THE EQ-5D AND THE SF-6D:
A COMPARISON OF METHODS FOR HEPATITIS A PATIENTS
J. Luyten1 , C. Marais1, N. Hens 1,2, K. De Schrijver3,4, P. Beutels1
1
Centre for Health Economics Research and Modeling of Infectious
Diseases (CHERMID), Centre for the Evaluation of Vaccinations (CEV)
Vaccine and Infectious Disease Institute (VAXINFECTIO),
University of Antwerp, Belgium, 2Interuniversity Institute of Biostatistics
and Statistical Bioinformatics. Hasselt University, Diepenbeek, Belgium
3
Department for Control of Infectious Diseases, Flemish Public Health
Authorities, Belgium, 4Epidemiology and Social Medicine, University of
Antwerp, Belgium
Economic evaluations of health care technologies predominantly use quality

adjusted life years (QALYs) to quantify health benefits. QALY weights can
be estimated from pre-scored multi-attribute classification systems in which
patients describe their health state. However, in practice, QALYs are
typically arrived at through different non-standardised analytical choices. In
addition to more widely discussed issues such as, which instrument (eg, EQ-
5D?) and which respondents (eg, patients?), researchers can choose between
different recall periods, scoring algorithms and interpolations between
points of measurement. We compare four different estimation methods, two
based on the EQ-5D (administered during illness without recall period) and
two on the SF-6D (administered after illness with 4 weeks recall period) in
114 patients with acute hepatitis A illness. We found statistically significant
differences between all methods aiming to estimate the QALY loss for the
same patient groups. This analytical choice can have a decision-changing
impact on the cost-effectiveness results, particularly if morbidity takes up a
substantial part of the total QALY loss. Researchers should be aware of the
influence these somewhat arbitrary analytical choices may have on their
results.
40
HOSPITAL RANKINGS IN THE NETHERLANDS DO NOT
PROVIDE RELIABLE PATIENT INFORMATION
H. Pons1, H.F. Lingsma2, E.W. Steyerberg2, R. Bal1
1
Institute of Health Policy and Management, Erasmus University,
Rotterdam, The Netherlands, 2Department of Public Health, Erasmus MC,
Rotterdam, The Netherlands
Background: In the Netherlands several rankings of hospitals are published

in the lay press every year, to inform patients on quality of care. The aim of
this study was to assess the consistency of the different rankings.
Methods: We assessed the yearly rankings between 2005 and 2008 from
‘Algemeen Dagblad’ (AD), a national daily newspaper, and ‘Elsevier’, a
weekly opinion magazine. We described on which quality of care
information the rankings are based. We tested consistency between the
Elsevier and AD rankings by computing correlation coefficients. We tested
consistency between the successive years of each ranking by predicting the
rank of a hospital in 2008 based on its rank in the previous years in
multivariable regression analyses.
Results: Elsevier bases its ranking on expert opinion from doctors, nurses,
quality managers, and board members, who are asked what they consider
poor and good performing hospitals in their specialty. AD bases its ranking
on quality indicators from the Healthcare Inspectorate combined with
patient satisfaction measurements. In 73 hospitals analysed, there was only
weak correlation between AD and Elsevier rankings (Spearman correlation
coefficients <0.4). There was moderate correlation between successive years
of each ranking (Spearman correlation coefficients 0.5-0.6). In multivariable
regression analyses only the ranks in 2007 were a significant predictor of the
ranks in 2008, for both Elsevier and AD.
Conclusion: The low correlations between the rankings in successive years
indicate limited consistency of both Elsevier and AD rankings. Such lay
press rankings do not provide patients with reliable information on quality
of care.
41
BENZODIAZEPINES RENEWALS BEYOND RECOMMENDED
DURATION IN FRANCE. AN OBSERVATION OF THE DECISION-
MAKING PROCESS IN GENERAL PRACTICE
C. Rat, J.P. Canevet, R. Senand
Department of General Practice, Faculté de Médecine, Université de Nantes,
Nantes, France
Background: Consumption of benzodiazepines and hypnotics remains high

in France. Guidelines limiting the duration of the prescription are an issue
for general practitioners.
Aims: Describe the process which leads to deciding whether or not to renew
such treatments beyond the recommended duration.
Method: Observation of the interaction between the doctor and the patient. It
was carried out by 21 students who observed 56 GPs during their training
session in general practice surgery. They noted down in a grid 21 indicators
characterising patient, doctor, elements of the diagnosis, background of the
prescription and the nature of the dialogue preceding the renewal.
Results: 245 consultations including the renewal of benzodiazepines beyond
the recommended duration have been observed. When the renewal was
preceded by a dialogue, the duration of the treatment was in average shorter
(58.3 months vs 86.9 months). In the same way, patients were in average
younger (64 years old vs 68.8). The request from the patient, often
considered as the main determining factor in the decision to prescribe,
actually leaded to a more frequently renewed evaluation of the treatments
(67,7% vs 53,7%). Whenever the patient expressed his request in the course
of the consultation, a dialogue systematically ensued (100% of the cases). In
cases of situations identified as complex (54.7% of the cases), the attention
given to evaluating the treatment again was not pushed into the background.
Conclusion: contrary to opinions generally conveyed, a more contrasted
reality appears, opening the ways to possible improvements.
42
MULTIDIMENSIONAL OMISSION BIAS IN PARENTS’ VACCINE
DECISION-MAKING
K.F. Brown1, J.S. Kroll2, M. Ramsay3, M. Hudson3, J. Green4, C. Vincent1,
G. Fraser3, N. Sevdalis1
1
Centre for Patient Safety and Service Quality, Imperial College, London,
UK, 2Department of Paediatrics, Imperial College London, UK, 3Health
Protection Agency, UK, 4Central and North West London NHS Foundation
Trust, London, UK
Background: Vaccine decision-makers may prefer outcomes of omissions

(e.g. catching a disease having not vaccinated) over outcomes of
commissions (e.g. taking a vaccine and reacting to it), even when those
outcomes are objectively identical or the omission outcome is worse. This
phenomenon has been demonstrated where outcomes are defined by their
likelihoods of occurrence, however outcome severity and duration may also
impact upon preferences. The present study investigates these factors.
Methods: Parents were recruited via UK parenting websites to complete an
online questionnaire. Respondents selected a likelihood (six options, range
0.0001% to 10%), symptom (13 options, range crying/irritability to death),
and duration (10 options, range <5 minutes to lifelong) constituting a low-
risk, medium-risk, and high-risk hypothetical disease; and a likelihood,
symptom, and duration (all options as for disease) constituting a low-risk,
medium-risk, and high-risk hypothetical vaccine reaction. Selections for
disease versus vaccine reaction were compared using t-tests.
Results: 142 responses were obtained. All likelihoods (t=2.98-5.44, p<0.01),
9 of 13 symptoms (t=2.00-5.16, p<0.05), and 5 of 6 durations (t=3.13-7.68,
p<0.01) were rated significantly higher-risk when relating to vaccine
reaction than to disease.
Discussion: These findings demonstrate that omission bias may be elicited
by outcome severity and duration as well as by outcome likelihood.
Decisions may be omission-biased even when vaccine-disease likelihood
balance is clearly in favour of vaccination, if the two outcomes are of
similar severity or duration. Bias-limiting interventions could be introduced
in these situations if severity and duration-based omission bias is
demonstrated in the context of real-world vaccines.
43
ORPHAN DRUGS: DOES SOCIETY VALUE RARITY?
A.S. Desser1, D. Gyrd-Hansen2, J.A. Olsen1,3, S. Grepperud1,
I.S. Kristiansen1,2
1
Department of Health Management and Health Economics, University of
Oslo, Oslo, Norway, 2Institute of Public Health, University of Southern
Denmark, Odense M, Denmark, 3Department of Community Medicine,
University of Tromsø, Tromsø, Norway
Background: Orphan drugs usually fail to meet the standard cost-

effectiveness thresholds used to determine reimbursement eligibility under
national health care systems. A general societal preference for prioritizing
treatment of rare diseases over common ones could provide a justification
for accepting higher cost-effectiveness thresholds for orphan drugs. We
attempt to determine whether such a preference exists.
Methods: We surveyed a random sample of 1547 Norwegians aged 45-67
via an internet questionnaire conducted by TNS Gallup Norway. There were
six survey versions in which respondents chose between funding treatment
for a rare versus common disease and completed a person trade-off (PTO)
exercise between the diseases for each of two scenarios: (1) identical per
person costs, and (2) higher costs for the rare disease. Diseases were
described identically with the exception of incidence. Respondents were
randomized to either no information or different amounts of information
about disease severity (severe vs. moderate) and expected benefits of
treatment (high vs. low). In five versions of the survey, choices were framed
as how to allocate additional funds, while in the sixth version choices were
framed as whether to treat rare disease patients by reducing the number of
common disease patients currently being treated. All respondents rated five
statements concerning equity attitudes on a Likert-scale. The survey was
tested in a pilot study with of 25 participants.
Results: 68% of respondents completely agreed with the statement that
orphan disease patients should have equal rights to treatment regardless of
costs. When faced with trade-offs in the equal cost scenario, 11.3% of
respondents favored treating the rare disease, 24.9% the common disease
and 64.8% expressed indifference. When the rare disease entailed a higher
opportunity cost, the results were 7.4%, 45.3% and 47.3%, respectively.
Framing (“extra funding” vs. “replace patients”) and amount of information
about disease severity and treatment effectiveness had a small impact on
preferences.
Conclusions: Although there is strong support for general statements
expressing a desire for equal treatment rights for rare disease patients, that
support is greatly diminished when individuals are asked to consider the
trade-offs inherent in providing special funding status to rare diseases.
44
ARE TRANSITION SUPPORT SERVICES FOR LOOKED AFTER
CHILDREN COST EFFECTIVE?
A. Duenas, J. Chilcott, E. Everson-Hock, R. Jones, E. Goyder
School of Health and Related Research, University of Sheffield,
Sheffield, UK
OBJECTIVE: The primary objective of this evaluation is to appraise the

cost-effectiveness of support services for transition to adulthood/leaving
care on the adult outcomes of looked after young people. METHODS:
Economic analyses were performed to model the cost-effectiveness and cost
utility of support services for transition to adulthood/leaving care (TSSs)
that are delivered towards the end of care for looked after young people. A
Markov model was designed in order to assess different adult outcomes. It
assessed the effectiveness of TSS interventions on employment, crime and
mental health with a life-time horizon using a public sector, including
criminal justice services (CJS), education, housing, NHS and personal social
services (PSS) perspective. The results are presented in terms of incremental
cost-effectiveness ratios (ICERs). The model evaluated the cost-
effectiveness of the intervention in males and females. Detailed reviews
were undertaken to obtain the most recent evidence on costs and utilities for
the different states modelled. RESULTS: The results for the economic
analysis, over a life time, suggest that TSS interventions in young males
were dominant in most cases. The analysis considered employment status
effectiveness found by the first in the series of three effectiveness review
performed by ScHARR. Although it appears that TSS interventions for
young females dominate no-TSS interventions, the results vary significantly
when compared to the males’ results. This is due to the difference between
crime rates for males and females.
CONCLUSION: The results generated are sensitive to the gender of the
young people leaving care, to their employment status and to the amount of
crime that they commit. The majority of results are governed by the costs
incurred by the Criminal Justice Services. The analysis demonstrates that
TSS interventions for young people leaving care (compared to no-TSS
interventions) can be cost-effective if the interventions focus on skills to
find employment. Further research is required to allow inclusion of other
adult outcomes such as education and housing. The major uncertainties in
this assessment relate to the probability of getting a job after leaving care,
having a major influence on the cost-effectiveness ratios. Considerable
variation is present in another parameter of the study, i.e. the cost of the
intervention (TSS). This parameter has a major influence on the cost
effectiveness estimates for TSS. Both young males and females will be less
likely to commit a crime if are employed. Employment will also have an
influence on health outcomes such as mental health particularly for young
females.
45
COST-EFFECTIVENESS OF SMOKING CESSATION WITH
VARENICLINE IN PATIENTS WITH CORONARY HEART
DISEASE
P. Aidelsburger1, J. Wasem2
1
CAREM Gmbh, Sauerlach, Germany, 2Institute for Health Care
Management, University of Duisburg-Essen, Essen, Germany
Background and objective: Smoking is one avoidable risk factor for the
development of Coronary Heart Disease (CHD). Aim of the study is to
assess the cost-effectiveness of smoking cessation with Varenicline
compared to smoking cessation without medication.
Methods: A Markov Model simulated CHD disease course, assuming one
single smoking cessation attempt. Once successful patients did not start
smoking again. The probabilities of events (fatal and nonfatal myocardial
infarction or stroke) were calculated mainly by use of Framingham
regression equations. Effectiveness data of Varencicline were taken from a
systematic review (RR=2.33; percentage of patients with successful
smoking cessation in placebo arm = 14.72%). Costs of Varenicline varied
between 258 and 466 Euro (base case: 261 Euro). Cost data for health states
were taken from literature and were adjusted for the year 2008. Effects and
costs were discounted by 3%. A German payers perspective was taken.
Multiple one- and two-way sensitivity analysis were performed to test for
uncertainty.
Results: Considering a 50 years time horizon smoking cessation with
Varenicline saved 2,681 Euro and gained additional 0.3 live years. Already
two years after the smoking cessation attempt with Varenicline placebo was
dominated. Neither variation of discount rate, drug costs nor health state
costs altered dominance. Using extreme values concerning effectiveness of
Varenicline resulted in an ICER of 121,645 Euro/lifeyears gained.
Discussion and conclusion: A single smoking cessation attempt with
Varenicline is dominant compared to placebo. Results are robust in most of
the sensitivity analysis performed.
46
MULTI AGENT SIMULATION TECHNIQUES FOR DYNAMIC
SIMULATION OF SOCIAL INTERACTION AND SPREAD OF
DISEASES WITH DIFFERENT SEROTYPES
N. Popper1, G. Zauner1, F. Breitenecker2, G. Endel3
1
DWH Simulation Services, 2Vienna University of Technology, Institute for
Analysis and Scientific Computing, 3Evidence Based Economic Healthcare,
Main Association of Austrian Social Insurance Institutions, Vienna, Austria
Purpose: For modeling vaccination strategies and spreading of infectious

diseases by airborne infection or contact transmission detailed individual
based simulation is needed. A new technique modeling heterogeneous
populations is presented.
Methods: A multi agent based model is implemented dealing with long
periods for short and long term effects, changing population structure,
implementation of a social model to simulate individual contacts and
simulation of various pathogens to differentiate between vaccine-covered
and non-covered serotypes.
The model consists of three parts:
Population part: Individual attributes for agents: Age, Gender, Infection
State, Pregnancy and a unique ID-Number, Age Class and Infection
Protocol are stored. Aging, Death and Birth of Agents is implemented.
Parameters are identified with real population data of Austria.
Social part: Epidemics can be spread through direct contact between two
agents. Contacts can happen at home, at work and randomly. Additional
rules (f.e. age distribution of people in contact depending on social
structure) are defined.
Epidemics part: The procedure of the epidemics part is depicting the contact
based infections, carrying time and end of illness, including time and age
specific carrying time of special strains.
Extra features for simulation of two or more pathogens in parallel are
developed.
Results: The concept has been validated using detailed data for serious
diseases for Austria. Stability analysis and dependency on starting
parameters was examined. Results show stable realistic behavior for
competing serotypes. Using this dynamic modeling concept, simulation of
non linear effects like herd immunity and serotype replacement for testing
vaccination strategies, is possible.
47
MODELING THE INTRODUCTION OF PCV7 TO THE CHILDREN
VACCINATION PROGRAM IN AUSTRIA USING MARKOVIAN
PROCESSES
C. Urach1, N. Popper1, G. Zauner1, F. Breitenecker2, G. Endel3
1
dwh Simulation Services, Vienna, Austria, 2Vienna University of
Technology, Institute for Analysis and Scientific Computing, Vienna,
Austria, 3Evidence Based Economic Healthcare, Main Association of
Austrian Social Insurance Institutions, Vienna, Austria
Introduction: Streptococcus Pneumoniae causes sepsis, meningitis,

pneumonia and otitis media. Prevenar (PCV7) is a vaccine against this
pathogen. Aim is to calculate epidemiological and economical outcomes for
an introduction of PCV7 to the basic children vaccination program in
Austria.
Concepts: A Markovian model which simulates the occurring cases in a
birth cohort without vaccination is implemented. Parameters are identified
with historical data from hospitals and literature whereas the cases of sepsis
and pneumonia are varied because of lack of secure classification of the
pathogen. Otitis media is excluded, because no fatality caused by otitis
media is reported. We introduce PCV7 to the children vaccination program
and run the model again for several scenarios. In the basic scenario the cases
are reduced by about 50%.
On top of the epidemiological part we now calculate the economic
consequences. Costs for treatment of the illness in hospital, long-term
sequelae, inflation, discounting and vaccination are considered to evaluate
the cost-effectiveness of the vaccine.
Results: In the base run focusing only on effects for children less than ten
years one case avoided costs about 160 000€ and one life year gained about
130 000€ without discounting. Regarding the results of all evaluated
scenarios we conclude that the introduction of PCV7 to the children
vaccination program, with actual serotype distribution and standard
vaccination rate for children immunization programs in Austria, is
preventing about half of the illnesses in the target group. However
multivariate sensitivity analysis shows at least a minimum of 85 000€ per
case avoided.
48
LONG-TERM EFFECTIVENESS AND COST-EFFECTIVENESS OF
PRIMARY HPV SCREENING FOR CERVICAL CANCER IN
GERMANY - A DECISION ANALYSIS
G. Sroczynski1, P. Schnell-Inderst1, N. Muehlberger1, K. Lang2,
P. Aidelsburger2, J. Wasem3, T. Mittendorf4, J. Engel5, P. Hillemanns6,
K.U. Petry7, A. Kraemer8, U. Siebert1,9,10
1
Department of Public Health, Information Systems and Health Technology
Assessment, UMIT - University for Health Sciences, Medical Informatics
and Technology, Hall i.T., Austria, 2Carem GmbH, 3Institute for Healthcare
Management, University of Duisburg-Essen, Essen, 4Institute for Health
Economics, University of Hanover, Hanover, Germany, 5Munich Cancer
Registry of the Munich Cancer Centre, Clinic Grosshadern,
Ludwig-Maximilians-University, Munich, Germany, 6Department of
Obstetrics and Gynecology, Hanover Medical School, Hanover, Germany,
7
Department of Obstetrics and Gynecology, Teaching Hospital Wolfsburg,
Wolfsburg, Germany, 8School of Public Health, University of Bielefeld,
Bielefeld, Germany, 9Center for Health Decision Science, Department of
Health Policy and Management, Harvard School of Public Health, Boston,
USA, 10Institute for Technology Assessment and Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Boston, USA
Objectives: To systematically evaluate the long-term effectiveness, and

cost-effectiveness of different cervical cancer primary screening strategies
for the German health care system.
Methods: A Markov-model for HPV-infection and cervical cancer was
developed for the German health care context, and applied to evaluate
different screening strategies, that differ by screening interval, and test
algorithms, including HPV-testing alone or in combination with cytology.
German clinical, epidemiological and economic data, and test accuracy data
from international meta-analyses were used. Predicted outcomes were
reduction in cervical cancer cases (CC) and deaths, life expectancy, lifetime
costs, and discounted incremental cost-effectiveness ratios (ICER). A third
party payer perspective and 3% annual discount rate were adopted.
Extensive sensitivity analyses were performed.
Results: HPV-based screening was more effective than cytology alone, with
71%-97% (depending on screening intervals) reduction in CC compared to
53%-80% for cytology. The ICER ranged between 2,600 Euro/LYG
(cytology, 5-yr-interval) and 155,500 Euro/LYG (annual HPV-testing age
30yrs, cytology 20-29yrs). Annual cytology, the current recommended
screening strategy in Germany, was dominated. Increasing screening start-
age to 25yrs had no relevant loss in effectiveness but resulted in lower costs
(ICER: 23,400 Euro/LYG).
Conclusions: Based on these results, HPV-based cervical cancer screening is
more effective than cytology and could be cost-effective, if performed at
intervals of two years or greater. In the German context an optimal
screening strategy could be biennial screening with cytology at age 25-29yrs
with switching to HPV-testing at age 30yrs. Longer screening intervals may
be considered in low-risk women with good screening compliance and in
populations with low HPV-incidence.
49
DIRECT COST AND NET COSTS OF ROAD TRAFFIC
ENFORCEMENT IN THAILAND
N. Singweratham1 , J. Podang2
1
Ministry of Public Health, Thailand,2 Epidemiology Department, Faculty of
Public Health, Mahidol University, Bankok, Thailand
Introduction: In Thailand, the main cause of road traffic injuries are risk
behaviors, such as drink-driving, not wearing helmets, driving without a
license, not wearing seat belts and driving above the speed limit). The
purpose of this study was to determine the direct and net cost benefits of
road traffic enforcement at police check-points under The Royal Thai
Police.
Methods: The study was conducted by collecting data using cost record
forms and interviews from 1 January to 30 June 2008. The costs were
analysed using the Direct Allocation Method.
Results: The research found that the unit cost of alcohol screening per
check-point is 5,329 baht, whereas it is 6 baht per suspect and in cases of
alcohol levels of more then 50 mg% it is 400 baht per offender.
In addition, the cost of (general) risk-behavior monitoring (surveillance) per
suspect is 0.69 baht, while the unit cost of detecting the use of safety
devices, such as seat belts and helmets, is about 6-8 baht extra per offender.
Per check-point, the cost of this safety device use detection is 1,547 baht.,
Other costs incurred are the unit cost of checking if drivers are keeping to
the speed limit at check-points, which is 3,740 baht per check-point, while
the cost per case is 0.19 baht. The costs of speed detection and offender
notification are between 15.25 and 15.75 baht per offender.
Increased traffic law enforcement can help to reduce hospital treatment
costs. The use of sobriety, safety device checking and speed limit check-
points for road traffic enforcement can reduce treatment costs by 61.35%,
32.97% and 3.87% respectively, among a 1,000 cases.
Conclusion and discussion: The Royal Thai Police should implement
sophisticated technology, such as computer systems and electronic cameras
which are accurate, effective and quick methods for detecting violators.
Highly-effective road traffic enforcement can reduce unit costs at check-
points and increase net cost benefits.
50
COST-EFFECTIVENESS OF DRUG-ELUTING STENTS VERSUS
BARE-METAL STENTS IN ACUTE MYOCARDIAL INFARCTION:
SUPERIORITY USING BOTH REGISTRY DATA AND TRIAL
DATA
T. Wisløff1, I.S. Kristiansen2, D. Atar3
1
Norwegian Knowledge Centre for the Health Services and University of
Oslo, 2University of Oslo and University of Southern Denmark, 3Oslo
University Hospital Aker, University of Oslo, Norway
Objective: To evaluate the cost-effectiveness of drug-eluting stents (DES)

compared to bare metal stents (BMS) using data from registries and
randomized controlled trials (RCTs).
Methods: In most patients undergoing percutaneous coronary intervention
(PCI) for acute myocardial infarction (AMI), one or more metal stents are
implanted during the procedure to avoid collapsing of coronary arteries.
During the last five years, there has been an ongoing debate regarding the
relative effectiveness of BMS versus DES (the latter group consisting of
either paclitaxel- (PES) or sirolimus-eluting (SES) stents).
Meta-analyses performed arrive at conflicting results, partly because they
include either randomized controlled trials (RCT’s) alone, or additionally
patient registries claimed to represent “real-world” data.
We developed a Markov model to follow patients for the rest of their lives
after a PCI. The model has half year-cycles with the following events: AMI,
repeat revascularisation (PCI or CABG), and death. Probabilities of events
are based on two Scandinavian registries (SCAAR and WDHR).
Effectiveness of different DES compared to BMS was assessed based on
either a meta-analysis of RCTs (Stettler 2009), or data from the SCAAR
registry (James 2009).
Results: Analyses based on RCT-data show that PES cost $555 per life year
compared to BMS while SES is not cost-effective at the current Norwegian
threshold for cost-effectiveness (approximately $90,000 per life-year
gained). When the assessment was based on registries, PES was also the
most cost-effective stent type ($1,327 per life year gained). Probabilistic
sensitivity analyses indicate a 64% probability of PES being the most cost-
effective strategy based on effectiveness from RCTs and a 48% probability
based on registry data.
Conclusion: Replacing BMS by DES is cost-effective with a threshold value
of $90,000 per QALY regardless whether this health-economic analysis is
based on trial- or registry-data.
51
ESTIMATING THE FINANCIAL BURDEN OF STROKE IN
FRANCE: A COST-OF-ILLNESS STUDY
K. Chevreul, A. Gouepo, I. Durand-Zaleski
URC Eco Ile-de-France, Université Paris, Creiteil, France
Introduction: Stroke represents a considerable burden for society in terms of

premature death and long-term disability. Better understanding of the
current burden of stroke is needed in France. We undertook a cost-of-illness
study to estimate the annual cost of stroke management in France in 2007
for national health insurance (NHI), local authorities and patients.
Method: We estimated health care costs and costs of care provided in social
services (nursing homes, community nursing services…). We used a
bottom-up approach for the former and a top-down approach for the latter.
Our choice was driven by data availability. For health care costs, we
estimated the cost of new stroke cases using the number of hospital stays for
stroke in 2007 and the cost of care during the first year post-stroke for
survivors and DRG tariffs for deaths. For stroke prevalence, the annual
health care expenditures of stroke patients identified in the NHI database
were used. For costs of care provided in social services, the estimated
proportions of stroke patients were imputed to national expenditures
allocated to each type of structure.
Results: In 2007, the total cost of stroke management was €8.3 billion, of
which one-third was for social care (€2.393 billion) and over two-thirds for
health care (€5.925 billion), representing 3.2% of national health care
expenditures.
Conclusion: This study brings decision makers elements to justify allocating
funds to develop access to stroke units, which can reduce morbidity
associated with stroke and therefore reduce the economic burden of stroke
in France.
52
COST-UTILITY ANALYSIS OF DIFFERENT SYSTEMS OF
ORGANISED INPATIENT (STROKE UNIT) CARE
L. Govan1, C.J. Weir2, P. Langhorne3
1
Section of Public Health and Health Policy, University of Glasgow, UK
2
Robertson Centre for Biostatistics, University of Glasgow, UK
3
Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, UK
Background: Stroke is the leading cause of long-term neurological disability

in adults meaning stroke-related costs are one of the largest components in
healthcare expenditure in Scotland. Stroke units reduce deaths, requirement
for institutionalisation and dependency in stroke patients. However, it is
unclear how different models of inpatient care compare in terms of costs and
benefits. A cost utility analysis was employed to evaluate the additional
costs per quality-adjusted life-year (QALY) gained by each of the different
inpatient service models.
Methods: Data were obtained from 29 trials (6515 patients) from the Stroke
Unit Trialists’ Collaboration systematic review. Six care systems were
identified: semi-intensive; comprehensive; rehabilitation; mixed-
rehabilitation; mobile stroke teams; and general medical wards (GMW).
NHS staff time and length of stay were assumed to contribute to costs;
utility values were obtained from the EuroQol EQ-5D, allowing incremental
cost-effectiveness ratios to be calculated.
Results: Rehabilitation units were shown to be the most effective system of
care (QALY 0.51) compared to semi-intensive (0.48), comprehensive
(0.48), mobile team (0.39) and GMW (0.44). Semi-intensive units appear to
be most cost-effective compared to comprehensive, saving £1,100,000 per
additional QALY gained. However, since costs are affected by length of
stay, semi-intensive care followed by rehabilitation, if required, is the most
cost effective pathway of care compared to comprehensive units (saving
£48,000 per additional QALY gained). Results were consistent in sensitivity
analyses varying the assumptions about costs and benefits.
Discussion: Semi-intensive care followed by rehabilitation stroke unit care,
if required, appears to be the most cost-effective pathway of care.
53
ECONOMIC EVALUATION OF OSTEOPOROSIS MANAGEMENT
STRATEGIES: HANDLING UNCERTAINTY PERTAINING TO
THE STRUCTURE OF DECISION-ANALYTIC MODELS
S. Bahrami1,2, K. Alzahouri1, F. Guillemin3, I. Durand-Zaleski1,2
1
URC-ECO IdF, AP-HP, Paris, France, 2AP-HP, Hopital Henri-Mondor et
Université Paris 12, Créteil, France, 3INSERM CIC-EC CIE 6, CHU Nancy,
France
Purpose : Decision-analytic models are increasingly used to inform decision

makers on the cost-effectiveness of osteoporosis management strategies.
Although state-of-the-art models are increasingly complex, there is little
evidence regarding the impact of the additional structural features on model
outcomes. Furthermore, epidemiological data needed to populate such
models are usually lacking. Our objective was to assess the impact of two
plausible structural assumptions on the cost-effectiveness of alternative
osteoporosis management strategies, using in a decision-analytic model
tailored to the French healthcare system.
Method : Several Markov cohort models suitable for the French context
were developed. We used alternative specifications for the dynamics of
fracture risk across time and explicitely modelled the possibility of entering
a nursing home after a hip fracture. Incremental cost-effectiveness ratios
(ICERs) were computed for each model. Impact of the changes in the model
structure were then compared to the magnitude of parameter-related
uncertainty estimated by sensitivity analysis.
Results : The impact of including a nursing-home state to our model was a
tenfold increase of the ICERs, similar to the impact of the main parameters
identified by sensitivity analysis. By constrat, alternative assumptions
regarding the evolution of the fracture risk over time had a less than one-
fold impact on the model results.
Conclusion : Plausible assumptions regarding the model structure may or
may not have a large influence on the conclusions of studies assessing
osteoporosis management strategies. Qualitative comparison of various
model structures is a simple way to provide information on the relevance of
structural assumptions.
54
HERD BEHAVIOR AND HERD IMMUNITY
DOES MAN HAVE PREEMINENCE ABOVE BEAST?
M.J. Cohen, M. Brezis
Center for Clinical Quality and Safety, Hadassah-Hebrew University
Medical Center, Jerusalem, Israel
Background: Public ambivalence towards H1N1 vaccination provides an

opportunity to explore decision making facing incomplete information and
beliefs regarding risks and vaccine effectiveness. We hypothesized that
individual behaviour might be influenced by mimicry of others.
Methods: 95 medical students were asked about perceived risks and utilities
regarding H1N1 influenza and whether they would take the vaccine, under
varying putative rates of immunization among their classmates. Expected
utilities of vaccination and non-vaccination were generated from
individualized decision trees and Reed-Frost models.
Results: Expected utilities of vaccination and non-vaccination were
positively correlated with rate of class immunization (r=0.95, p<0.001 for
both). At low class immunization rates, vaccination was found to dominate.
The herd immunity threshold was 78%, beyond which the dominant strategy
would be not to take the vaccine. However, among 59% of the students,
decision was not affected by rate of class immunization: of these, nearly half
would take the vaccine. In 41% of students, decision was correlated with
rate of immunization (r=0.27, p=0.001).
Discussion: Some individuals gain utility by mimicking others, forfeiting
seemingly rational strategies. Others opt for rational strategies, while
distancing themselves from the majority they sometimes depend on.
Maximising populations’ utilities might require seemingly paradoxical
global strategies. It would be in the public’s interest to allocate some
members to lesser utilities than their comrades, as occurs with vaccination
and herd immunity. This balance would be difficult to maintain without
external intervention. These findings can be generalized to other scenarios
where personal utility might not correspond to the public’s preferences.
55
DOES ADJUSTING FOR HEALTH-RELATED QUALITY OF LIFE
MATTER IN COST-EFFECTIVENESS ANALYSES? A
COMPARISON OF COST/LIFE YEAR AND COST/QALY
ESTIMATES
D. Greenberg1,2, J.T. Cohen2, C-H. Fang2, P.J. Neumann2
1
Department of Health Systems Management, Ben-Gurion University of the
Negev, Beer-Sheva, Israel, 2Center for the Evaluation of Value and Risk in
Health, Tufts Medical Center, Boston, MA, USA
Objective: We investigated the extent to which adjusting for health-related-

quality-of-life (HRQoL) alters incremental cost per life-year (LY) gained
ratios and the implications for reimbursement decisions.
Methods: We identified all studies in the Tufts Medical Center Cost-
Effectiveness Analysis Registry (www.cearegistry.org) in which both a
cost/QALY and a cost/LY were reported. We used $50,000 and $100,000
per QALY/LY thresholds to identify interventions where the use of
cost/QALY ratio might yield different reimbursement decisions than the use
of cost/LY.
Results: Cost/QALY and cost/LY ratios were reported for the same
intervention for 1,016 interventions. We excluded 53(5%) of these ratio
pairs, where the intervention was either dominant or dominated, because no
ratios could be calculated. The rank-order correlation between these two
measurers was 0.937 for cancer-related interventions (n=195), 0.880 for
cardiovascular diseases (n=176), 0.902 for infectious diseases (n=140), and
0.854 for all other interventions (n=452); (p<0.0001 for all comparisons).
Cost/QALY ratios exceeded cost/LY in 49% of cases whereas cost/LY
exceeded cost/QALY in 49%. In 84% of comparisons, both cost/QALY and
cost/LY ratios were below a pre-specified threshold (e.g., $50,000 per
QALY or LY). Adjusting for HRQoL resulted in a higher ratio such that it
crossed the $50,000 threshold in 4% of interventions whereas in 7%, the
ratio fell below $50,000/QALY after adjusting for HRQoL.
Conclusions: We suggest that the method used for HRQoL adjusting or even
HRQoL adjusting at all does not matter for most reimbursement decisions
on life-saving interventions. The results could differ for interventions that
have large impacts on patients' HRQoL and a relatively low impact on
survival.
56
MODELING APPROACHES FOR ANALYSING HEALTH CARE
PROBLEMS – AN INTRODUCTORY OVERVIEW AND
COMPARISON
WORKSHOP
Speakers:
S. Brailsford, School of Management, University of Southampton,
Southampton, UK
B. Jahn, UMIT - University for Health Sciences, Medical Informatics and
Technology, Hall i.T., Austria
M. Roberts, Department of Health Policy and Management, University of
Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
J. Stahl, MGH – Institute for Technology Assessment, Massachusetts
General Hospital, Boston, MA, USA
Most courses about modeling in health care have their focus on a single
modeling approach. This workshop provides an overview about alternative
approaches: 1) Decision trees (DT), 2) Markov Models (MM), 3) Discrete
Event Simulation (DES), 4) Agent based modelling (ABM), 5) System
Dynamics (SD) 6) Transmission models. It is structured in five sections on the
key concepts followed by an interactive discussion with the participants on
strength and limitations and model selection.
Introduction (B. Jahn, 5min).
Session 1 - (M. Roberts, 8min): This session covers widely used DT and MM.
MM are based on a set of health states (state-transition models). They have
been applied for decision analysis in prevention, diagnosis and chronic
diseases. We will introduce cohort and individual-based simulation
(microsimulation).
Session 2 (B. Jahn, 8min): DES is an alternative method in which entities (e.g.,
patients) interact and compete for resources (e.g., hospital beds or organ
transplants). We will cover the main DES-components, i.e., entities, attributes,
resources, and queues.
Session 3 (J. Stahl, 8min): ABM is a new approach to modeling autonomous,
interacting agents. The fundamental feature of an agent is the capability to
make independent decisions. ABM has been used to examine economics,
emerging behaviour and epidemiology. We will cover the role of agents as
active model components.
Session 4 (S. Brailsford, 8min): SD is a powerful modelling approach,
combining both qualitative and quantitative aspects. It takes a "whole system"
view, showing how a small change in one part of a system can have major
unanticipated effects elsewhere, which is particularly suitable for healthcare
applications.
Session 5 (G. Zauner, 8min): To model infectious disease spread and vaccine
strategies transmission models (compartment models) have historically been
used. The session covers modeling approaches using differential equations.
Discussion (All, 15min): The discussion will provide guidance and key criteria
for model selection such as interactions, dealing with time and space, resource
constraints, and autonomy.
This workshop provides an overview for those not familiar with simulation and
for those that are already experienced in one or two methods, but want to have a
look ‘outside the box’.
Funded in part by ONCOTYROL - Center for Personalized Cancer Medicine *
57
AGENT BASED MODELING AND THE BENEFITS REGARDING
SIMULATION RESULTS
WORKSHOP
Speakers:
M. Gyimesi, Vienna University of Technology, Institute for Analysis and
Scientific Computing, Vienna, Austria
N. Pfeffer, Main Association of Austrian Social Insurance Institutions,
Vienna, Austria
N. Popper, dwh Simulation Services, Vienna, Austria
Motivation: Modular Agent Based Modeling is one possibility to implement

dynamic models which integrate social behavior, spreading of viruses,
economical effects and other features to compute various scenarios.
Different strategies for decision makers can be tested and compared
dynamical.
Workshop discussion: Modeling and simulation techniques based on
modular agent based concepts are presented and discussed. Differences
between state of the art methods like Markovian models and decision trees
and the new bottom up strategy are figured out.
Parametrisation of single agents (single persons in the model) can be done
interactively with the presenter and the differences to cohorts will be shown.
What is an agent and what are differences to other modelling techniques?
Analysis of the parameters and the identification with real data will also be
shown.
One focus is on the different possibilities in implementations of agent based
models, like population models, social models, infection model, economical
model and how they can be combined. To discuss these aspects various
modules are changed (f.e. static population vs. dynamic population) to
compare the effects of changing different model parts and get a feeling for
the stability and sensitivity of the models.
As an example parametrisation and validation of household structure
modeling and its influence on the result and prediction quality are
comprised. Using a real world example for agent based modeling the
Austrian household structure, the discussed approach and the pitfalls on the
way to highly flexible decision support methods are figured out. A typical
SIR model with characteristic epidemic duration will be tested.
Summary: As validated and descriptive data is used the concept leads to
better readability and interdisciplinary usability for all partners.
Advandtages but also boundaries and restrictions (like complexity in
building models and an increased amount of computing time) of this
technique are shown in theory and using the described examples. This will
give an overview of targets (f.e. the future opportunity offered by this
modeling technique to simulate scenarios like quarantining people) and
“non targets” of agent based modeling.
58
MARKET ACCESS GOAL & MANAGEMENT OPTIMISATION
(MAGMO) ANALYSIS AS EVIDENCE-BASED METHOD TO
EFFICIENTLY SUPPORT STRATEGIC DECISIONS
WORKSHOP
Speakers:
E. Rogozinska, CASPolska, Myslenice, Malopolskie, Poland
N.M. Wilk, Arcana Institute, Krakow, Malopolskie, Poland
Public funding decision-makers’ willingness to finance innovative drugs as

well as to keep the current scope of financing for other drugs is decreasing.
Comprehensive recognition of public funding opportunities and threats is
therefore increasingly important.
The purpose of the workshop is to interactively familiarize participants with
MAGMO analysis method. It incorporates information from evidence and
appraisals within a framework of economic theory of consumer preferences
(Cobb-Douglas utility function). MAGMO analysis is a novel method
already being used in decision-making practice. At its core there is an idea
of a market access goal – a set of conditions describing public funding of
a given health technology. Based firmly on evidence MAGMO analysis
limits the multiplicity of variants to a set of few optimal market access goal
variants (optimal means providing maximum utility) in groups according to
the manager’s approach to risk. With minor adjustments it could also be
used by public funding appraisal bodies to systematize and objectify their
decision making processes.
The stages of MAGMO analysis are: 1. Systematic search for evidence
(prevalence studies, CT, systematic reviews, HTAs, etc.) and appraisals
(registration decisions, clinical guidelines, public funding recommendations
and decisions, etc.), for both the analyzed drug and optionally its
competitors within a specific field of healthcare. 2. Identification of options
and components (parts of market access goal variant) with justification. 3.
Paired ranking of options and components in two dimensions: probability of
a positive public funding decision and company’s yearly income from
public funding, with justification. 4. Indication of optimal variants based on
simulations regarding manager’s approach to risk of public funding denial.
The participants will work on a real-life example of a drug that has already
been widely accepted for public funding. They will be asked to rank (group
work) the previously defined options and components and provide
justification based on evidence and appraisals available at the time of the
drug registration in Europe. They will then have an opportunity to verify
their MAGMO analysis results with conditions published in real public
funding decisions. Conclusions will be summarized and discussed.
59
CURRENT AND FUTURE USE OF PHARMACOECONOMIC AND
PHARMACOTHERAPY OUTCOMES RESEARCH DATA IN
DECISION MAKING
WORKSHOP
Speakers:
J. Biskupiak, Department of Pharmacotherapy, University of Utah College
D.I. Brixner, Department of Pharmacotherapy, University of Utah College
A-P. Holtorf, BioBridge Strategies, Basel, Switzerland
Pharmacoeconomics and Outcomes Research (PEOR) are disciplines, which

have advanced considerably over the last decades, in both methodology and
quantity. With increasing access to and use of healthcare, resources become
more restricted and prioritization in healthcare becomes unavoidable. It
therefore, seems appropriate that the results of health economic studies and
health outcomes studies are used in addition to the traditional clinical and
production criteria (efficacy, safety, quality) to make decisions such as
which patients have access to specific drugs and how much of the drug or
treatment cost is reimbursed by the healthcare system.
A small group of researchers and decision makers in the USA have
discussed such use of PEOR in the frame of a roundtable discussion series.
They came to the conclusion that these data are ‘underused’ and identified
some persisting challenges, which need to be addressed. At the same time, a
tendency can be observed towards cost or outcomes based reimbursement
agreements between decision makers and manufacturers. We have therefore
conducted a survey among US decision makers to analyze their current and
perceived future use of PEOR.
The presentation of the key conclusions from the roundtable discussions as
well as from the survey will be used in this workshop to elicit the audience’s
opinion on the use of PEOR data in decision maker from a European
perspective.
Workshop Content:
In this workshop, the audience will receive an overview of the key results
from the US roundtable and survey. The faculty will subsequently lead a
structured discussion with the audience to establish key differences and
similarities. The results of this workshop would then be used as a starting
point for a similar approach among the European stakeholders.
Objectives:
1. Discuss the opportunities and hurdles in the use of PEOR by example of
USA experiences
2. Transfer and test the USA experiences in the European context
3. Develop key questions to be addressed concerning the use of PEOR in the
European decision making context
60
A REVIEW OF MODELING THE MANAGEMENT OF
COMPLICATIONS OR THE PROGRESSION OF DIABETES
MELLITUS
L. Renard1,2, I. Borget3
1
Centre for Health Studies, CRP-Santé, Strassen, Luxembourg, 2EA 4069 -
Epidemiology, Assessment and Health Policies, University Paris Descartes,
Paris, France, 3Studies and Research in Health Economics, Biostatistics and
Epidemiology Department, Gustave Roussy Institue, Villejuif, France
Context: Markov and Monte-Carlo (MC) models are commonly used to

simulate diabetes mellitus (DM) progression and its complications over the
time. A literature review was performed to describe modeling methods used
to represent DM and to identify various factors influencing the model
choice.
Methods: Original studies developing a model of progression of DM and its
complications were selected. Literature reviews and methodological articles
were excluded. Each full-paper went through a 27-items checklist via a
double-reading process. Factors influencing the model choice were
identified by logistical regressions.
Results: Sixty-three original models were selected, including 42 Markov, 19
MC and 2 studies including both a Markov and a MC. Median time since
publication was 6 years. Type-2 DM was considered in 34 models (58%).
Models were used to evaluate prevention or disease-management programs
(54%) more than treatment (40%). They were built with a mean of 11 states
and 2.8 complications. MC models were significantly more used than
Markov models when both 1 and 2 DM, a prevention or disease
management program and a lifetime perspective were concerned. MC
models had a significant higher number of states (>10) and complications
(>2). The multivariate analysis showed the influence of the type of DM and
the number of complications on the type of model chosen.
Conclusion: This literature review allowed to identify quantitative factors
influencing the type of model used to consider DM progression. Further
qualitative analyses will focus on the model choice justification and the
adequacy of the model to the objective of the study.
61
A POLICY MODEL FOR COPD: USING CONCEPTUAL
MODELLING OF CAUSAL LINKAGES TO GET BEYOND THE
MARKOV CHAIN
A.H. Briggs1, H. Starkie1, N. Roberts1, M. Chambers2
1
Department of Public Health and Health Policy, University of Glasgow,
Glasgow, Scotland, UK, 2Global Health Outcomes, GlaxoSmithKline,
Brentford, Middlesex, UK
Background: Chronic Obstructive Pulmonary Disease (COPD) is a major

public health concern. Nevertheless any interventions require appropriate
cost effectiveness modelling to ensure that treatment provides health
systems with value for money. We report on a novel approach to the
modelling of COPD based on a formal conceptual model of disease which
outlines the causal mechanisms to guide the statistical estimation of model
parameters.
Methods: A conceptual model of COPD was developed based on a literature
review and in consultation with clinical experts. The causal relationships
defined by the conceptual model were used to guide the statistical analysis
of model parameters. Data sources included both long-term observational
data sets and short term clinical trial data available to the study team.
Results: A series of regression equations were developed based on the
conceptual model for FEV1 % predicted, exacerbation rates, quality of life,
life expectancy and cost. For example, the model predicts that a 55 year old
male, with lung function of 47% predicted FEV1 will have a life expectancy
of 16 years, a quality adjusted life expectancy of 7 years and a COPD
related lifetime treatment cost (excluding pharmacotherapy) of £11,000.
Conclusions: We outline a novel approach to the modelling of COPD
guided by conceptual modelling of the disease. Using statistical models in
continuous time, the artificial disease staging required by state transition
models is avoided. This alternative approach to disease modelling is based
directly on the causal linkages that represent current epidemiological
understanding of the disease.
62
ESTIMATING SURVIVAL GAINS – CAN WE RELY ON
“END-of-STUDY” RESULTS?
I.S. Kristiansen
Department of Health Management and Health Economics, University of
Oslo, Norway
Objective: Economic evaluation of interventions for chronic diseases is

frequently based on data at the end of clinical trials. This approach is based
on the assumptions that relative hazards are constant across time. The aim of
this study was to explore whether this assumption is violated in terms of
survival curve crossings or convergences.
Design: We identified all time-to-event graphs during 2007 in Annals of
Internal Medicine, BMJ, JAMA, New England Journal of Medicine and
Lancet. The following data were extracted: type of disease, type of
exposure, number of comparator groups, number of paired comparisons,
type of primary and secondary end-points, sample size, maximum follow-up
time, survival curve convergences, survival curve crossings and type of
epidemiologic design.
Results: In total 78% of the 177 publications had survival curve
convergences and 42% survival curve crossings. In multivariate logistic
regression, survival curve convergence was positively associated with ‘more
than one paired comparison’ (OR 3.7, 95% CI 1.3-10.8) and death as a
secondary endpoint (OR 8.1, 95% CI 1.1-65.5). No association was found
between survival curve crossings and any of the explanatory variables.
Conclusion: Survival curve convergences and crossings are common
phenomena in medical research. The results warrant care in making
inferences about the effectiveness of interventions for chronic diseases on
the basis of measurement at a single point in time.
63
THE NUMERACY UNDERSTANDING IN MEDICINE
INSTRUMENT (NUMi): A NEW MEASURE OF HEALTH
NUMERACY DEVELOPED USING ITEM RESPONSE THEORY
M.M. Schapira, M.C. Walker, K.E. Fletcher, P. Ganchow, E. Jacobs,
S. Del Pozo, C. Schauer
Medical College of Wisconsin, Milwaukee, WI, USA
University of Wisconsin, Milwaukee, WI, USA
Rush University Medical Center, Chicago, IL, USA
Background: Health numeracy can be defined as the ability to understand

and use medical information presented with numbers, tables and graphs,
probability, and statistics. The objective of this study is to develop a
comprehensive assessment of health numeracy using Item Response Theory
(IRT) methods.
Methods: A cross-cultural approach was used to develop the Numeracy
Understanding in Medicine Instrument (NUMi). Participants were recruited
from metropolitan areas in the United States. An expert panel, focus groups,
and cognitive interviews were used to support the development of 111
numeracy questions. A two parameter logistic model was used for IRT
analysis using BILOG IRT software. Calibration procedures identified the
difficulty parameter and the discrimination parameter. An item selection
procedure was used that required that maximized the test information
function and included at least five items from each domain. In this
presentation we report an analysis from the first 501 participants.
Results: A 20 item test was developed. The item content and IRT
parameters are presented in Table 1. The Test Information Function was
centered at a -1.0 indicating that this test provided the most information
(i.e.is most discriminating) for persons with a level of health numeracy that
is slightly below the mean of 0.0.
Conclusions: We report a new test for health numeracy based upon IRT
scaling methods. The test provides a measure of numeracy trait across the
domains of number sense, tables and graphs, probability, and statistics. In
future work the item bank will be used to develop a computerized adaptive
test of health numeracy.
64
Table: Calibration of Health Numeracy Items from IRT Analysis (n=501)
Difficulty Discrimination
Domain/Number Description of Test Parameter Parameter
Question
Doubling a dose of
Number Sense 1 1.089 -1.225
medication
Identifying a glucose
level at goal
Number Sense 3 Using a pain scale 1.371 -1.079
Calculating the # of
pills needed for a trip
Interpreting a 1/150 0.713 0.398
Number Sense 5
rate of disease
Comparing breast
Tables/graphs 1 0.949 -1.387
cancer rates in a table
Interpreting a bar
graph
Interpreting a
survival curve
Interpreting a
Tables/graphs 4 0.582 0.606
pictograph of2/1000
Calculating % daily
salt from a table
Comparing numeric
Probability 1 0.634 -0.197
risk formats
Doubling a
Probability 2 percentage lifetime 1.417 -0.987
risk
Interpreting a 90%
Probability 3 0.981 -0.526
risk
Probability 4 Interpreting 50% risk 1.109 -1.332
Understanding
Probability 5 absolute risk 0.404 1.508
reduction
Statistics 1 Interpreting a p-value 0.647 1.239
Statistics 2 Understanding
1.191 -0.853
statistical significance
Statistics 3 Interpreting
confidence interval 1.476 -0.022
#1
Interpreting
Statistics 4 confidence interval 1.477 -0.148
#2
Making inferences
Statistics 5 from a scientific 0.570 -1.013
study
65
ECONOMIC EVALUATION OF HUMAN LIFE –
A NEW APPROACH BASED ON COMPENSATION FOR PAIN AND
SUFFERING
A. Leiter1, M. Thöni2, H. Winner3
1
Department of Economic Theory, Economic Policy and Economic History,
Faculty of Economics and Statistics, University of Innsbruck, Innsbruck,
Austria, 2Department for Human and Economic Sciences, UMIT -
University of Health Sciences, Medical Informatics and Technology, Hall in
Tirol, Austria, 3Department of Economics and Social Sciences, University
of Salzburg, Salzburg, Austria
Valuating health outcome (e.g. extension of life expectancy or improved

health) is of high relevance for decision making in public health, since
decisions on public investments in the health sector should not only
incorporate costs but also benefits, such as saved human lives, to reach a
societal optimal outcome. One possible way of evaluating this crucial
benefit is to price human life. But how can such a price be defined if a
market is missing? Previous economic literature points out different
evaluation methods for human lives and widely uses the Human Capital
Approach, the Value of Statistical Life (VSL) or QALYs. By contrast we
introduce an alternative to the hitherto used valuation measures for assessing
human life monetarily: the compensation for pain and suffering, a value that
monetarily reflects pain and suffering or the loss of a certain body part. We
base this approach on an empirical analysis of compensation for pain and
suffering, which refers to a dataset including more than 1500 German and
Austrian judgements over the last 30 years. First results show that body
parts can be clearly monetarised (e.g. legs € 550.000, arms € 113.000).
Based on these findings an aggregation of single body parts to a functional
human body leads to an estimation of € 1.7 mio. per statistical life, a value
that is in line with international VSL studies. Concluding, the impact of this
new evaluation approach for medical decision making is twofold. First, the
database is composed of objective values given by judgements and therefore
the recourse to individual risk perception (as necessary for VSL or QALYs)
is not required. Second not only the whole human body (compared to VSL)
but also body parts can be monetarised, which leads to a possible variation
of benefits within decision making in the health sector.
66
DIAGNOSIS OF SPUTUM SMEAR-NEGATIVE PULMONARY
TUBERCULOSIS BY THE TB DIAGNOSTIC COMMITTEE:
LOGLINEAR AND CLASSIFICATION TREE MODELS OF A
POSITIVE CHEST X-RAY READING
C.R.E. Alfonte
University of the Philippines, School of Statistics, Quezon City, Philippines
The TB Diagnostic Committees (TBDC) evaluate cases of pulmonary

tuberculosis (PTB) symptomatics who are smear-negative, but whose chest
x-rays show lesions suggestive of tuberculosis that may warrant anti-TB
treatment.
In a review of referral forms of 851 new patients who consulted at Manila
health centers from 2006 to 2008, the demographic and clinical
characteristics associated with a positive chest x-ray and leading to a
diagnosis of active PTB are identified using loglinear models and
classification trees.
The TBDC gave a diagnosis of active PTB and recommended anti-TB
treatment to 516 subjects (60.64%); while 335 (39.36%) were negative for
PTB. Among the 516 subjects with active PTB, 303 patients (58.72%) had
a chest radiograph reading of extensive parenchymal lesions and 213
(41.28%) had minimal PTB lesions.
The diagnosis of active PTB individually associates with symptoms of
hemoptysis (Odds ratio 2.98; 95% Confidence intervals 2.02, 4.40) and
weight loss (OR 1.69; 1.28, 2.22). Subjects below 53 years old, together
with a history of alcoholic beverage drinking, are more likely given a
diagnosis of active PTB (OR 3.39; 1.92, 5.96). In further classifying active
PTB into extensive or minimal PTB, the presence of cough (OR 3.55; 1.91,
6.62) is most strongly related to a finding of extensive parenchymal lesions.
Searching for reasonable and economical approaches to case diagnosis, the
complementary use of loglinear models and classification trees improves the
classification analysis. The TBDC may find the models useful as a decision
tool in support of the chest radiograph.
67
FRAMING EFFECTS OF MEDICAL BELIEFS IN DECISIONS
MAKING AND CAUSAL JUDGMENTS
S.M. Müller1, R. Garcia-Retamero1,2, A. Catena1, A. Maldonado1
1
Departamento de Psicologia Experimental, University of Granada, Spain
2
Max Planck Institute for Human Development, Berlin, Germany
There is a broad amount of evidence suggesting that people often rely on

their causal beliefs in their decisions and judgments. But, does causal
knowledge have a similar impact on people’s decisions in different
domains? Do decisions about health differ from those with less life-
threatening consequences (e.g., money)? To answer these questions, we
conducted a study in which we examined the impact of causal knowledge
and empirical evidence on judgments and decision making. Participants
(N=96) made 120 decisions in a prognostic task, which was framed either in
a medical (heart disease) or economic (stock market) context. Before each
decision, participants could actively search for information about the
criterion (“occurrence of a disease” or “decreasing value of a company’s
shares”) on the basis of four selectable cues. Two cues were linked causally
to the criterion (causal cues); the remaining two cues had a preventative
relation to the criterion (preventative cues). We further investigated whether
participants are able to perceive the predictive power of the cues in the
medical and economic context. Results of the study revealed a substantial
difference in decisions and judgments depending on the context: While
participants stuck to their causal beliefs when making judgments and
decisions in the medical context, they adapted to the empirical evidence in
the economic context. We conclude that empirical evidence is often
neglected in decision making about health and underline the need to train
doctors and patients in dealing with the strong impact of causal beliefs in
this context.
68
RISKY DECISION MAKING WITH GAMBLES AND MEDICAL
TREATMENTS
M.H. Birnbaum, J.P. Bahra
California State University, Fullerton, CA, USA
Because people violate implications of expected utility when making

medical, investment, and gambling decisions, it has been argued that
measurement of utility and probability weighting for applied medical
decisions should be based on cumulative prospect theory, which is more
accurate than expected utility as an empirical description of human decision
behavior. However, recent work with monetary gambles has shown that
people violate cumulative prospect theory systematically; people exhibit
eleven “new paradoxes” that refute this theory. These new paradoxes, like
the Allais paradoxes, result in self-contradiction when the theory is used to
analyze choices that people make. This paper will review a new experiment
in which 129 participants made a series of choices between monetary
lotteries and between medical treatments based on doctors’ advice
concerning the probabilities that each treatment would lead to various
treatment outcomes. The majority of participants violated stochastic
dominance in a specially designed type of medical choice problem. By
using the canonical split form of this choice, it was possible to reverse the
majority preference so that the majority satisfied stochastic dominance.
Violations of lower and upper cumulative independence, restricted branch
independence, and upper distribution independence were also observed;
these findings refute cumulative prospect theory for both monetary and
medical decision tasks. It will be shown that cumulative prospect theory
could result in the false implication that worse medical states are
subjectively better. Implications for public health policy and for optimized
medical decisions for individuals will be described.
69
THE EFFECT OF RISK AVERSION ON TESTING AND
TREATMENT THRESHOLDS IN DIAGNOSTIC TESTING
S. Felder, T. Mayrhofer
Faculty of Economics and Business Administration, Duisburg-Essen
University, Essen, Germany
Testing and treatment thresholds confine the range of the a priori probability
of disease within which a diagnostic test is indicated. The testing threshold
marks the point at which the decision maker is indifferent between not
testing and testing. At probabilities below the testing threshold, the weight
attributed to the patient’s disutility from treatment following a false-positive
test outcome leads decision makers to abstain from testing. The treatment
threshold is the probability at which the decision maker is indifferent
between testing and treating without testing. Immediate treatment of patients
with a higher probability is due to the weight given to their utility loss from
a false-negative test outcome.
This paper analyzes the effect of risk aversion on the two probability
thresholds. We extend the well known expected utility model of (imperfect)
diagnostic testing to distinguish between risk-averse and risk-neutral
decision makers. We first show that the testing threshold is lower for a risk-
averse decision maker than for a risk-neutral one. From a risk-averse
perspective, a patient’s disutility from a false-positive test outcome is less
than from a risk-neutral perspective, resulting in a lower testing threshold.
Secondly, the treatment threshold also shifts downward when the decision
maker is risk-averse as the utility loss of false-negatively tested patients
increases. Risk-averse decision makers thus treat earlier than their risk-
neutral colleagues.
We conclude that risk-aversion lowers the testing range of the a-priori
probability of disease. Risk-averse decision makers thus test earlier but not
more often than risk-neutral physicians.
70
SELF-ESTIMATION ON FRACTURE RISK AND LENGTH OF
LIFE: ISSUES TO CONSIDER FOR 10-YEAR FRACTURE RISK
BASED DECISION MAKING IN OSTEOPOROSIS
M. Péntek1,2, V. Brodszky2, K. Érsek2, P. Baji2, E. Orlewska3, E. Tóth1,
C. Horváth4, L. Gulácsi2
1
Department of Rheumatology, Flór Ferenc County Hospital, Kistarcsa,
Hungary, 2Health Economics and Health Technology Assessment Research
Centre, Corvinus University of Budapest, Budapest, Hungary, 3Centre for
Pharmacoeconomics, Warsaw, Poland, 4First Department of Medicine,
Semmelweis University, Bupapest, Hungary
Background: The FRAX® model (recently developed by WHO) gives 10-

year probability of major osteoporotic and hip fracture, offering new basis
for medical decision making in osteoporosis (OP).
[http://www.shef.ac.uk/FRAX/]
Objectives: Our aim was to study whether FRAX® data differ from OP
patients’ and attendant especialists’ self-estimation on fracture risk. We also
assessed expectations on longliving that is a crucial point to perceive a 10-
year projection relevant.
Methods: In 2009 a cross-sectional survey was performed in 10 Hungarian
rheumatology centres. Postmenopausal OP patients appearing on routine
visit and switching to second line antiporotic drug were involved.
Demographics, main clinical characteristics were registered. Patients’
estimation on 10-year fracture risk and longliving were surveyed.
Physicians’ expectations on patients’ perspectives were likely detected.
FRAX® was calculated and matched with the estimations.
Results: 224 patients were involved, mean(SD): age 69.5(8.9)years, duration
of OP care 6.7(5.1)years, lumbar Tsc-3.17(0.82), femoral Tsc-2.69(0.87),
133(40.6%) patients had OP fracture previously. Health status VAS was
59(17)mm. FRAX®-major OP fracture was 26(15.7)%, patients estimated
32.7(25.8)%, physicians marked 29.9(21.4)%. Results for hip fracture were:
FRAX® 12.6(15.3)%, patients 26.7(25.3)%, physicians 21.5(19.1)%
(p<0.01). Patients’ expected to live until age 82.4(8.2)years, physicians’
estimation was nearly same (82.5, SD7 yrs). Less than 10-year survival was
expected by 42,4% and 33.7%, respectively.
Conclusions: Both patients and physicians overestimate fracture risk,
especially for hip, therefore a more extensive use of FRAX® is advisable.
Patients often expect to live shorter than the time-frame of the fracture risk
projection, an issue that should be highly considered when implementing
FRAX® in everyday practice.
71
CHOOSING BETWEEN HOSPITALS: THE INFLUENCE OF
PATIENT EXPERIENCES
I.B. de Groot1, J. Dijs-Elsinga1, W. Otten2, J. Kievit1,
P.J. Marang-van de Mheen1
1
Department of Medical Decision Making, Leiden University Medical
Center, Leiden, The Netherlands, 2TNO Quality of Life, BU Prevention and
Health, Section Reproduction and Perinatology, Leiden, The Netherlands
Objectives: Information on hospital performance in the public domain is

increasing, with the aim to support consumers when choosing a hospital.
This information includes general hospital information, information on
outcomes of care and other peoples’ experiences. The aim of this study was
to assess which information regarding other peoples’ experiences has the
greatest influence on hospital choice and whether this information has
greater influence than other information.
Methods: A web-based questionnaire was sent to 158 new surgical patients
and to 300 healthy volunteers. Using Adaptive Choice Based Conjoint
analysis, respondents were asked to select between 4 and 10 items they
would use for future hospital choice from a list of 41 items. Then multiple
comparisons of 3 hospitals were presented characterized by the selected
items, and the respondent had to choose the hospital where they wanted to
be treated. The relative importance (RI) of each item was estimated using
Hierarchical Bayes estimation.
Results: In total 113 patients (71.5%) and 279 volunteers (93%) completed
the questionnaire. The item ‘Report card regarding physician’s expertise’
had the highest RI (14.78 [13.19-16.38]) followed by ‘Waiting time for
appointment at the outpatient clinic’ (13.41 [11.72-15.10]). These items
clearly had greater influence than the next items ‘Waiting time for surgery’
(7.75 [6.75-8.74]) and ‘Positive judgment about physician communication
(5.96 [5.21-6.71]). No differences between patients and volunteers were
found.
Conclusion: Regarding other peoples’ experiences, physician’s expertise
and communication are important for consumers besides waiting time.
These seem to have greater impact than information on outcomes of care.
72
CLINICAL EFFECTIVENESS OF TRIPLE THERAPY IN THE
MANAGEMENT OF COPD
K. Gaebel1,2, G. Blackhouse2,3, P. Hernandez4, F. Xie1,2,3
D. Robertson2,3, A. McIvor6, N. Assasi2,3, R. Goeree1,2,3
1
Centre for Evaluation of Medicines, St. Joseph’s Healthcare Hamilton,
Hamilton, ON, 2Programs for Assessment of Technology in Health
Research Institute, McMaster University, Hamilton, ON, 3Department of
Clinical Epidemiology & Biostatistics, McMaster University, Hamilton,
ON, 4Department of Medicine, Dalhousie University, Halifax, Nova Scotia,
5
Department of Medicine, McMaster University, Hamilton, ON, 6Firestone
Institute of Respiratory Health, St Josephs Healthcare, Hamilton, ON,
Canada
Background: Three classes of inhaled drugs are prescribed for the treatment
of moderate to severe COPD: long-acting anti-cholinergic (LAAC) and
long-acting beta-agonist (LABA) bronchodilators, and inhaled
corticosteroids (ICS). Guidelines from the Canadian Thoracic Society
advocate triple therapy for the management of some COPD patients.
Objective: To evaluate the clinical effectiveness of triple therapy in the
management of COPD compared to dual bronchodilator therapy,
combination therapy or monotherapy.
Methods: Systematic literature search to identify relevant clinical
evaluations of triple therapy in the management of moderate to severe
COPD.
Results: Of 2314 publications, four articles evaluated triple therapy for the
management of COPD. There was insufficient evidence to determine if
triple therapy is clinically superior to dual bronchodilator therapy or
combination therapy. There was also inconclusive evidence to determine
whether triple therapy decreased the overall exacerbation rate when
compared to monotherapy.
Triple therapy does decrease the number of severe COPD exacerbations
resulting in hospitalization compared to monotherapy [RR (95% CI): 0.53
(0.33-0.86)]. Triple therapy produced greater improvements in the quality of
life of patients compared to monotherapy; mean differences across three
trials were 2.3 - 4.5 points on the St. George’s Respiratory Questionnaire
with p-values in the range of 0.023 –0.01. The overall mean difference in
the FEV1 measures between triple therapy and monotherapy was 0.047L
(p<0.05).
Conclusion: In patients with moderate to severe COPD triple therapy
decreases COPD hospitalizations, improves FEV1 and QoL compared to
LAAC monotherapy. There is not sufficient evidence to determine whether
triple therapy decreases the exacerbation rate.
Word count 250
73
KEY PRINCIPLES FOR TECHNOLOGY ASSESSMENT
PROGRAMS: DEBATE AND NEW DIRECTIONS
PANEL DISCUSSION
Moderator: M. Helfand, Oregon Evidence Based Practice Center, Portland,
OR, USA
Panelists:
M. Drummond, Department of Health Sciences, University of York
Heslington, York, UK
N. McElwee, U.S. Outcomes Research, Merck & Company, Inc, North
Sumneytown Pike, North Wales, PA, USA
J.S. Schwartz, Department of Health Care Management, University of
Pennsylvania, PA, USA
Recently, the small international group the drafted the principles for
technology assessment published a scorecard indicating the degree to which
some of the leading, most respected HTA groups apply these principles.
This analysis found that some of the proposed principles have not been
universally adopted. There was, for example, wide variation among
programs in the degree of required data transparency when issuing
recommendations; emphasis on 'efficacy' vs. pragmatic 'effectiveness’ trials,
and the use of economic information in assessments. This variation may
reflect fundamental disagreement about the principles or social or
methodological challenges to implementation.
Although the principles have been presented and published, they have not
been subjected to extended debate within the decision-making and
technology assessment community. This panel discussion will begin with a
brief review of the results of “scorecard”, bringing attention to areas
variation in technology assessment methods across countries and programs.
Then, speakers who were not involved in developing the principles will
critique them, and members of the international group will respond. The
majority of time allotted for this panel discussion will be given to audience
questions and comments about the validity and completeness of the
proposed principles.
74
AN EXAMPLE OF A SUCCESSFUL IMPLEMENTATION OF
VACCINATION PROGRAMME: THE PUBLIC HEALTH IMPACT
OF ROTAVIRUS VACCINATION
PANEL DISCUSSION
Moderator: C. Giaquinto, University of Padua, Padua, Italy
Panelists:
N. Alsayed, Sanofi Pasteur MSD, Lyon, France
M. Toumi, Creativ-Ceutical, Paris, France
Background: Rotavirus is the leading cause of acute gastroenteritis in

children aged less than 5 years old. At the age of 5 years, almost every child
will be infected at least once. The majority of rotavirus gastroenteritis
(RVGE) occurs between 3 months and 3 years of age with a peak incidence
between 6-24 months of age. In Western Europe, RVGE places a
considerable burden on healthcare system through hospital services
disruption and association with nosocomial gastrointestinal infections in
children
Panelist 1: Impact of rotavirus vaccination with RotaTeq® on health care
resource use: From randomised clinical trials to universal routine
vaccination
RotaTeq®, a Rotavirus vaccine, is available in Europe and the US since
2006. During the clinical development, RotaTeq had demonstrated a good
safety profile with high and sustained protection of 94% against
hospitalisation and emergency visits up to 3 years after vaccination. In the
US, RotaTeq was introduced in routine immunisation since 2006 and has
since demonstrated to be 98-100% effective in the prevention of RVGE
hospitalisations and/or emergency visits. Similar results with 98%
effectiveness had been observed in a study conducted in France. Several
observational studies described a rapid and significant reduction of RVGE
related health care utilisation not only in vaccinated children but also in non
vaccinated and older children (indirect protection).
Panelist 2: Public health impact of rotavirus vaccination
The economic impact of RV gastroenteritis is substantial. RVGE in children
<5 years old would cost about M€319 in the US and ranges from about M€7
(Belgium) to M€128 (Germany) in Europe. In Europe, hospitalisations and
ambulatory care are key cost drivers representing 60-69% and 10-27%
respectively of total disease costs. These would fall to 4% and 1%
respectively with universal rotavirus vaccination. Consequently, hospital
resources could be optimally reallocated.
Conclusion: With timely implementation, the medical as well as economic
impact of universal rotavirus vaccination with RotaTeq® has demonstrated
its significant impact on medical and economic burden of RV-disease in
Europe.
75
HOSPITAL MORTALITY OR FOLLOW-UP MORTALITY FOR
QUALITY REPORTING? ANALYSIS OF QUALITY REPORTS
COVERING INSURED FROM LOCAL SICKNESS FUNDS
J. Stausberg
Institut für Medizinische Informationsverarbeitung, Biometrie und
Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Germany
Introduction: Many quality indicator sets focus on hospital mortality rates as

major outcome measures. Several arguments motivate the extension of the
observation time to a period after discharge. For example shortening of the
inpatients’ length of stay could shift adverse events caused by hospital
treatment to the outpatient sector. With quality reports provided by local
sickness funds, rates on hospital mortality and follow-up mortality become
available in Germany for the first time. This work analyzed whether follow-
up mortality adds knowledge to a quality assessment based on hospital
mortality.
Methods and Materials: Respective quality reports are available from 31
hospitals. The quality reports cover four tracers like heart failure and hip
replacement. Mortality rates are reported for four different periods: hospital,
30, 90 and 360 days after admission. Thus, a quality report includes 32
mortality rates at a maximum. Coherence between different periods was
estimated using the non-parametric correlation coefficient. A trend analysis
for each tracer in each hospital was performed using linear regression.
Results: There is a relevant (r between 0.552 and 0.908) and highly
significant (p<=0.006) correlation between the periods looking at non-
surgical tracers. The results for surgical tracers are weaker. In 15 from 84
courses with complete data, there is a statistical significant trend for the
standardized mortality ratio (SMR). However, a change between the
superior side and the inferior side (i.e. a change according to the threshold 1
of the SMR) occurs only four times.
Discussion: This analysis does not reveal strong arguments for the
replacement or supplementation of hospital mortality rates by follow-up
mortality rates. Especially for non-surgical tracers, the results in the
different periods are highly correlated. Evaluating the outcome of hospital
treatment at the time of discharge will bring up more information on quality
than focusing on changes of hospital ranks in follow-up periods.
76
IMPACT OF ALTERNATIVE DEFINITIONS OF MEDICATION
COMPLIANCE ON TREATMENT COST FOR MEDI-CAL
PATIENTS WITH SCHIZOPHRENIA
J. Pai, J.M. McCombs
University of Southern California, School of Pharmacy, Department of
Pharmaceutical Economics and Policy, Los Angeles, CA, USA
Objective: Investigate the relationship between persistence with drug

therapy and treatment costs in patients with schizophrenia.
Methods: A retrospective database study was performed using California
Medicaid data from 1994 to 2003. 238,754 episodes of psychotropic drug
therapy were identified for patients with schizophrenia. A series of ordinary
least squares (OLS) regression models of post-treatment cost were estimated
using alternative definitions of persistence adjusting for patient
demographics, drug use history, prior use of medical care and co-morbid
medical conditions.
Results: A ‘gold standard’ for persistence defined as one year of continuous
therapy with no augmentation or switching was compared to other
classifications of persistent and non-persistent behavior. The least
expensive patients were quitters [-$1,484] and patients who use medication
intermittently [-$1,791]. Patients who were persistent on their initial drug
while adding a second drug and patients who achieved persistence on a
second drug were significantly more costly to treat than ‘gold standard’
patients [+$1,935 and +$3,185, respectively].
Conclusion: The intermittent use of psychotropic medications may be cost-
effective for some patients. However, intermittent use may also indicate
that the patient has disengaged from the health care system. Conversely,
patients who add or switch drugs while maintaining uninterrupted therapy
are the most costly. Therefore, medications used to treat more severely ill
patients may appear to be the most expensive medications when compared
head-to-head with medications used to treat intermittent therapy patients.
Clearly, using persistence as a measure of drug performance in comparative
effectiveness research may be misleading without data on switching and
augmentation.
77
CHANGES IN QUALITY OF LIFE AND UTILITY IN HEART
FAILURE PATIENTS: A COMPARISON OF TRAJECTORIES
P. Kolm, C.T Jurkovitz, W.S. Weintraub
Christiana Care Health System, Newark, DE, USA
Background: The Efficacy of Vasopressin Antagonism in Heart Failure

Outcome Study with Tolvaptan (EVEREST) trial randomized a total of
4,133 heart failure patients to tolvaptan (2,072) or placebo (2,061) in 359
sites in Europe, North and South America to assess change in global clinical
status and mortality. In this study, we assessed the relationship between
trajectories of utility and quality of life in heart failure patients enrolled in
the EVERST trial.
Methods: Quality of life was measured by the Kansas City Cardiovascular
Myopathy Questionnaire (KCCQ) and utility by the Euro-Qol 5D (EQ5D).
These measures were obtained at baseline, 1, 8, 24, 48 and 72 weeks post-
treatment. The longitudinal relationship between utility and KCCQ domain
and summary scores were analyzed from baseline to 24 weeks by first
modeling the trajectories across time and then cross-correlating the resulting
time series.
Results: Utility and KCCQ scores showed large increases from baseline to
1 week post-treatment (> 19%) regardless of treatment. From 1 week on,
EQ5D and KCCQ scores remained at much the same levels. Cross-
correlation analysis indicated that EQ5D and KCCQ trajectories were
essentially parallel over time. Conclusions: For all patients in the EVERST
trial, utility and quality of life followed similar trajectories up to 24 weeks
post-treatment – a large, immediate increase, but little subsequent change.
The strong relationship between the trajectories has implications for
successful mapping of KCCQ scores to a utility score specific to heart
failure patients.
78
IS QUALITY OF LIFE EVALUATED BY EXPERTS AND BY THE
GENERAL POPULATION IN THE SAME MANNER? IMPACT ON
A COST-UTILITY ANALYSIS
V. Koné, S. Calmus, G. Vidal-Trécan
Public Health Service, Risk Management and Quality of Care, Hospital
Cochin Saint Vincent de Paul, AP-HP, Department of Public Health,
Faculty of Medicine, University Paris Descartes, France
Objective: To measure the influence of expertise in evaluating the quality of

life (QOL) of health states related to the management of primary
hyperparathyroidism and the impact of outcomes on a cost-utility analysis.
Methods: We interviewed163 subjects not suffering from primary
hyperparathyroidism, including 55 experts randomly selected from the
French Society of Endocrinology database. Other subjects consisted in an
opportunist sample of the general population. A vignette described each
health state and QOL weight was elicited using time-trade-off. The QOL
weights elicited from experts and non-experts were compared. Quality
adjusted life expectancies and incremental cost-utility ratios (ICR) of the
therapeutic strategies (medical monitoring, unilateral neck exploration
(UNE), videoendoscopic-assisted parathyroidectomy (VAP) and bilateral
neck exploration) obtained from a Markov model were compared.
Results: Thirty-three percent of the subjects did not want to trade any health
state, more in experts than in non-experts (50% vs. 25%, p<0.01). Mean
QOL weights elicited from experts were higher than those elicited from
non-experts. This leads experts to prefer another strategy than non-experts.
UNE was the most effective strategy according to experts whereas VAP was
the most effective according to non-experts. VAP was a cost-effective
strategy for non-experts (ICR of 21.429€ related to UNE) whereas it was
dominated by UNE according to experts.
Conclusion: Our results raised the question of using QOL elicited from
experts in cost-utility analysis. Indeed, experts seem to overestimate the
weight QOL of health states. This could lead to preferring another strategy
than what would be chosen by a general population sample.
79
INDIVIDUAL PATIENT DATA META-ANALYSIS OF COMPLEX
INTERVENTIONS – AN EXAMPLE WITH EARLY
MOBILISATION IN STROKE
L.E. Craig1, J. Bernhard2, P. Langhorne3, O. Wu,1
1
Public Health and Health Policy, University of Glasgow, Glasgow, UK
2
National Stroke Research Institute (part of Florey Neuroscience Institutes)
3
Academic Section of Geriatric Medicine, University of Glasgow, Glasgow,
UK
Background: Very Early Mobilisation (VEM) is a distinctive characteristic

of care in some stroke units; however evidence of its effectiveness is
limited. To date, two Phase II trials have compared VEM with standard care
(SC): A Very Early Rehabilitation Trial (AVERT) in Australia and the
recently completed Very Early Rehabilitation or Intensive Telemetry after
Stroke (VERITAS) trial in the UK. The aim of this individual patient data
(IPD) meta-analysis was to investigate the impact of VEM on independence
by pooling these two comparable trials.
Methods: Individual patient data from both trials were pooled and analysed.
The primary outcome was independence defined as Modified Rankin Score
[mRS] of 0-2 at three months. Logistic regression was used to assess the
effect of VEM on outcome with multivariate analysis used to adjust for
known confounders including age, baseline stroke severity and pre-morbid
mRS.
Results: All patients in AVERT (N=71) and VERITAS (N=32) were
included. The baseline characteristics of VEM patients were largely
comparable with SC patients. A shorter time to first mobilisation for VEM
patients in comparison to SC patients was achieved in both trials. VEM
patients had a greater odds of independence compared with SC patients
(adjusted OR 3.11, 95% CI, 1.03, 9.33).
Interpretation: Patients receiving VEM showed improved independence at
three months compared with SC, however, both trials are limited by small
sample sizes. Individual patient data (IPD) meta-analysis offers a more
precise estimate of effect than individual studies and a robust approach to
explaining heterogeneity in trials of complex intervention.
80
CARE COORDINATION: WHAT WORKS? HARNESSING A VAST
LITERATURE THROUGH A SYSTEMATIC REVIEW OF
SYSTEMATIC REVIEWS
K.M. McDonald1, V. Sundaram1, C. Smith-Spangler1, L. Albin1,
D.M. Bravata1, D.K. Owens2,1
1
Center for Primary Care and Outcomes Research, Stanford University,
Stanford, CA, USA, 2VA Palo Alto Healthcare System, Palo Alto,
CA, USA
Background: For clinicians and policymakers deciding among strategies to

improve care through coordination interventions, understanding the
effectiveness of alternate strategies is essential.
Objective: To assess the evidence base about the types of interventions
available, the patient populations targeted, and the effectiveness and cost-
effectiveness of evaluated approaches.
Methods: We systematically searched MEDLINE and other sources for
systematic reviews that evaluated care coordination interventions, assessed
the quality of each review, and abstracted data on the definitions of the
interventions and reported outcomes.
Results: Our searches identified 4730 articles, from which we included 43
systematic reviews evaluating 20 care coordination interventions. Care
coordination strategies were most frequently evaluated among patients with
mental health problems (13 reviews), followed by heart failure (9) and
diabetes (3). The mostly frequently evaluated care coordination
interventions were: multidisciplinary teams; disease management; case
management; integrated care; and interprofessional education.
Multidisciplinary team interventions reduced hospitalizations and improved
service utilization among mentally ill patients; improved mortality and
reduced hospitalizations for heart failure; and reduced dependencies in
activities of daily living among stroke patients. Disease management
programs improved glycemic control in diabetic patients, heart failure
mortality and readmission rates, and depression severity and treatment
adherence. Case management improved outcomes for mental health, heart
failure, and diabetes. There was insufficient evidence about economic
consequences of care coordination interventions.
Conclusions: Care coordination interventions can result in important
improvements in health outcomes. The extent to which particular care
coordination strategies or components of care coordination interventions are
superior to others has yet to be established.
81
HORIZON SCANNING IN ONCOLOGY – EVALUATION OF NEW
AND EMERGING ANTICANCER DRUGS IN AUSTRIA
A. Nachtnebel1, S. Geiger-Gritsch1,2,3, K. Hintringer1,2
1
Ludwig Boltzmann Institute for Health Technology Assessment, Vienna,
Austria, 2Institute of Public Health, Medical Decision Making and Health
Technology Assessment, Department of Public Health, Information Systems
and Health Technology Assessment, UMIT, Hall i.T., Austria
3
ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck,
Austria
Objectives: Since particularly expenditures for cancer therapies have

Increased considerably in Austria, the Ludwig Boltzmann Institute for
Health Technology Assessment (LBI-HTA) was commissioned to set up a
‘Horizon Scanning System (HSS)’ in oncology. The aim of the project was
the stepwise development and implementation of a system for the evaluation
of new anticancer drugs in order to inform decision makers before their
routine introduction into clinical practice.
Methods: Identification of common stages involved in HSS and developing
a process for a HSS in Oncology. Piloting of the major stages, adjustment to
the Austrian context and implementation of the system as standard practice
at the LBI-HTA by introducing a regular scanning and prioritization process
and setting up a standard assessment procedure.
Results: Five work steps were identified to be crucial for a HSS in oncology.
The testing of two important steps in the context of a short pilot [1] resulted
in the reduction of information sources for the scanning process, the
enlargement of the expert team and the adjustment of the prioritisation
criteria. Based on these findings, the implementation of the HSS has begun
in 2008 in cooperation with an interdisciplinary expert team, EuroScan and
several decision makers. Seven assessments on novel anticancer drugs with
a likely therapeutically and/or financial impact were published since
October 2009 [2]. These assessments serve as decision aids for funding
agencies.
Conclusion: The HSS in oncology was developed and implemented
successfully. Future amendments will include the optimization of applied
methods, the involvement of additional stakeholders, the expansion of
international cooperation and the evaluation of the HSS.
82
FROM 10-YEAR RISK SCORING TO LIFETIME (RISK) BENEFIT
IN THE PREVENTION OF CARDIOVASCULAR DISEASE
A.H. Briggs, K.D. Lawson, J. Lewsey
Department of Public Health and Health Policy, University of Glasgow,
Scotland, UK
Policy background: Guidelines recommend treating patients with a high risk

of a CVD event (≥ 20% over 10 years) identified through risk scoring (e.g.
Framingham, ASSIGN). However, risk scores have a strong age gradient,
whereas the ultimate intention of clinicians and policy makers is to prevent
premature CVD. There is a need to focus prevention upon modifiable risk.
Objectives: To introduce a new approach to primary prevention where
treatment prioritisation can be made on the basis of expected lifetime (risk)
benefit, defined by quality adjusted life years (QALYs).
Methods: Lifetime risk was estimated by extrapolating beyond the 4 year
follow up study of primary and secondary events from the Framingham
cohort (D’Agostino, 2000). We made adjustments for changing risk factors
and the competing risk of death. Life expectancy was “quality adjusted” by
the negative impacts of incurring an event. We populated the model using a
screened population within Glasgow (n=8,000) and estimated CVD adjusted
lifetables. Finally, we simulated the impacts on QALYs of risk factor
reductions across patient groups.
Results: The greatest gains in QALYs from risk factor reductions (e.g.
cholesterol) are in 50 to 60 years olds – by as much as 4 years. However,
many such patients wouldn’t qualify as “high risk” under current guidelines.
In contrast, a 70 year old non-smoking male would be termed high risk by
virtue of age whereas the expected benefit of prevention is as low as 0.1
years. Prioritising interventions on the basis of QALYs is a more clinically
and economically sensible approach.
83
DOES COST-EFFECTIVENESS ANALYSIS DISCRIMINATE
AGAINST PATIENTS WITH SHORT LIFE EXPECTANCY?
MATTERS OF LOGIC AND MATTERS OF CONTEXT
M. Paulden1, A.J Culyer2,3,4
1
Toronto Health Economics and Technology Assessment (THETA)
Collaborative, University of Toronto, Toronto, Canada
2
Department of Health Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada, 3Department of Economics and Related
Studies, University of York, York, UK, 4Centre for Health Economics,
University of York, York, UK
The UK’s National Institute for Health and Clinical Excellence (NICE) has
been accused of discriminating against patients with shorter life expectancy
through its consideration of quality-adjusted life years (QALYs). The aim of
this paper is to explore this claim more formally and to identify the
circumstances under which such discrimination might arise. A simple model
is developed which demonstrates that NICE’s recommendations do not
inherently discriminate on the basis of life expectancy per se but that scope
for discrimination may arise in the case of specific technologies having
identifiable characteristics. Such discrimination may favour patients with
either longer or shorter life expectancy. It is shown that NICE’s policies,
procedures and the context in which NICE makes its decisions not only
reduce the scope for discriminatory recommendations but also – in the case
of “end of life” treatments – increase the likelihood that NICE’s
recommendations favour those with shorter, rather than longer, life
expectancy.
84
FUZZY LOGIC APPROACH TO ELABORATION OF MEDICAL
GUIDELINES
K. Pagava1,2, T. Kiseliova3, L. Bakashvili2, I. Korinteli1,
J. Meladze4
1
Tbilisi Medical State University, 2Tbilisi Institute of Medical
Biotechnology, 3Ivane Javakhishvili Tbilisi State University, 4St. Andrew
the First-Called Tbilisi University, Tbilisi, Georgia
Background: Purposeful usage of medical guidelines (MG), covering both

diagnostics and treatment is considered as a crucial condition for good
clinical practice. MG has being invented through the compilation of data
and opinions from different sources. Additional challenge is the necessity to
take into account national and regional peculiarities, availability of health
resources (which is extremely important for countries with limited
resources), epidemiological situation etc. Uncertainty of the above-
mentioned factors, at least of part of them, speaks for the appropriateness of
Fuzzy logic approach in elaboration of MG.
Aim: Working out of a model for computer-supported elaboration of MG
for diagnosis of different syndromes and diseases, incl. rare diseases as well.
Methods: Fuzzy control methodology was used to build our model: medical
knowledge was represented in the form of fuzzy “if-then” rules; the
mechanism of approximate reasoning was applied to deduce necessary
recommendations.
Results: Created model contains the following components: evaluation of
appropriate reference sources according to the level of evidence; evaluation
of “if-then” estimates according to their level of evidence and strength;
determination of level of invasiveness, price and availability of different
investigations; consideration of severity of diseases confirmed or refuted by
means of special investigations. Based on this information a special
computer program delivers recommendations on priority and sequence of
needed diagnostic investigations. The model was tested on the example of
Fever of Unknown Origin in children and adolescents.
85
COVERAGE WITH EVIDENCE DEVELOPMENT AS A SILVER
BULLET? – SOME CAUTIOUS CONSIDERATIONS
P. Storz, D. Bühler, B. Egger
GKV-Spitzenverband (German National Association of Statutory Health
Insurance Funds), Berlin, Germany
Currently an upswing is observed in adopting concepts of temporary

coverage decisions under the condition to generate further evidence (CED)
to overcome frequent stalemates and unfortunate situations when decisions
under uncertainty have to be made. The attractiveness and intuitive appeal
of such concepts seems apparent in avoiding wrongful decisions – which
might even subsequently never be identified as such – the systematic
generation of reliable evidence to enable a reasonable decision after a
limited time period seems certainly superior. Some cautionary remarks are,
however, in order: 1. CED concepts may be only a second best choice,
compared to the plausible expectation that manufacturers and would-be
users will have generated the evidence already. 2. Recent reviews regarding
CED concepts seem to show that decisions are frequently made without
reference to existing CED-schemes or even contradicting their results (CED
as "alibi" endeavor) 3. Trial designs within CED-schemes are quite often
inadequate 4. The sometimes stated objective for CED to be used in
particular regarding "promising" technologies may render them redundant.
Finally: In a truly ("comparative") decision making perspective it has to be
asked what the results of CED-schemes in terms of outcomes are compared
to no such schemes? These questions result from recent experiences of
decision making within the German healthcare system where CED-concepts
are currently discussed and results from existing CED-Schemes, particular
regarding PET technology, might be cited in it's favor. Nevertheless the
CED-concept is indeed promising. It does, however, need to be protected
from distortions – "Use it (well) or lose it".
86
VALUING GENETIC TESTS AND SERVICES: THE ROLE OF
HEALTH STATUS
K. Payne1,3, M. McAllister2,3, L. Davies1
1
Health Sciences Economics, School of Community Based Medicine,
University of Manchester, UK, 2Medical Genetics Research Group, School
of Biomedicine, University of Manchester, UK, 3Nowgen - A Centre for
Genetics in Healthcare, Manchester, UK
Clinical genetic services are a complex intervention combining genetic

diagnosis, sometimes using genetic tests, risk estimation and counselling.
These services also perform a co-coordinating function, referring patients to
other services offering screening and/or treatments. In the UK, qquality
adjusted life years are the preferred measure of patient benefit and as
currently measured emphasise health status.
Aims: To identify the benefits (health and non-health) and process attributes
of genetic tests and services. A secondary aim was to define the genetics
service users’ utility function.
Methods: Data were combined from three studies with a shared primary
aim: systematic review to identify validated outcome measures used to
evaluate clinical genetics interventions; postal Delphi survey of users (n=72)
and providers (n=115) of genetics tests and services to identify the degree of
consensus about the relevance of existing outcome measures; focus groups
and interviews to explore the outcomes valued by patients, patient
representatives and providers (n=52). Pre-defined decision rules informed
data triangulation. Identifying agreement, silence and dissonance between
the data involved successive, iterative rounds of analysis.
Results: The interventions offered by clinical genetics services were valued
by participants, not because they improve patients’ health status, but
because they provide information that empowers patients and their relatives
to cope better with the condition in the family, make medical treatment
and/or management, as well as personal reproductive and other decisions.
Flexible valuation methods are required to value the (dis)benefits from
genetics, and other, services where outcomes are primarily non-health rather
than health related.
87
COST-EFFECTIVENESS OF THE CHEK2 GENOTYPING AND
PERSONALIZED BREAST CANCER SCREENING IN THE POLISH
HEALTH-CARE SYSTEM
E. Orlewska1,2, J. Lubinski2
1
Centre for Pharmacoeconomics, Warszawa, Poland,2International
Hereditary Cancer Center, Department of Genetics and Pathology,
Pomeranian Medical University, Szczecin, Poland
OBJECTIVE: to assess cost-effectiveness of genotyping every women at

CHEK2 and offering – on the basis of her BC risk profile - a personalized
screening programme.
METHODS: The cohort simulation started with 25-year-old women and
projected costs and outcomes over patients’ lifetimes. Two scenarios were
compared: (A) DNA CHEK2 test in all women, screening strategy
beginning at 25 years of age only in CHEK2-positive women (1.2%) and
standard screening strategy (beginning at 50 years) in the remained
population; (B) without DNA CHEK2 test, in all women standard screening
strategy. Data on life expectancy, BC risk, efficacy of screening strategy and
medical costs were obtained from published literatures. Effectiveness was
measured as life years gained (LYG). Only direct medical costs were
included, assessed from health-care payer perspective and reported in PLN
(1 EUR=4.0 PLN in 2010). 5% and 3.5% discount rate was used for cost
and effectiveness, respectively.
RESULTS: The total lifetime costs/patient were estimated to be 2223.85
PLN (discounted: 644.84 PLN) in (A) and 1998.20 PLN (discounted:
430.15 PLN) in (B). The total LY generated with scenario (A) were 50.958
vs. 50.939 with scenario (B) (without discounting) and 23.170 vs. 23.165
(discounted), respectively. This results in ICER for (A) of 11,862 PLN/LYG
(without discounting) and 41,865 PLN/LYG (discounted). Results were
robust to sensitivity analyses.
CONCLUSIONS: The use of CHEK2 genotyping and pesonalized BC
screening improves survival compared to standard strategy and considering
the suggested threshold for cost-effectiveness in Poland (80,000 PLN/LYG),
is cost-effective in the Polish health-care system.
88
SHOULD WE IMPLEMENT TARGETED ACTIONS TO IMPROVE
ADHERENCE TO THE NATIONAL PROGRAM OF COLORECTAL
CANCER SCREENING?
J. Le Breton1, N. Journy2, A. Prigent2, P. Le Corvoisier3, Z. Brixi4,
K. Chevreul2
1
Département de médecine générale, Faculté de médecine de Créteil, France
2
Département de santé publique, CHU Henri Mondor Créteil, France
3
Centre d’investigation clinique, CHU Henri Mondor Créteil, France
4
Association de dépistage organisé des cancers dans le Val de Marne,
France
While the French program of colorectal cancer screening was extended

nationwide in 2009, the average rate of adherence was estimated at 42%.
With the objectives unmet, the way to improve the adherence is still in
question. From data collected by a local coordinative structure, this study
aimed at identifying factors that influence patients’ non-adherence to the
program. All 50 to 74 years-old persons living and having a general
practitioner (GP) practicing in a local authority during the 2007-2009 period
were included. Multilevel modeling was used to quantify the contribution of
GPs to variation in adherence and identify patients and GPs characteristics
that influence non-adherence. Amongst 158 934 patients, the adherence was
28.5% ranging from 0 to 77% across the 923 included GPs with at least 5
eligible patients. Modeling shows that 14% of this variability was related to
practitioners. Along with male and the youngest patients, those ones with a
GP who practiced in a group, did not take appointments, charged a
supplementary fee or had a large number of eligible patients showed lower
adherence. Results highlight an important role of GPs on patients’
adherence to screening program. It argues for a formative action that
specifically target GPs who present characteristics associated with lower
adherence. They also suggest that an awareness campaign towards men and
the youngest patients could have a positive effect.
89
MATCHING HTA FOR THE REQUIREMENTS OF NATIONAL
HEALTH CARE SYSTEMS? LESSONS LEARNED: THE
BISMARCK SYSTEM, EXAMPLE OF GERMANY AND AUSTRIA
PANEL DISCUSSION
Moderator: A. Ruether, German Institute for Quality and Efficiency in
Health Care, (IQWiG), Cologne, Germany
Panelists:
S-L. Antoine, German Institute for Medical Documentation and
Information (DIMDI), Cologne, Germany
M. Hofmarcher, Gesundheit Österreich GmbH (GÖG), Vienna, Austria
I. Rosian-Schikutav, Austrian Health Institute (ÖBIG), Vienna, Austria
Since years the HTA community discusses the best way to efficiently and
effectively address and support decision maker in Health Care. The
discussion deals with many important but general aspects like possibilities
of sharing results, minimizing resources or standardizing methodology. The
main challenge for HTA agencies is touched marginally only: How can
HTA fit to the requirements of the own Health Care system? Legal, political
and cultural demands claim for a tailored HTA. But it should not loose its
quality, international standard and acknowledgement. The scope of this
panel is to address challenges and solutions of tailoring HTA to National
Health Care Systems. Although, as there is now an immense variation of
available health care systems, in general a classification in two main types is
possible: The social insurance based health care systems, the so called
“Bismarck-Model” which originates from the German Chancellor Otto von
Bismarck, and the so called “Beveridge-Model”, which is named after
Wiliam Henry Beveridge, who proposed a state funded health care system in
Britain. This session shows by means of the example of Germany and
Austria, that due to different organizational and institutional aspects in
Bismark-countries, HTA faces some other requirements/challenges
compared to Beveridge-countries. This session should provide an insight
and enable a focused view on HTA and its policy process in Bismarck
health care systems. Based on these examples and experiences it will be
discussed, which lessons had been learned and how the process of tailoring
HTA could be integrated in the general discussions for efficiency and
effectiveness of HTA worldwide.
The proposed structure of the session is:
The Health Care System of Bismarck type and its adaptation in
Germany and Austria
HTA in Austria: Where is it fitted?
The need for the efficiency frontier: HTA and health economy in
Germany
The new HTA strategy in Austria: all player at one table
Plenary discussion: Tailoring HTA for national Health Care
Systems? Solutions and challenges.
90
COHERENCE AND CORRESPONDENCE IN MEDICINE:
BRINGING NEW LIGHT TO MEDICAL CONTROVERSIES
PANEL DISCUSSION
Moderator: R. Poses, Brown University, Providence, RI, USA
Panelists:
T.G. Tape, University of Nebraska Medical Center College of Medicine,
R.S. Wigton, University of Nebraska Medical Center College of Medicine,
Many controversies in medical science can be framed as tension between a

coherence standard of truth (which seeks logic and explanation) and a
correspondence standard (which emphasizes empirical evidence). A
coherence based position may be quite reasonable but not be supported by
evidence (prescribing antibiotics for acute bronchitis), while a
correspondence based position may seem illogical to practitioners but have
good empirical support (rate control for atrial fibillation).
Medical professionals are generally not aware of the coherence-
correspondence distinction and may form opposing viewpoints without
realizing that their beliefs stem from different standards of truth rather than
the correctness of their information or judgment. In some cases, physicians
favor coherence knowledge even in the face of strong, contradictory
correspondence evidence. Much of the criticism of evidence based
medicine, for example, comes from a misunderstanding of how it handles
coherence knowledge.
This panel will discuss examples of controversies based on coherence vs.
correspondence views of truth and show how these issues can be framed to
allow productive discussion. These examples will be drawn from medical
history (e.g. bloodletting, stress and ulcers) as well as current controversies
(e.g. long-acting bronchodilators for asthma, low carbohydrate diets for
weight reduction, antioxidants to prevent heart disease). The panel will also
discuss the importance of coherence and correspondence theories in
understanding the shifting paradigms of biomedical knowledge. The end of
a paradigm is signaled by correspondence evidence being increasingly at
odds with coherence theories. A new paradigm begins when new coherence
theories appear that align with existing correspondence evidence.
Finally, we will show that coherence and correspondence approaches when
used together can lead to rapid advances in medical science. Examples
include the development of Sildenafil for erectile dysfunction and Imatinib
for chronic myelogenous leukemia. These concepts can be very helpful to
decision makers in understanding seemingly irreconcilable controversies.
91
PSYCHOMETRIC PROPERTIES OF THE SHARED DECISION-
MAKING QUESTIONNAIRE – PHYSICIAN VERSION
(SDM-Q-DOC)
I. Scholl1, A. Buchholz2, L. Kriston1, J. Dirmaier1, M. Härter1
1
Department of Medical Psychology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany, 2Section Clinical Epidemiology
and Health Services Research, Department of Psychiatry and
Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
Background: Recently the 9-item Shared Decision-Making Questionnaire

(SDM-Q-9) was developed to assess patients’ involvement in decision
making from the patients’ perspective. It was shown that the SDM-Q-9 is a
reliable and well accepted instrument [1]. However, there still is a lack of
psychometrically sound self-assessment instruments to measure the
involvement in decision making from the physicians’ perspective. The aim
of the present study was to develop a physician version of the SDM-Q-9 and
to determine its psychometric properties.
Methods: The adaptation was done by two of the authors (AB, IS). The
SDM-Q-Doc is currently applied in a study with 30 physicians rating N=312
outpatient medical encounters. In order to check the dimensional structure
of the construct, factor analysis is performed. Psychometric characteristics
are analysed.
Preliminary Results: At present, 4 physicians have rated 54 consultations.
Analyses of this first data indicate reasonable internal consistency
(Cronbach’s alpha .76) and high acceptance (proportion of missing values
<10%). However, some items show little variance, probably as a
consequence of the limited sample size. Final results in the total sample
including factor analysis will be presented and discussed at the conference.
Conclusions: First results suggest that the SDM-Q-Doc is a reliable and well
accepted instrument to assess the involvement in decision making form the
physicians’ perspective.
92
WHY DO SOME PATIENTS WITH SCHIZOPHRENIA WANT TO
BE ENGAGED IN MEDICAL DECISION MAKING AND OTHERS
DON’T?
J. Hamann, R. Mendel, W. Kissling, A. Berthele
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische
Universität München, München, Germany
Objective: Treatment guidelines for schizophrenia recommend that medical

decisions should be shared between patients with schizophrenia and their
physicians. It is, however, unclear why some patients want to participate in
medical decision making and others don’t.
Method: To identify determinants of participation preferences in
schizophrenia patients and in a non-psychiatric comparison group (multiple
sclerosis) we undertook a cross-sectional survey in four psychiatric and
neurologic hospitals in Germany. Inpatients suffering from schizophrenia or
multiple sclerosis (but not both) were consecutively and N=203 patients
participated in the study (N=101 with schizophrenia and N=102 with
multiple sclerosis). Predictors for participation preferences were identified
using a structural equation model.
Results: Patients’ reports about their participation preferences in medical
decisions can be predicted to a considerable extent (52% of the variance).
For patients with schizophrenia poor treatment satisfaction, negative
attitudes towards medication, better perceived decision making skills and
higher education were related to higher participation preferences. In the
comparison group drug attitudes and education were also shown to be
related with participation preferences.
Conclusions: Patients with schizophrenia who want to participate in
decision making are often dissatisfied with care or are skeptical towards
medication. Patients who judge their decisional capacity as poor or who are
poorly educated prefer not to participate in decision making. Future
implementation strategies for shared decision making must address how
dissatisfied patients can be included in decision making and how patients
who currently do not want to share decisions can be enabled, empowered
and motivated for shared decision
93
CONSTRUCTING EXPLANATORY PROGNOSTIC PROFILES
FROM CONDITIONAL PROBABILITY TABLES BY CLUSTER-
KBM2L ANALYSIS
J.A. Fernandez del Pozo1, C. Bielza1, P.J.F. Lucas2
1
Computational Intelligence Group, Departamento de Inteligencia Artificial,
Universidad Politécnica de Madrid, Madrid, Spain, 2Institute for Computing
and Information Sciences, Radboud University Nijmegen, The Netherlands
BACKGROUND: A prediction model for clinical prognosis may act as a source

for clinical decision making; when based on probability theory it will typically
include random variables dependent of many factors. A conditional probability
table, or CPT for short, is a table with probabilities for a discrete random variable X
conditioned on a set of other discrete random variables Y. One position (i, j) in the
CPT yields P(X = xj|Y = yi)). CPTs of prognostic probabilistic models may be very
large and complex, and, as a consequence, it may be hard to grasp the tables’
content when building or using a the model. Yet, a good understanding of their
content is required when developing a model that is accurate.
METHODS: We applied a procedure for CPT analysis using the recently proposed
KBM2L framework to an influence diagram described in the literature, modelling
the treatment decisions of gastric non-Hodgkin lymphoma (NHL). KBM2L
provides a compact list composed of items <index; response|: response corresponds
to the X conditional probability distribution and index is the last vector of Y values
from the set of consecutive rows in the CPT with similar response. KBM2L
searches for the order of the vector components that yields more similarity, and
therefore, more coalesced CPTs. Similarity is measured via the PAM (Partitioning
Around Medoids) cluster algorithm merging the CPT rows into k clusters. The
resulting cluster ‘representatives’, here medoids, with associated cluster profiles
were optimized using the KBM2L procedure, resulting in explanations of the
profiles.
RESULTS: We analyzed two CPTs associated with variables Early Result and
FiveYears Result (FYR) consisting of 970 and 1920 conditional probability
distributions, respectively. For complex variable FYR (alive, death), Y consisted of
six variables, such as Age, Clinical Stage, and Bulky Disease. We synthesized its
CPT into up to four clusters according to the physician’s preference. The following
four clusters were obtained:
• Favourable prognosis profile, P(FYR=alive)>0.8, explained by full,
unadjusted treatment and gastroscopically confirmed complete or partial
remission of NHL.
• Unfavourable prognosis profile, 0.35<P(FYR=alive)<0.60, explained by
full, unadjusted treatment, gastroscopically confirmed complete or partial
remission, bulky disease with low-grade histology or stage I NHL.
• Bad prognosis profile, P(FYR=alive)<0.25, associated with
gastroscopically confirmed partial remission after unadjusted treatment.
• Grim prognosis profile, explained by the side effects of treatment with
associated reduced effectiveness of adjusted treatment, and
gastroscopically confirmed disease progression or no change.
CONCLUSION: This technique was shown to be promising for assisting clinical
researchers in constructing, validating and explaining clinical models with large
CPTs.
94
ALGORITHMIC APPROACH TO DIAGNOSTICS OF RARE
DISEASES
T. Kiseliova1, M. Korinteli2, I. Korinteli2, K. Pagava2,
1
Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia, 2Tbilisi
Medical State University, Tbilisi, Georgia
Background: Rare diseases become an emergent problem over the world.

Because of their multiplicity it is almost impossible for a general
practitioner (GP) to know them sufficiently. Often GP does not even suspect
a rare disease. As a result, a correct diagnosis is belated; quite frequently it
is not made at all.
Aim: Elaboration of a model for computer-supported identification
(suspicion) of rare diseases.
Methods: As description of patient's state is usually connected with
imprecision, we applied methods of fuzzy logic to build our model. The
model was created based on the principles of existing decision support
systems (in particular, known as CADIAG-like systems [1,2], as well as
approaches, elaborated by authors [2,3]).
Results: Our algorithmic approach is based on the obvious assumption, that
when GP considers a diagnostic picture of the patient, he/she should pay due
attention to some parameters (or their absence) which are not normal for the
hypothetical disease; and, therefore, such case should be regarded as “non-
normal” with suspicion for some rare disease. Thus, the essence of the
algorithm is to determine presence or absence of signs and symptoms
indicative of some deviation of clinical picture from the standard one. In
another words this algorithm is to help GP to recall probable rare diseases
and administer appropriate investigations if necessary.
95
96
ABSTRACTS
POSTER PRESENTATIONS
97
98
COST-EFFECTIVENESS OF VARENICLINE FOR SMOKING
CESSATION IN PATIENTS WITH DIABETES MELLITUS TYPE 2
P. Aidelsburger1, J.Wasem2
1
CAREM GmbH, Sauerlach, Germany, 2Institute for Health Care
Background and objective: Smoking is one risk factor for the development
of diabetes mellitus type 2 (DMT2) as well as of micro- and macrovascular
complications. Aim of the study is to assess the cost-effectiveness of
smoking cessation with Varenicline compared to smoking cessation without
medication in patients with DMT2.
Methods: A Markov Model simulated disease course of DMT2. One single
smoking cessation attempt was assumed. Once successful patients did not
start smoking again in the model. The probabilities of macrovascular events
were calculated by use of regression equations of UKPDS. Due to the poor
data quality concerning microvascular complications, these were only
considered in sensitivity analysis. Effectiveness data of Varenicline were
taken of a systematic review (RR=2.33; percentage of patients with
successful smoking cessation in placebo arm = 14.72%). Costs of
Varenicline varied between 258 and 466 Euro (base case: 261 Euro). Cost
data for health states were taken from literature (basic year: 2008). Effects
and costs were discounted by 3%. A German payers perspective was taken.
Multiple one- and two-way sensitivity analysis were performed to test for
uncertainty.
Results: Considering a lifelong time horizon smoking cessation with
Varenicline saved 1,155 Euro and gained additional 0.27 live years. Neither
variation of discount rate, drug costs nor health state costs altered
dominance. Using extreme values in sensitivity analysis concerning
effectiveness of Varenicline and considering costs due to smoking resulted
in a lost of dominance.
Discussion and conclusion: Smoking cessation with Varenicline is the
dominant strategy. Results are robust in most of the performed sensitivity
analysis.
99
COST-EFFECTIVENESS OF SMOKING CESSATION WITH
VARENICLINE IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
K. Lang1, J. Wasem2, P. Aidelsburger1
1
CAREM GmbH, Sauerlach, Germany, 2Institute for Health Care
Background and objective: Smoking is the most important and avoidable

risk factor for disease progression in patients with Chronic Obstructive
Pulmonary Disease (COPD). Aim of the study is to analyse the cost-
effectiveness (cost per life-year gained, LYG) of smoking cessation with
Varenicline in patients with COPD compared to smoking cessation without
medication (placebo).
Methods: A Markov Model simulates the disease progression of 45 year old
COPD patients. A single smoking cessation attempt is considered in the
beginning of the simulation. Transition probabilities between COPD
severity levels are calculated based on published literature, cost data are
adapted to the year 2008. A systematic review provides effectiveness data
for Varenicline (RR=2.33; percentage of patients with successful smoking
cessation in placebo arm = 14.72%). Costs of Varenicline vary between 258
and 466 Euro (base case: 261 Euro). Effects and costs are discounted by 3%.
A German payers' perspective was taken. Multiple one- and two-way
sensitivity analyses were performed to test for uncertainty.
Results: Considering a lifelong time horizon, smoking cessation with
Varenicline saves 1,338 Euro and results in additional 0.46 LYG. Neither
variation of discount rate, drug costs nor health state costs altered
dominance. Only extreme low values for the RR and the negligence of costs
due to smoking result in a loss of dominance of Varenicline compared to
placeo for smoking cessation.
Discussion and conclusion: A single smoking cessation attempt with
Varenicline is the dominant strategy. Results are robust in most of the
sensitivity analyses performed.
100
HTA IN GERMANY - SUPPORTING HEALTH
DECISION-MAKING
S-L. Antoine
German Institute of Medical Documentation and Information/DIMDI,
German Agency for HTA (DAHTA), Cologne, Germany
Healthcare innovations and demands for medical services are increasing.

Thus, costs for health are boosting. Simultaneously, resources in the
healthcare sector are scarce. This causes an immense burden for national
healthcare systems and whole societies. Therefore, political decisions and
priority-setting regarding the financing of health services are necessary.
A supportive applied tool for decision-making in Germany is Health
Technology Assessment (HTA) which involves the evaluation of health
practices and technologies. HTA is an effective instrument to safeguard the
quality and economy of the German healthcare system. The German Agency
for HTA (DAHTA) at the German Institute of Medical Documentation and
Information (DIMDI) is responsible for conducting HTA-reports. It
provides scientific information on healthcare to support political decision-
making as well as all participants and actors in German healthcare. At
DAHTA, HTA-reports address the effectiveness, efficiency, social, ethical
and legal implications of medical services. The agency is supported by the
HTA Board of Trustees regarding determining HTA topics suggested by the
public. The HTA Board of Trustees represents a typical cross section of
self-administration bodies across the German healthcare system.
Topics of HTA-reports cover the main fields of public health (diagnosis,
prevention, care and methodology). Examples for HTA-reports that
currently influenced and supported public health decision-making in
Germany are: Hormones for therapy of climacteric afflictions, HPV
vaccination to prevent cervical cancer, Oral health with fixed appliances
orthodontics
101
COST-EFFECTIVENESS ANALYSIS OF CAPECITABINE FOR
THE ADJUVANT TREATMENT OF COLON CANCER IN
ROMANIA
A. Croitoru1, P. Curescu2, P.C. Radu3, B. Pana3, S. Baculea4
1
Clinical Institute Fundeni, 2District Hospital Timisoara, 3Panmedica SRL,
4
Roche Romania SRL, Bucharest, Romania
Purpose: Capecitabine (Xeloda®; F Hoffmann-La Roche Ltd, Basel,

Switzerland) is an effective oral treatment of adjuvant colon cancer. The X-
ACT trial (M66001) assessed the efficacy of adjuvant X vs. 5-FU/LV in
CRC, and demonstrated at least equivalent disease-free survival (DFS) and
an improved safety profile. We evaluated the cost-effectiveness of
capecitabine (X) vs. 5-FU/LV, from the Romanian payer perspective.
Methods: A three-state (disease-free survival, relapse and death) Markov
model was developed based on data from the M66001 and NO16966
studies. DFS was modeled using a two-parameter Gompertz function
truncated at median follow-up of 6.8 years of study M66001. Overall
survival was modeled as a Markov process with the rate of death modeled
from study NO16966. All-cause mortality was obtained from Romanian
life-tables. Time horizon considered is 20 years. Utility values were drawn
from published sources. Direct costs considered were drug acquisition, drug
administration, adverse events and supportive care costs. Unit cost values
were used from published sources in Romania. Costs were discounted by
5%, outcomes by 0%. Sensitivity analyses were performed.
Results: Compared with 5-FU/LV, X is projected to increase QALYs by
0.563 for a 20-year time horizon, at additional direct costs of 2,456 Euro.
Therefore, the incremental cost-utility ratio of X vs. 5FU/LV from the
Romanian payer perspective is estimated to be 4,362 Euro per QALY.
Sensitivity analysis confirmed the robustness of results.
Conclusion: This study demonstrates that capecitabine can be considered a
highly cost-effective therapy when compared to 5-FU/LV from the payer
perspective in Romania.
102
ECONOMIC EVALUATION OF HOSPITAL INFECTION
CONTROL INTERVENTIONS: DESIGN ISSUES IN THE
EVALUATION ALONGSIDE THE MOSAR CLINICAL TRIALS
S. Bahrami1, M. Padget2, I. Durand-Zaleski1
On behalf of the MOSAR-09 Study Team
1
URC-ECO IdF, Hopital Henri-Mondor, AP-HP and Université Paris 12,
France, 2URC-ECO IdF, AP-HP and Université Paris 12, Créteil, France
Purpose: There has been a relative paucity of cost studies on the subject of
anti-microbial resistant bacteria (AMRB) and nosocomial infection.
Furthermore, there exists no validated method for estimating these costs.
Our objective was to design the economic evaluation of interventions
designed to reduce the spread of AMRB within the context of ongoing
cluster-randomized and cohort studies conducted in intensive care, surgical
units and rehabilitation centers.
Method: We reviewed the literature focusing on the economic evaluation of
infection control measures and the suggested methods to estimate the costs
associated with AMRB were critically assessed.
Results: Previously published economic evaluations are hampered by the
lack of a viable control population (selection bias) and trends in the
incidence of AMRB (confounding). Three main solutions have been
proposed to deal with these problems : 1) refining the description of the
patients severity status for matching purposes 2) analyzing time-series of
ecological data on AMRB incidence and resource use 3) identifying settings
in which AMRB colonization and infection are unrelated to patient severity
status or AMRB history (quasi-experimental design).
Discussion: Although none of the solutions simultaneously addresses all
identified issues, a time-series analysis of prospectively planned infection
control interventions could provide an unbiased estimate of the costs
attributable to AMRB. To our knowledge, no study has been published yet
using this methodology. This approach has been applied in the economic
evaluation of the clinical trials.
Acknowledgement: The MOSAR Project is supported by the European
Commission (MOSAR Network Contract LSHP-CT-2007-037941)
103
CAREFUL COMPARISON OF THE USE OF DEPRESSION-
RELATED MEDICATIONS AFTER INITATION TO SCREENING
FOR PROSTATE CANCER: USEFUL FOR DECISION MODELS?
N. Booth, T. Tammela, A. Auvinen, P. Rissanen
Finland
A number of studies concerning health-related quality of life suggest that,

following screening, there appears to be decrements in quality of life related
to depression. To verify this, we undertook a comparison of the
reimbursement of antidepressant medication following invitation to
screening in the Finnish Prostate Cancer Screening Trial (FinRSPC).
Records from the Finnish Social Insurance Institution were linked to the
FinRSPC’s database using unique identifiers. ‘Invitation’ dates for men in
the control arm were allocated to make the two trail arms comparable. The
analysis focused on reimbursements for depression-related within 30 days of
invitation to screening, comparing the ‘start’ of reimbursement for
depression-related medication. We present results for two rounds of the
FinRSPC, for the first round our analysis showed that the control arm had a
reimbursement rate of 1‰ for medication within 30 days of invitation to
screening, The screening arm (PSA compliant) and screening arm (PSA
non-compliant) had a reimbursement rate of 2‰ and 3‰, respectively.
Contrary to results in the second round, first round differences were
statistically significant at the 0.05 level. It appears that the PSA non-
compliant screening arm may be subject to a selection effect, i.e., this group
of men may not comply with PSA mass-screening due to some propensity
associated with depression. Overall, this study suggests that there is some
additional, but minor, burden of increased use of depression-related
medication in PSA compliant men in the screening arm. Therefore, we also
discuss the potential impact of these findings and methods on future
decision-analytic models.
104
IS PET/CT IMAGING FOR PATIENTS WITH RECURRENT
COLORECTAL CANCER COST-EFFECTIVE? A PRE-TRIAL
ECONOMIC MODEL
H. McIntosh, M. Dozier, J. Glanville, A. Renehan, D. Weller
University of Glasgow, Glasgow, Scotland, UK
Purpose: To assess the cost-effectiveness of PET/CT as an add-on imaging

device in staging recurrent colorectal cancer.
Method: A decision model was developed in consultation with clinical
experts to compare PET/CT as an add-on to conventional imaging
techniques. The model was developed to capture not only diagnostic test
accuracy, but the resultant up- or down-staging of cancer and the impact of
this on appropriate and inappropriate treatment, quality of life and overall
survival. The model was populated with data from a concurrent systematic
review and meta-analysis for the DTA, with data from the literature on
therapeutic impact and quality of life, and with expert opinion where
necessary.
Results: Improved DTA of PET/CT led to changes in patient management,
most commonly through the additional identification of metastases and the
resultant avoidance of unnecessary surgery or unnecessary chemotherapy.
The incremental cost per correct diagnosis and incremental cost per QALY
will be presented with a discussion of the uncertainty in the overall model.
Value of Information (VOI) techniques will identify what further
information is required to provide a more comprehensive estimate of cost-
effectiveness.
Conclusion: Developing a pre-trial model can be a complex process,
particularly for a multifaceted technology, however, attempting to capture
the process involved and establishing appropriate outcomes using the best
information available can answer questions regarding cost-effectiveness,
and the pre-trial modelling exercise and VOI methods can establish whether
(and what type of) further research is required.
105
THE VALUE OF PET/CT IMAGING FOR STAGING IN PATIENTS
WITH PRIMARY COLORECTAL CANCER: A PRE-TRIAL
ECONOMIC MODEL FOR COST-EFFECTIVENESS ANALYSIS
H. McIntosh, M. Dozier, J. Glanville, A. Renehan, D. Weller
University of Glasgow, Glasgow, Scotland, UK
Purpose: An economic evaluation of PET/CT as an add-on imaging device

in staging primary colorectal cancer.
Method: A decision analytic model was developed in consultation with
clinical experts. In order to appropriately capture variations in diagnostic
test accuracy (DTA), alternative imaging devices, and management
pathways separate models were created for primary rectal and primary colon
cancer. The models were developed to capture the impact on patient
management, quality of life and any impact on overall survival. The
decision models were populated with data from a concurrent systematic
review for the DTA, with therapeutic impact data from the literature and
with expert opinion where necessary.
Results: The addition of PET/CT was found to have no impact on overall
survival; however the additional DTA led to changes in patient
management, incurring NHS cost and quality of life implications for
patients who received appropriate and inappropriate treatment. The
incremental cost per correct diagnosis and incremental cost per QALY will
be presented and Value of Information (VOI) techniques will establish what
further information is required to provide a more comprehensive estimate of
cost-effectiveness.
Conclusion: Developing a pre-trial model is a complex process, particularly
for a multifaceted technology where there may be little or inconclusive
published evidence. However, attempting to capture the process involved
and establishing appropriate outcomes using the best information available
can answer questions regarding cost-effectiveness, and the pre-trial
modelling exercise incorporating VOI methods can establish whether further
research is worthwhile, and if so, what type of information is required from
further research.
106
EARLY IMPACT AND COST-EFFECTIVENESS OF A
VACCINATION AGAINST HERPES ZOSTER AND
POSTHERPETIC NEURALGIA ESTIMATED FOR VARIOUS AGE
COHORTS IN THE UK
M. Martin1, M. Papageorgiou1, X. Bresse2
1
i3 Innovus, Uxbridge, Middlesex, UK, 2Sanofi Pasteur MSD, Lyon, France
Objective: To estimate early benefits and cost-effectiveness of a zoster

vaccination for various age cohorts in the UK.
Method: A Markov model developed for Europe was used to estimate early
benefits and cost-effectiveness of a vaccination with Zostavax® compared
to a non-vaccination policy in the UK. Discount rates at 3.5% for costs and
benefits, lifetime vaccine duration of protection, NHS perspective and 40%
coverage rate were assumed in the base case. Results are presented under
two temporal horizons, 5 years and lifetime, to estimate early benefits.
Results: When vaccinating the 50+ population, approximately 20% of the
disease burden avoided (number of HZ and PHN cases, disease costs) would
be averted 5 years after the introduction of Zostavax®. The lifetime
incremental cost-effectiveness ratio (ICER) would be £13,077/QALY
gained. For the 60+ population, 29% of disease costs, 28% of HZ and 24%
of PHN cases avoided would be averted at 5 years after vaccination; lifetime
ICER would be £13,418/QALY. For the 70+ population, 42% of disease
costs could be saved 5 years after launch, and 42% of HZ and 39% of PHN
cases avoided could be averted; lifetime ICER would be £16,866/QALY.
Discount rates, epidemiological data and duration of vaccine protection
were the most impactful parameters on ICERs when performing sensitivity
analysis.
Conclusion: A zoster vaccination remains highly cost-effective and offers
early benefits regardless of age. The earlier the vaccination starts, the
greater the cost-effectiveness is. On the contrary, early benefits are expected
to be higher when vaccinating older age groups (70+).
107
HOW DO PARENTS PRIORITISE INFORMATION IN VACCINE
DECISIONS? A MULTIFACTORIAL EXPERIMENTAL MODEL
K.F. Brown1, J.S. Kroll2, M. Ramsay3, M. Hudson3, J. Green4, C. Vincent1,
G. Fraser3, N. Sevdalis1
1
UK, 2Department of Paediatrics, Imperial College London, UK, 3Health
Protection Agency, UK, 4Central and North West London NHS Foundation
Trust, London, UK
Background: A substantial minority of parents in developed countries refuse

to vaccinate their children, inhibiting reduction in population disease
incidence. Understanding which factors most influence vaccine decisions
could streamline and strengthen uptake-improvement interventions. Current
vaccine decision-making models are typically disease/vaccine-specific and
do not reflect the range and complexity of real-life predictors. The present
study aimed to produce a generalisable, multidimensional model.
Methods: Parents were presented with vignettes describing hypothetical
vaccine/disease scenarios in which information on four multi-component
factors was systematically manipulated. These factors were: vaccine
characteristics, disease characteristics, individual circumstances, and
social/media advice, each with 3 levels – vaccination-conducive, neutral, or
vaccination-nonconductive. In a partial factorial design, respondents were
randomly allocated 4 of the 81 information permutations. Participants rated
their likelihood of vaccinating for each vignette, reported general anxiety
(modified STAI-6, α=0.83), real-life vaccine attitudes (α=0.91), and
provided demographic information.
Results: 298 parents participated. The four-factor model predicted 40% of
the variance in likelihood of vaccinating (adj.R2=0.40). Individual
circumstances was the strongest predictor (β=0.41, p<0.001), followed by
real-life vaccine attitude (β=0.39, p<0.001), disease characteristics (β=0.23,
p<0.001), vaccine characteristics (β=0.11, p<0.001), social/media advice
(β=0.06, p<0.05) and real-life education (lower education=higher likelihood,
β=-0.08, p<0.05).
Discussion: This model is comprehensive and generalisable so may inform
interventions for new and existing vaccines. Parents were most influenced
by the disease and vaccine reaction implications specific to their child, and
by perceived vaccine contraindications. Coverage of these factors in generic
information materials could be increased; tailored intervention from
clinicians may be more appropriate but is resource-intensive.
108
THE UK MMR CATCH-UP CAMPAIGN 2008-9: EVALUATION IN
TWO LONDON PRIMARY CARE TRUSTS
K.F. Brown1, R. Shanley1, N. Cowley1, J. van Wijgerden2, P. Toff3,
J.S. Kroll4, M. Ramsay5, M. Hudson5, J. Green6, C. Vincent1, G. Fraser5,
N. Sevdalis1
1
UK, 2Ealing Primary Care Trust, London, UK, 3Brent Primary Care Trust,
London, UK, 4Department of Paediatrics, Imperial College London, UK,
5
Health Protection Agency, UK, 6Central and North West London NHS
Foundation Trust, London, UK
Background: In 2008-9 UK Primary Care Trusts (PCTs) implemented a

catch-up campaign to improve uptake of measles, mumps and rubella
(MMR) vaccine. The campaign message was to be delivered in two ways:
via personal MMR invitations sent to parents of inadequately immunised
children (all PCTs), and via additional social marketing (SM), e.g.
awareness-raising posters in public places (some London PCTs). The
campaign was evaluated on three elements: effectiveness of message
delivery, relationship with MMR uptake, relationship with MMR/measles
beliefs.
Methods: 2020 parents across two London PCTs (one with SM, one
without) were posted an evidence-based questionnaire assessing MMR
invitation receipt, SM awareness, 20 beliefs and 7 demographic items
relating to MMR uptake.
Results: 350 (23%) parents completed a questionnaire. 76% of parents
eligible for MMR invitation did not receive one, and only 30% of SM PCT
parents had seen marketing materials. MMR invitation receipt related to a
fourfold increase in MMR uptake (21.9% vs 5.3%, Z=2.86, p<0.01), whilst
SM awareness bore no relation to uptake. MMR invitation receipt related to
mistrust of health professionals and engagement in personal research about
MMR, whilst SM awareness related to belief that measles is serious and that
MMR offers effective measles prevention.
Discussion: This evaluation’s cross-sectional design cannot ascertain
causality, however these findings suggest that whilst SM may improve
MMR/measles attitudes its visibility is limited and its impact on MMR
uptake is minimal. Targeted invitations to parents may more effectively
increase MMR uptake if database accuracy is improved.
109
EVALUATION OF DISEASE MANAGEMENT PROGRAMMES IN
FRANCE: METHODS, PRACTICE AND PERSPECTIVES
K. Chevreul1,2, M. Brunn1,2, I. Durand-Zaleski1,2
1
Paris Health Economics and Health Services Research Unit, University
Paris-East, Paris, France, 2The DISMEVAL Consortium (funded under the
European FP7 programme)
The dominant variant of Disease Management Programmes in France are

provider networks (also known as « health networks »), that currently cover
about 1 million patients with chronic disease. The objective of this study is
to identify and compare the methods used for health network evaluation in
France and to assess the appropriateness of statutory evaluation in terms of
validity and feasibility.
Qualitative content analysis has been performed. The data sources included
policy documents, evaluations and activity reports and were complemented
by semi-structured interviews of programme operators and stakeholders.
The results show that the evaluation practice of French health networks
reflects the heterogeneity of the existing programmes. At the same time,
these bottom-up interventions are subjected to a uniformly stipulated top-
down comparative evaluation, which poses a particular problem as it is not
compatible with the prevailing selection bias of physicians, of and by
patients. This is underlined by the finding that patients enrolled in health
networks significantly differ in their characteristics from control groups. For
instance, enrolees benefit more often from the statutory chronic disease
coverage scheme, which is a proxy for morbidity.
Hence, a mismatch between administrative requirements and current
practice can be stated. The traditional HTA approach of randomized and
controlled trials is neither valid nor feasible for diversified and pragmatic
public health interventions such as local health networks in France. More
individualized approaches to evaluation are needed, which could
prototypically involve goal-setting and performance incentives or time
series analysis rather than unrealistic comparative settings.
110
THE COST-EFFECTIVENESS OF BASELINE MRI VERSUS CT IN
PATIENTS WITH CLINICAL SYMPTOMS STRONGLY
SUGGESTIVE OF STROKE—A DECISION ANALYSIS
K. Burton
Departments of Health Policy, Management and Evaluation and Medical
Imaging, University of Toronto, Toronto, ON, Canada
Purpose: patients with stroke symptoms should undergo a baseline MRI or

CT study. Immediate CT scanning of these patients has been demonstrated
to be cheaper and more effective yet it remains unclear whether baseline
imaging choice yields a difference in long-term outcomes or costs. The
objective of this study was to evaluate the cost-effectiveness of baseline CT
imaging versus MR imaging in these patients.
Materials & Methods: a Markov decision analysis model was used with a
target population of any patient eligible to receive thrombolytic therapy who
presents on any time of day and any day of the week to a healthcare facility.
The time horizon measured was 30 years and the study perspective was that
of health policy. The interventions studied were CT or MRI scan at
baseline. The outcomes measured were costs, quality-adjusted life years
(QALYs), and incremental cost-effectiveness.
Results: the MRI strategy has an incremental cost-effectiveness ratio (ICER)
of $4,765 per QALY gained, gains more QALYs than the CT strategy and
incurs lower incremental costs. Over a wide range of variables, the ICERs
of the MRI imaging strategy were less than $50,000 per QALY gained,
except for the cost associated with stroke-related life-years lost. Varying the
prevalence of acute ischemic stroke, the costs of MRI and CT scans and the
sensitivity and specificity of CT and MRI had no effects on outcomes.
Conclusion: the most cost-effective strategy for baseline imaging of patients
presenting with symptoms strongly suggestive of stroke is MR imaging.
111
IMPACT OF CONSUMER DIRECTED HEALTH PLANS ON
HEALTHCARE UTILIZATION AND COSTS
T.M. Waters1, C.F. Chang2, D.M. Mirvis1, W.T. Cecil2, P. Kasteridis3
1
Department of Preventive Medicine, University of Tennessee Health
Science Center, Memphis, TN, USA,2Methodist Le Bonheur Center for
Healthcare Economics, the University of Memphis, Memphis, TN, USA,
3
Department of Agriculture Economics, Institute of Agriculture,
The University of Tennessee at Knoxville, Knoxville, TN, USA
Background: Consumer Directed Health Plans (CDHPs) are of high interest

to employers, policymakers and insurers because of the potential benefits
and risks of this fundamentally new coverage model.
Objective: To investigate the impact of CDHPs on health care utilization
and costs in a heterogeneous group of enrollees drawn from a variety of
individual and employer-based health plans.
New Contribution: Almost all prior studies have used data from one or a
few large employers that are not representative of the overall U.S.
population. The few studies that have employed larger data samples
typically have not had a wide range of health care utilization data. This
study examines the impact of CDHP plan enrollment on a heterogeneous
population, including enrollees from a wide range of employer sizes and
types, across a geographically-dispersed area. Our ability to study the same
population over a three-year period also allows us to avoid significant
selection issues (i.e. consistent differences between CDHP enrollees and
comparison enrollees) that have been problematic in other studies.
Data: Claims and member benefit data from the largest private insurer in
Tennessee and zip code-level census data.
Study Design: Retrospective difference-in-differences (DID) analyses were
used to examine the impact of CDHP plans. This analytical approach
compared changes in utilization and expenditures over time (2007 versus
2005) across the two major comparison groups (CDHP switchers versus
matched PPO controls).
Results: Total health care expenditures actually increased more in the CDHP
switch group than in the control group for those with any expenditure. In
terms of utilization, CDHP enrollment was associated with reduced primary
care physician and emergency room use, but small increases in generic and
discretionary medication use. The impact of CDHPs on utilization differed
by population subgroup. Chronically ill enrollees and those who clearly had
a choice of plans (CDHP and PPO) were more likely to increase utilization
in specific categories after switching to a CDHP plan.
Conclusions: Whether CDHPs are associated with lower costs is far from
settled. Various subgroups of enrollees may choose CDHPs for different
reasons and react differently to the incentives of the new plan.
112
THE COST OF SCHIZOPHRENIA: AN INTERNATIONAL NON
SYSTEMATIC LITERATURE REVIEW
I. Durand-Zaleski, N. Charrier, A. Bourmaud, A. Gouepo, K. Chevreul
URC Eco Ile de France, Paris, France
Introduction: Schizophrenia, affecting 24 million people worldwide,

generates a great burden on patients, their families, health systems and
societies. The objective of this review is to document the economic burden
of schizophrenia.
Method: Medline search:
Key words: schizophrenia and cost, burden of disease, qaly or price
Publication date: 1998 to 2009
Languages: English, French
Exclusion criteria:
Schizophrenia diagnosis criteria not in DSM IV or ICD 10
Cost data not in monetary terms
Studies reporting only differential costs
Unknown data sources
Low/Middle income countries data
Results presentation: To improve comparability costs were reported as a
percentage of total personal health care expenditures and of GDP.
Results: Among the 1 377 articles and the grey literature titles identified, 69
were included.
Median schizophrenia health care cost was 0.12% of GDP ranging from
0.04% (Ireland) to 0.17% (France). Annual per capita expenditure was 4
times higher than that of an average citizen, ranging from 2.2 (USA) to 6.3
times (Australia).
Hospital cost representing 50 % of total health care cost (median) was the
main driver. However it ranged from 19% (USA) to 92% (Belgium)
demonstrating a great variability in treatment pattern.
The major loss of productivity cost due to patient unemployment was
similar to the health care cost of schizophrenia (median: 0.11% of GDP
ranging from 0.06 % to 0.21 %).
Conclusion: The economic burden of schizophrenia is significant. It varies
greatly across countries as does the pattern of care delivery.
113
BEYOND COST EFFECTIVENESS ANALYSIS:
THE ORGANIZATIONAL IMPACT OF TECHNOLOGICAL
CHANGE IN HEALTH CARE. APPLICATION TO INNOVATIONS
IN COLORECTAL CANCER SCREENING
P. Chauvin1, D. Heresbach2, J-M. Josselin1, J. Grolier1
1
University of Rennes 1, Faculty of Economics, Rennes, France
2
University of Rennes 1, University Hospital, Rennes, France
Medical innovation does not only involve new costs and greater
effectiveness, it also induces changes in the production patterns of health
care providers. Beyond the necessary cost-effectiveness analysis and cohort
simulation, one must thus inquire into the capacity of the health care system
to handle the structural change in the organization of health care provision.
The aim of the article is to propose an evaluation framework for assessing
the relevance and feasibility of such innovations. We illustrate this approach
through colorectal cancer screening strategies.
In a standard cost-effectiveness analysis, we first intend to compare usual
(Guaiac fecal occult blood test) and innovative (immunological fecal occult
blood test or Computed tomography colonography) screening techniques for
a simulated cohort. The analysis evidences that innovative technologies are
cost-effective but involve significant variations in the number of
confirmation and follow-up procedures required during the implementation
of each screening policy.
We then use this information to evaluate the ability of the health care system
to adequately adjust to the pressures on supply. Those pressures arise both at
the screening test level (financial ability to invest in new equipment,
possible shortage in radiological expertise, etc…) and at the confirmation
and follow-up levels (capacity of the gastroenterological departments to
cope with confirmation colonoscopies, aggregate impact of complications,
reorganization of services, etc...). The organizational dimension of the
competing screening policies is thus assessed not only at the hospital level
but also at the regional and national levels.
114
THE EFFECTS OF ABSOLUTE RISKS, RELATIVE RISKS,
FREQUENCIES, AND PROBABILITIES ON DECISION QUALITY
J. Covey
Department of Psychology, Durham University, Queen’s Campus,
Stockton-on-Tees, UK
Background: It is important to understand how the quality of people’s

decision making may be affected by the format used to present treatment
benefits.
Methods: Two experiments compared the accuracy of presenting the
benefits of cancer screening tests or vaccines using either absolute or
relative risk formats that included baseline risk information. Moreover, the
absolute and/or baseline risks were presented using either natural
frequencies or probabilities.
Results: In both experiments accuracy was measured by the sensitivity of
choices to differences in absolute rather than relative risks. Experiment 1
showed no significant differences in sensitivity between the relative and
absolute risk formats when the risks were presented as natural frequencies.
Sensitivity was however poor in both probability versions. Experiment 2
tested the natural frequency versions more stringently by presenting choices
with different levels of difficulty. It was found that decision quality was
significantly less affected by increases in difficulty in the absolute risk
format.
Conclusions: Presenting baseline risks using natural frequencies may help to
reduce the biasing effects of relative risks but decision quality may not be
on a par with the accuracy of decisions made when absolute risks are
presented in natural frequency formats.
115
DECISIONS BY MIDWIVES TO TRANSFER SLOW PROGRESS IN
LABOUR CASES TO OBSTETRIC CARE: A VIGNETTE STUDY
TO EXPLAIN VARIATION IN TRANSFER RATES
L. Dalgleish1, H. Cheyne2, C. Niven2
1
Department of Nursing and Midwifery, University of Stirling, Stirling,
Scotland, UK, 2Nursing, Midwifery and Allied Health Professionals
Research Unit, University of Stirling, Stirling, Scotland, UK
In the UK midwives provide the majority of interpartum maternity care.

Research shows wide variation in transfer rates across remote and rural and
urban maternity units in Scotland. A crucial task for midwives is to assess
the suitability of the pregnant woman for their care and to decide whether to
transfer or not. This study uses the General Assessment and Decision
Making model in which people make an assessment of a situation by
combining information from the situation factors. To arrive at a decision,
this assessment is compared against a threshold for action. If it is above the
threshold action is taken. Differences in threshold placement or differences
in the relative importance of the case factors may explain the variation in
transfer rates. This study measured thresholds and case factor importance of
midwives and obstetricians in remote, rural and urban regions and tested
these explanations for the variation in transfer rates. 120 midwives and 12
consultant obstetricians from across Scotland considered 72 hypothetical
vignettes and judged of the degree of suitability for midwifery-led care and
decided about transfer.
Clinical factors had higher relative importance than non-clinical factors.
There was considerable disagreement between participants in the decisions
to transfer. Threshold placement was related to views of childbirth, fear of
negative evaluation and the relative importance of the consequences of
unnecessary transfers (false positives) and false negatives. Provision of
clinical guidelines will not reduce variation in transfer rates. Rather training
midwives and obstetricians about factors influencing the threshold may be
more effective.
116
FACTORS DETERMINING FUTURE HOSPITAL CHOICE OF
SURGICAL PATIENTS: EXPLORATORY FACTOR ANALYSIS
P.J. Marang-van de Mheen1, Y. Peeters1, J. Dijs-Elsinga1, I.B. de Groot1,
J. Kievit1,2
1
Leiden University Medical Center, Department of Medical Decision
Making, Leiden, The Netherlands, 2Leiden University Medical Center,
Department of Surgery, Leiden, The Netherlands
Objectives: Information on hospital performance is increasingly available in

the public domain, aiming to support hospital choice. However, information
is diverse containing for instance information on number of hospital beds,
parking facilities and percentage of complications. Purpose of this study was
to assess whether the available hospital data can be grouped into fewer
factors that determine hospital choice.
Methods: Questionnaires were sent to 2122 elective surgical patients, of
whom 1329 (62.6%) responded. Patients were asked which information
from a list of 22 items they would use when they would need similar surgery
in the future. For each item, patients could answer Yes, Maybe, or No.
Principal component analysis with varimax rotation was used on all hospital
items.
Results: The Scree plot of Eigenvalues plotted against factors suggested 3
independent components explaining 54% of the variance. The first
component consists of 11 items with high loadings (range: 0.64-0.87) and 1
item (waiting time) with fair loading (0.43). Based on the item contents, this
component is named ‘quality-of-care’ (variance explained=34.4%;
Cronbach’s α=0.923). The second component is named ‘general hospital
information’ with high loadings (range: 0.56-0.73) of 6 items like distance
and facilities (e.g. in hospital room) (variance explained=13.2%; Cronbach’s
α=0.783). The third component is named ‘experience of others’ with high
loadings (range: 0.66-0.76) of 3 items like reputation (variance
explained=6.3%; Cronbach’s α=0.695).
Conclusions: Patients intend to use information from 3 domains for future
hospital choice: quality-of-care, general hospital information and other
people’s experiences. Presentation of information in domains may facilitate
patient’s decision making.
117
HOSPITAL PERFORMANCE DATA IN THE PUBLIC DOMAIN:
DO PATIENTS COMPARE HOSPITALS?
I.B. de Groot1, J. Dijs-Elsinga1, W. Otten2, J. Kievit1,
P.J. Marang-van de Mheen1
1
Department of Medical Decision Making, Leiden University Medical
Center, Leiden, The Netherlands
2
TNO Quality of Life, BU Prevention and Health, Section Reproduction
and Perinatology, Leiden, The Netherlands
Objectives: Given the information on hospital performance in the public

domain, patients can compare hospital data to support their decision making.
The aim of this study was to assess to what extent new patients compare
hospitals and whether they choose differently than patients who do not
compare hospitals.
Methods: Questionnaires were sent to 158 patients who visited the surgical
outpatient clinic for the first time. Patients were asked whether they had
used information to compare hospitals and which factors influenced their
hospital choice. They were also asked to select between 4 and 10 items of
hospital information (total: 41 items), which were used to compare hospitals
in an Adaptive Choice Based Conjoint analysis.
Results: 113 patients (71.5%) completed the questionnaire. Only 24 (21.2%)
patients compared hospitals. Regardless of whether hospitals were
compared, patients mostly relied on the advice of the general practioner
(29.2%) and their own positive experience with the hospital (26.0%) when
choosing a hospital. For both groups, report card regarding physician’s
expertise had the highest relative importance (RI) followed by waiting time
for outpatient clinic appointment. However, patients who compared
hospitals seemed to find hospital distance less important given the lower RI
for this item in this group (P = 0.001 mean difference 3.834 [0.727-6.941]).
Conclusion: A minority of new surgical patients compared hospitals and
seems to be prepared to travel further to visit their hospital of choice. Their
own positive hospital experience and advice of the general practitioner are
more important than public information.
118
VACCINE EFFECTIVENESS (VE) – VACCINATION IMPACT.
DEFINITION, SIMILARITIES AND DIFFERENCES. THE
EXAMPLE OF ROTAVIRUS (RV) VACCINATION
T. Derrough, G. Dominiak-Felden
Epidemiology Department, Sanofi Pasteur MSD, Lyon, France
To obtain registration, a vaccine has to demonstrate significant efficacy with

acceptable safety. After licensure, when provided to a large population, its
profile has to be confirmed in real-life through VE and impact studies.
Besides, they allow to highlight additional benefits, including herd
immunity.
The aim of this presentation will be to define and highlight
similarities/differences of VE and impact and to illustrate it using results of
RV vaccination programmes.
VE could be defined as efficacy in real-life conditions of usage and is
considered as a product-related characteristic. It consists in comparing
disease incidence among vaccinated and unvaccinated individuals under
routine circumstances. Designs used for RV include comparative cohort
studies, concurrent case-control studies, case-cohort studies and screening
method. Proper case ascertainment, choice of appropriate comparison group
and accurate knowledge of individual vaccination status are among
essentials elements to its correct assessment.
Impact reflects the public health benefit of a given vaccination program at
population level. It is commonly used but not well defined. It is commonly
understood as the observed modification in disease burden in the population
(targeted and not targeted by the vaccination programm) in conjunction to
increased vaccine coverage through before-after or here-elsewhere studies.
These ecological studies are easy to conduct but difficult to interprete and
prone to biases. Biases may be limited by using identical case definitions,
endpoints, methodology of data collection and study population between
comparison groups and over periods. The differences observed may be
attributed to the vaccination programme, provided that the vaccine coverage
is high and differences observed are significant.
119
ARE DIET AND EXERCISE INTERVENTIONS COST EFFECTIVE
IN THE WEIGHT MANAGEMENT AFTER CHILDBIRTH?
A. Duenas, A. Radwin, J. Chilcott, J. Messina, F. Campbell, E. Goyder
School of Health and Related Research, University of Sheffield,
Sheffield, UK
OBJECTIVE: To appraise the cost-effectiveness of weight management

after childbirth interventions. METHODS: Economic analyses were
performed to model the cost-effectiveness and cost utility of weight
management interventions targeted at women who have given birth within 2
years. The model was designed in order to assess different outcomes. It
assessed the effectiveness of dietary interventions and or physical activity
interventions for either post natal weight management or any dietary or
physical activity following pregnancy that may impact on weight
management. It has a NHS and personal social services (PSS) perspective.
RESULTS: The results are presented in terms of incremental cost-
effectiveness ratios (ICERs). Detailed reviews were undertaken to obtain the
most recent evidence on costs and utilities for the different states modelled.
UK specific data were used although the effectiveness of dietary and
physical activity interventions were taken from US setting studies. The
mean incremental cost effectiveness ratio of the diet and exercise
interventions was £44,144 per QALY over a 15 year time horizon with a
95% confidence interval ranging from £15,000 per QALY to dominated (e.
g. less effective and more costly). Over a lifetime horizon this cost
effectiveness improves to £9,096, ranging from £4,000 to dominated.
CONCLUSION: The review of effectiveness concluded that interventions to
manage weight gain after childbirth were shown to be effective in the short
term. In contrast the economic results were highly dependent on the long
term impact of these short term effects. These long term effects are
dependent on key assumptions within the modelling. The 15 year impact on
weight change and the lifelong impact on survival are estimated from
observational studies that demonstrate associations rather than causative
effects. The long term economic estimates are thus prone to high levels of
structural uncertainty not represented in the probabilistic sensitivity
analysis.
120
COSTING AN INNOVATIVE DIAGNOSTIC TEST IN HEPATITIS B
AND C (FIBROSCAN®) AND PREDICTING THE IMPACT OF ITS
REIMBURSEMENT
K. Chevreul, A. Gouepo, P. Perez, J. Asselineau, F. Degos,
I. Durand-Zaleski
URC Eco Ile-de-France, Université Paris, Creiteil, France
Introduction: Fibroscan®, a non-invasive test, aims at predicting liver

fibrosis and partly replacing biopsy in chronic hepatitis. This innovative
technology is commonly used but not covered by national health insurance
(NHI) in France.
Objective: To quantify Fibroscan’s cost for hospitals and to estimate the
budgetary impact for the NHI if it is reimbursed.
Method: 1993 patients with chronic hepatitis B or C receiving biopsy
(reference test) in 23 public hospitals were prospectively included during 24
months. We used a micro-costing method from the hospital perspective. The
budget impact analysis was based on the cost of implementation of the test
on the targeted population and the savings of avoided biopsies. We used a
hypothetical tariff for the test based on current practice. Costs of avoided
biopsies are calculated with the DRG tariff and the substitution rate of
Fibroscan® to biopsy.
Results: Depending on whether the operator is a nurse or a physician, the
unit cost of Fibroscan for hospitals is estimated at €23 and €33 for an
average annual number of 1212 tests. For a €32 tariff evaluated on real cost
and current practice, using the substitution rate resulting from the
Fibroscan® study, the budgetary impact of the coverage of Fibroscan® is an
additional cost of €3.7 million for the NHI. If the NHI prices Fibroscan® at
the current €50 level claimed by private doctors, the additional cost would
be €7.7 million for the NHI.
Conclusion: This study gives decision aid elements concerning coverage
and pricing issues.
121
COST EFFECTIVENESS OF A FULL PUBLIC REIMBURSEMENT
OF SMOKING CESSATION TREATMENTS IN FRANCE
E. Chan, K. Chevreul, I. Durand-Zaleski
Urc Eco IDF, Health Economics and Health Services Research Unit,
AP-HP, University Paris 12, Paris, France
Context: Tobacco is the leading preventable cause of premature mortality in

France. Although smoking cessation treatments have proven their efficacy
on quitting, only a public partial reimbursement is proposed for
pharmaceutical aids in France.
Objective: Our objective was to estimate the cost effectiveness of a full
reimbursement of smoking cessation aids compared to the current partial
reimbursement.
Methodology: We calculated the incremental costs per death averted over
the lifetime as main outcome, from the National Health Insurance
perspective. We extrapolated this outcome to the incremental costs per Life
Year Gained (LYG).
Annual mortality rates from a lifelong follow up cohort were used to
estimate efficacy. Quitting rates and costing were extracted from French
national surveys and a literature review.
Results: The incremental cost effectiveness ratio (ICER) was estimated to
3408€ per death averted and 277€ per LYG. The efficiency of full
reimbursement increased with the precocity of quitting. Hence, the ICER
per LYG doubled for each aging decade, ranging from 196€ when quitting
at age [35-44] to 757€ at [55-64] years. When including the lifetime
smoking-related healthcare costs, the ICER was estimated to -8373€ per
LYG, and remained favourable when applying a 50% relapse rate and 5%
cost discounting.
Conclusions: Full reimbursement of smoking cessation aids is cost effective
compared to partial reimbursement and is long term cost-saving. Health
policies should enhance this coverage scheme particularly among young
adult smokers.
122
CPG-RECOMMENDATIONS: A VALID BASE FOR DECISION-
MAKING? NEW METHODS FOR THE ASSESSMENT OF CPG
CONTENT
M. Eikermann, N. Holzmann, A. Ruether
Institute for Quality and Efficiency in Health Care, Cologne, Germany
Background: CPGs are becoming more and more important in supporting

clinical and health care decisions. Even though there have been numerous
initiatives in recent years to improve the quality of CPGs the assessment of
CPG content has been neglected up to now.
Aim: The purpose was to develop transparent, comprehensive methods to
assess the internal validity of CPG recommendations while also considering
existing international evaluation methods.
Methods: n analysis of 3 internationally established instruments for CPG
development and appraisal (GRADE, ADAPTE, AGREE) was carried out.
The instruments were compared using pre-defined items. The aim and
purpose of the instruments and the definitions and dimensions of “CPG
quality” were recorded. In addition, concrete test steps and evaluation
criteria to check the evidence base of a CPG recommendation were
analysed. Completeness, depth of detail and documentation requirements of
the instruments, and transparency and comprehensibility of the evaluation
criteria were some of the criteria that were compared and contrasted.
The analysis carried out served as a basis for developing methods for
assessing the internal validity of CPG recommendations.
Result: GRADE, ADAPTE and AGREE enable a structured development
and appraisal of CPGs. The test steps and evaluation criteria described in the
instruments represent numerous elements of internal validity of CPG
recommendations. However, the instruments often lack concrete
operationalization and thus transparent, comprehensible and reproducible
justification for the evaluation carried out. Furthermore important aspects
such as questions concerning the inclusion of unpublished data are missing.
From the analysis, numerous starting points could be identified to develop
methods for the assessment of internal validity of CPG recommendations.
As the next step, a pilot project will be conducted on the newly developed
methods
123
DEVELOPMENT OF A DYNAMIC MODEL STRUCTURE FOR
COMPARING AMBULATORY REIMBURSEMENT SYSTEMS
F. Breitenecker3, P. Einzinger1, G. Endel2, M. Gyimesi3, L. Meier3,
N. Pfeffer2, N. Popper1, A. Weisser2
1
dwh Simulation Services, Vienna, Austria, 2Evidence Based Economic
Healthcare, Main Association of Austrian Social Insurance Institutions,
Vienna, Austria, 3Vienna University of Technology, Institute for Analysis
and Scientific Computing, Vienna, Austria
Introduction: It is important to have methods for comparing effects of

different reimbursement systems as there is evidence that the payment
system influences medical decision making and therefore favours different
clinician treatment styles. Dynamic computer models can provide deeper
insight into systems, are cost efficient and are able to replace empirical
studies to some extent. Thus we use this approach and integrate existing
billing data of the Austrian health insurance system as well as expert
knowledge on the health care system. The study will compare the payment
system currently used in Austria with other reimbursement systems e.g. a
case-mix system.
Methods: We use an agent-based object-oriented model approach based on
individual-related billing information for two years. In our model, health
care providers as well as patients are the agents, with patients visiting
providers when they develop medical problems. They incorporate different
diseases corresponding to the medical problems they have. Every simulation
run uses up to 100.000 agents, different treatment pathways and payment
systems to build up the appropriate billing information and calculates each
provider’s reimbursement.
Results: The developed model structure maps the processes leading to
reimbursement in extramural health care with special regard to episodes of
care and treatment pathways. It presents a detailed and flexible framework
for mapping and comparing financial effects of reimbursement systems both
on micro level (medical providers) and macro level (entire health
insurances), even though parameterisation – for example for incidences of
medical problems and possible treatment pathways – from the available data
is an important challenge.
124
MOBILE MEDICAL RECORD – A LIFE SAVING TOOL
N. Friedman1,2,3, A. Goldberg2,3
1
Faculty of Health Sciences, The Joyce and Irving Goldman Medical
School, Ben Gurion University, Beer Sheva, Israel, 2Faculty of Health
Sciences, Department of Health Systems Management, Ben Gurion
University, Beer Sheva, Israel, 3Center for the Research of Preparedness and
Response to Emergency and Disaster Situations, Israel
Introduction: An emergency services team is launched to treat a man who

collapsed in the street. The team takes John Doe’s mobile phone, and within
seconds retrieves all the required clinical parameters from his Mobile
Medical Record (MMR) thus providing a life-saving treatment suited to his
personal health condition. Have the necessary clinical parameters, required
at emergency situations, ever been examined in order to best match both the
emergency situations and the cellular technology?
Objective: Characterization of the clinical parameters which assemble an
MMR in the context of saving life and propose a model for an MMR in
emergency medicine.
Methodology: Characterization of the essential emergency medicine clinical
parameters in the context of life-saving treatments, through interviews with
prehospital and hospital experts in emergency medicine.
Supported by a Cellular multimedia expert, analysis of the results in order to
incorporate the clinical parameters into the cellular world as an MMR.
Conclusions: Emergency medicine treatment teams chose individual and
specific clinical parameters in a certain order of appearance from the general
medical record which should assemble, in their opinion, emergency
medicine MMR.
MMR was chosen by the emergency medical treatment teams as one of their
preferred communication method among the possible communication
methods presenting a patient medical record in the context of life-saving
treatment.
Summary: The MMR model, if applied correctly, will provide the
emergency medicine treatment teams an available, reliable, homogeneous
database of real time clinical parameters adapted to life-saving conditions.
125
QUANTIFYING THE AVOIDABLE COST BURDEN OF
PREECLAMPSIA – A COMPARATIVE CASE STUDY
N. Hadker1, E. Shaw-Caffrey1, J. Gartemann2, W. van der Helm2, S. Garg1,
J. Creeden2
1
Abt Bio-Pharma Solutions, Inc., Lexington, MA, USA, 2Roche Diagnostics, Ltd.,
Rotkreuz, Switzerland
Preeclampsia, a leading cause of maternal and perinatal morbidity and

mortality, and a driver of pregnancy-related healthcare costs, is currently
detected only after the onset of clinical symptoms. Earlier diagnosis may be
possible with a novel serum test using soluble fms-like tyrosine kinase-1
(sFlt-1) and placental growth factor (PlGF) biomarkers. We conducted a
comparative cost analysis between the cost of current care and costs if the
novel test was adopted, from a UK and German payer perspective.
We developed two country-specific, decision-analytic models of the clinical
and economic impact of current practice and the improved performance of
the new test. The base-case analysis assumed that 10% and 15% of all
pregnant women present with risk factors in Germany and the UK
respectively. Data pertaining to incidence, treatment practices, resource
utilization, costs, and funding for detection and management of
preeclampsia in each country were obtained through published literature,
public databases and interviews with clinicians, laboratory managers, and
payers.
Model results suggest that by not adopting the test, healthcare systems incur
preventable costs. Specifically, payers currently spend €1,579 (Germany) /
£2,726 (UK) per patient, which is €942 (Germany) / £1,781 (UK) more per
patient than if utilizing the novel test. Savings result from averting costs
associated with misdiagnoses and the appropriate detection and management
of subclinical cases.
Healthcare payers, in both countries, have a significant avoidable cost
burden associated with the misdiagnosis and mismanagement of
preeclampsia patients. Adoption of this novel test could lead to significantly
reduced societal healthcare costs.
126
MOBILE PHONE USE FOR CONTACTING EMERGENCY
SERVICES IN LIFE THREATENING CIRCUMSTANCES: A
RECORD LINKAGE STUDY
O. Wu1, A. Briggs1, T. Kemp2, A. Gray3, K. MacIntyre1, J. Rowley4,
K. Willett5
1
Division of Community Based Sciences, Faculty of Medicine, University
of Glasgow, Glasgow, Scotland, UK, 2Emergency Department, John
Radcliffe Hospital, Oxford, UK, 3Health Economics Research Centre,
University of Oxford, Oxford, UK, 4GSM Association, London, UK
5
Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
Background: The potential health benefits of mobile phone use have been
less widely studied, except for telemedicine-type applications. This study
seeks to determine whether initial contact with emergency services via a
mobile phone in life threatening situations is associated with potential health
benefits when compared to contact via a landline.
Methods: We carried out a record-linkage study. Data from all emergency
dispatches for immediately life-threatening events from a UK county
ambulance service were linked to the Patient Admission System at two
major local hospitals. Mortality (at scene, at emergency department (ED),
and during hospitalisation), transfer to the ED, admissions (inpatient care,
and intensive care unit (ICU)) and length of stay were analysed by initial
exposure (mobile phone versus landline) controlling for available potential
confounding variables.
Results: Of 354 199 ambulances dispatched to attend emergency incidents,
66% transported patients to hospital while 2% stood down due to death at
the scene. Mobile phone compared to landline reporting of emergencies
resulted in significant reductions in the risk of death at scene OR 0.77, but
not for death in ED or during inpatient admission. The risk of being
transferred to ED and subsequent inpatient admission were significantly
lower with reporting from mobile phones compared to landline (OR 0.93
and OR 0.82, respectively).
Conclusions: In this study, evidence of statistical association was shown
between the use of mobile phones to alert emergency services and improved
outcomes for patients.
127
EVALUATING THE EFFECT OF FRAME AND LEXICAL
VALENCE ON COLON-CANCER SCREENING UPTAKE
T. Gavaruzzi, L. Lotto
Department of Developmental Psychology and Socialization, University of
Padova, Padova, Italy
We evaluated the effectiveness of a message promoting colon-cancer

screening with actual patients. Two factors were manipulated: verbal
framing (gain vs. loss) and lexical valence of the consequences (expressing
them with lexically positive vs. negative terms). Previous studies have
almost always expressed the consequences of the promoted health behavior
with lexically positive terms (e.g., conservative surgery) preceded by a
negation term in the loss frame. However, psycholinguistic literature
suggests that the message framing would be more effective when using
terms lexically coherent (i.e., gain frame expressed with positive terms and
loss frame expressed with negative terms, e.g., radical surgery). Based on
the different effect that framed messages have depending on the function of
the behavior promoted (i.e., detection vs. prevention), we predicted that: a)
when promoting a detection behavior, the loss-negative message will be
more effective than the loss-positive message, which is usually more
effective than the gain-positive message; and b) when promoting a
prevention behavior, the loss-negative message will be less effective than
the loss-, which is usually less effective than the gain-positive. The results
supported partially this prediction: The loss-negative message was more
effective than the loss-positive message, but the loss-negative message was
as effective as the gain-positive one. We propose that this result depends on
the fact that the targeted behavior was described as both a detection and a
preventive behavior for colon-cancer. These findings could both explain the
weakness of the framing effect resulted in recent meta-analyses and inform
cancer screening communication research and practice.
128
DEVELOPMENT OF A COMPUTER –ADAPTIVE VERSION OF
ONCOLOGICAL PATIENT-REPORTED OUTCOME MEASURES
J.M. Giesinger, G. Kemmler, E.M. Gamper, A. Oberguggenberger,
B. Holzner
Univ.-Klinik für Biologische Psychiatrie Medizinische Universität
Innsbruck, Innsbruck, Austria
Background: Computer-adaptive testing (CAT) is an advanced method for

measuring patient-reported outcomes. Based on item response theory
models CAT selects the items most relevant for an individual patient
sequentially from an item bank. Within a large project of the EORTC
Quality of Life Group, our study aims at developing CAT versions of the
EORTC QLQ-C30 scales Fatigue, Emotional Functioning and Role
Functioning, their implementation in a software and their use in daily
clinical routine.
Methods: CAT development was based on an extensive literature search to
collect possible items. These items were refined through multi-stage expert
reviews and translated to major European languages to collect patient
feedback. Next a large patient sample was recruited to gain data for
development of the item bank and the CAT algorithm. A software for CAT
administration in clinical routine is currently being implemented in a
software called Computer-based Health Evaluation System (CHES).
Results: Literature research resulted in 588 fatigue items, 1711 emotional
functioning items, and 123 role functioning items. Expert reviews and
patient feedback reduced this number to 44 fatigue items, 63 emotional
functioning items and 18 role functioning items.
Data collection for item response theory analysis has started in November
2009 (520 patients recruited; aim n=4500). Preliminary results of the CAT-
analysis will be presented.
Conclusion: By generating individually tailored item sets, CAT reduces
patient burden and assessment duration, and increases measurement
precision. In addition, electronic data capture increases data quality and
reduces the amount of human resources required for data collection.
129
DEVELOPMENT OF A TYPOLOGY OF DECISIONS IN MEDICAL
ENCOUNTERS
P. Gulbrandsen
Akershus University Hospital and University of Oslo, Oslo, Norway
Using a material of 380 videotapes from a wide array of hospital encounters,

we aim to explore any link between communication behaviour and
subsequent decisions in detail. Decisions are diverse and may be classified
along several more or less well-defined dimensions pertaining to content,
situation, participants, or process (e.g. degrees of importance, risk, certainty,
medical or administrative, diagnostic, therapeutic, or palliative, doctor- or
patient-centered, paternalistic, deliberative or consumer-like, relation to
values, preferences etc.). Examples are not exhaustive. The plan was to base
the study on established classifications, however, despite extensive literature
searches and contact with SMDM members we were not able to identify a
detailed typology of decisions in medical encounters. Hence, we aim to
provide building blocks for a typology, beginning with identification of any
decision made, however small, and the development of a classification with
no a priori classes. The approach is qualitative, based on medical expertise.
We report the results from the first thirteen videotapes picked at random.
These were eight from internal medicine, three from gynaecology, three
from paediatrics, one from otorhinolaryngology, and two from
anaesthesiology.
We found 122 decisions (9.4 per encounter). Regarding content, 26 (21%)
were administrative, 17 (14%) were non-medical advices. Of the rest, 69
(57%) were diverse medical decisions. So far, these were of eight different
kinds (among them expectation, prescription, diagnosis, alleviation, surgical
intervention). The thirteen encounters were very different in nature, with
gross variation in decisional patterns and frequency of types of decision
content. Most decisions were of limited importance.
130
EXPLAINING RISK REDUCTIONS TO PATIENTS:
DO PHYSICIANS USE NUMBERS?
P.A. Halvorsen1, O.G. Aasland 2,3, I.S. Kristiansen3
1
University of Tromsø, Norway, 2The Research Institute of the Norwegian
Medical Association, Oslo, Norway, 3University of Oslo, Norway
Objective: Traditional measures of benefit from risk reducing drug therapies

are absolute risk reduction (ARR), relative risk reduction (RRR) and
number needed to treat (NNT). We explored whether physicians use such
numbers in their encounters with patients.
Methods: General practitioners (n=450) and internists (n=450) were mailed
a questionnaire and asked whether they in clinical practice explain the
benefits of risk reducing drug therapies in qualitative terms, such as “great
risk reduction” versus “small risk reduction”, numerical terms, such as
ARR, RRR or NNT, or both.
Results: We obtained responses from 428 physicians (48%). The proportion
that use qualitative terms only was 58%, compared to 3% for numerical
terms only, and 34% for using both qualitative and numerical terms. The
numbers of physicians that use ARR, RRR and NNT were 132, 115 and 92,
i.e. 31%, 27% and 22%, respectively. Mulitivariate logistic regression
analysis indicated that male physicians and internist were more likely to use
numbers in general (OR for males vs females 1.61, 95% CI 1.01–2.59 and
OR for internists vs GPs 1.54, 95% CI 1.01 – 2.35, respectively). Male sex
was a predictor for using ARR, being an internist predicted using ARR and
RRR, whereas age was negatively associated with using NNT (OR 0.96 per
year, 95% CI 0.94 – 0.99).
Conclusion: Male physicians, younger physicians and internists were more
likely to use numbers when explaining risk reductions to patients. The
associations were modest, however. The majority of physicians seem to
avoid using numbers when explaining risk reductions to patients.
131
HOW SHOULD PATIENTS BEHAVE TO FACILITATE SHARED
DECISION MAKING – THE DOCTORS’ VIEW
J. Hamann, R. Mendel, W. Kissling, E. Knipfer, H.H. Eckstein
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische
Universität München, München, Germany
Objective: Little is known about how patients can foster the process of
shared decision making and how physicians feel about patients’ efforts to be
engaged in decision making.
Methods: We assessed which patient behaviors physicians find helpful for
shared decision making and which behaviors they find annoying.
Results: We surveyed N=407 physicians from two different disciplines
(psychiatrists, surgeons). Active patient behaviors were generally rated quite
positive. There were, however, some behaviors which were perceived as
less helpful and more annoying (e.g. patients searching the internet, patients
being assertive). There were no major differences in the ratings between the
two medical disciplines.
Conclusion: Physicians are generally quite open toward active patient
behavior in the consultation. They, however, do consider it as less helpful
and become more annoyed if patients insist on their preferences and doubt
their doctors’ recommendations.
132
POPULATION GROWTH IMPACT ASSESSMENT (PGIA),
THE NEGLECTED MILLENIUM DEVELOPMENT GOAL
A. Hamedanizadeh
Institute of Health Management and Health Economics, University of Oslo,
Oslo, Norway
The Millennium Development Goals (MDGs) for 2015 can be considered as

the most agreed upon development goals as they were endorsed by all
United Nations member states in 2000. Although all eight goals influencing
the public health status and population growth rate; the direct effect on
population growth can be seen by goal 4 (reduce child mortality) and goal 5
(improve maternal health). As the achievement in MDGs are measure by
proportional improvement in population, increased population as result of
implemented MDGs, could potentially prevent countries to achieve MDGs.
To illustrate the effect of international development aid versus a national
driven process in achieving MDGs, Norwegian demographic data utilized.
The current status of Norway is considered as the result of a national driven
development process. By assuming an international development aid
intervention in 1900 year, which led to 100% achievement of MDG 4 (2/3
reduction of child mortality) and MDG 5 (75% reduction of maternal
mortality) from then, potential population excess in 2010 estimated.
The study introduced the Population Growth Impact Factor (PGIF), which
is defined as potential intervention population growth rate divided by
original population growth rate, and recommends its calculation whenever
possible as part of Population Growth Impact Assessment (PGIA). The
study concluded that improvement in public health dimension of
development would not necessary improve the development status of a
nation, unless it is in harmony with other development dimensions. Thus,
PGIA and PGIF should be an obligatory component for all internationally
funded development projects.
133
THE USE OF PROXY OUTCOME MEASUREMENTS: A REVIEW
AND A CASE STUDY
B. Hanson
AO Clinical Investigation & Documentation, Dübendorf, Switzerland
Proxy outcome measurements are used in medicine for a variety of reasons.

For example, since there is no accurate measure of overall bone strength,
proxy outcomes measures such as a Z score or bone mineral density (BMD)
rate are often used.
This presentation begins by reviewing some examples from the literature
where proxy outcome measurements were employed in order to highlight
the problems encountered as well as the creative solutions in use in modern
medicine.
The second part of the presentation profiles and discusses the ongoing
Angular Stable Locking System (ASLS) study currently being conducted at
seven different clinics. The stated objective of the ASLS randomized control
trial is to investigate if full weight-bearing with minimum pain is achieved
earlier in ASLS patients with distal tibial fractures undergoing
intramedullary nailing with Expert Tibia Nails (ETN).
ASLS was developed to improve fracture stability in patients undergoing
intramedullary fixation for long bone fractures who present with fractures
close to a joint or with osteoporotic bone.
Measuring fracture stability is only possible in a laboratory set-up, so a
proxy outcome measure has to be found for patients. In this study, the
ability to bear full weight with minimum pain serves as a proxy outcome
measurement for a stable fracture.
134
ADAPTIVE CONJOINT ANALYSIS AS A DECISION AID FOR
DYSFUNCTIONAL UTERINE BLEEDING
L.M. Hess1,2, A. Litwiller2, K. Kasper2, J. Stutsman2, J. Byron3,
L. Learman2
1
Departments of Public Health and 2OB/GYN, Indiana University,
Indianapolis, IN, USA, 3Southern Pines Women’s Health Care, Southern
Pines, NC, USA
Purpose: To conduct a qualitative pilot study to identify and address the key
characteristics of treatment options for dysfunctional uterine bleeding
(DUB); to develop and refine an adaptive conjoint analysis (ACA) survey
for a randomized trial that will test ACA as a decision aid to improve patient
satisfaction and reduce decisional regret.
Methods: Sawtooth Software SSI Web 6.4.4 was used to develop an ACA
survey in English and in Spanish to be administered at the time of the
patient’s clinic visit. Patients with DUB completed the survey and a disease
severity scale. Interviews were audiorecorded for content and the ACA
survey was revised for implementation in a randomized trial setting,
comparing ACA to usual care.
Results: Eight patients participated in the qualitative study assessing the
feasibility of ACA as a decision aid for DUB. All of the patients completed
the web-based survey in less than 40 minutes and required minimal staff
support. Patients verbalized concerns about fertility and sexual function, and
key wording was included in the final ACA survey to more clearly to
address these issues. The final ACA survey included eight attributes of
various treatment alternatives: treatment efficacy; sexual function; medical
care; cost; fertility; frequency of medication use; permanence; and recovery
time).
Conclusions: The ACA survey is acceptable and understandable to patients,
and may an important tool for clinicians in the discussion about treatment
options. A 330-patient randomized trial is now ongoing to further test the
efficacy of this approach as a clinical decision aid for DUB.
135
DEVELOPMENT OF A FLAG SYSTEM FOR THE
COMPUTERIZED DETECTION OF CANCER PATIENTS WITH
ADDITIONAL TREATMENT NEEDS BY MEANS OF THE
“COMPUTER BASED HEALTH EVALUATION SYSTEM” (CHES)
B. Holzner1, G. Kemmler1, J. Giesinger1, E. Gamper1,
A. Oberguggenberger1, A. Zabernigg2, B. Sperner-Unterweger1
1
Department of Biological Psychiatry, Medical University of Innsbruck,
Austria, 2County Hospital, Kufstein, Austria
Aims: Studies evaluating computer-aided routinely assessment of patient

reported outcomes (PRO) suggest important benefits for physicians, patients
and their treatment. This project's aim was developing a flag system for
computerized detection of cancer patients with additional treatment needs.
Methods: The detection system is part of the “Computer based Health
Evaluation System (CHES)”, a software for the computerized collection,
processing and presentation of PRO data. The flag system helps identify
cancer patients with conspicuous subscale patterns. This includes cut-off
values (patients marked with orange or red buttons) and significant changes
over time (yellow deltas).
The testing data set was derived from a longitudinal study on QOL (assessed
using the EORTC QLQ-C30) in chemotherapy patients at an oncological
outpatient unit. Several criteria of “relevant” changes were compared
regarding the prevalence of such changes in the study population and their
statistical significance on an individual patient level.
Results: QOL data of 167 cancer patients were analyzed (on average 5.3
assessments per patient). The 75th and 90th percentile showed to be useful
cut-off values. Recommended thresholds of relevant QOL changes appear to
be unduly low when considering changes in the individual patient. Based on
empirical data we suggest a modified criterion of relevant change for the
EORTC QLQ-C30 which appears clinically and statistically more
meaningful.
Conclusion: The developed flag system enables physicians to detect patient
reported health deficits (e.g. fatigue) at one glance. However, more research
involving various diagnostic groups is needed for a more profound empirical
basis for developing refined criteria.
136
GEOGRAPHIC DISTRIBUTION OF CCU BEDS IN IRAN
A.A. Kiadaliri1, H. Safari2, R. Hosseinpour2
1
Lund University, Department of Clinical Sciences, Malmö University
Hospital, Malmö, Sweden, 2Ministry of Welfare and Social Security, Health
Insurance Department, Tehran, Iran
Objective: Equity in access to and use of health services is a common goal

for policy-makers in most countries. The aim of the present study was to
examine geographic distribution of CCU beds (as an important medical
resource) and identify possible inequalities regarding the distribution of it
among 30 provinces of Iran in 2006.
Data and Methods: Census data on the number of provinces population was
obtained from the Iranian Bureau of Statistics. Data related to CCU beds
was obtained from Planning and Management Organizationُ s reports. The
CCU beds-to-population ratio (CBPR, the number of CCU beds per 100,000
people) was calculated to compare the distribution of CCU beds among
provinces. We plotted the Lorenz curve and calculated Gini Index (proposed
by Brown et al.) and Index of Dissimilarity (ID) to our goals.
Results: Average of CBPR was 5.95 in Iran in 2006. 23 out of 30 provinces
(61% of total population) have CBRG lower than average country’s CBPR.
CBPR ranged between 1.83 (Ilam Province) to 11.2 (Yazd Province), a
6.12-fold difference. The Gini index for the distribution of CCU beds in
2006 was 0.214. The ID for 2006 was 0.161 (16.1%), which corresponds to
676 CCU beds which should be relocated in order to achieve equality.
Conclusion: These aggregate-level results showed that the distribution of
CCU beds was not equally distributed among provinces in 2006. Governing
bodies must consider this distribution in their calls for increasing the
number of CCU beds.
137
DETERMINING THE TECHNICAL EFFICIENCY OF HOSPITALS
USING DATA ENVELOPMENT ANALYSIS: A NATIONAL-WIDE
STUDY ON GOVERMENTAL HOSPITALS IN IRAN
B. Najafi1, A.A. Kiadaliri2
1
Iran University of Medical Sciences, Division of Health Economics,
Tehran, Iran, 2Lund University, Department of Clinical Sciences, Malmo
Hospital University, Division of Health Economics, Malmo, Sweden
Introduction: Scarcity of resources and the increasing trend of health

expenditure necessitate the efficient utilization of health sector resources.
Examination of hospital efficiency and determining the causes of
inefficiency is considered as a main step in improvement of resource
utilization in health system of countries.
Method: Using Data Envelopment Analysis we determined the technical
efficiency of governmental hospitals in Iran for 2007. Because of
insufficient data, we excluded 4 out of 140 governmental hospitals which
were selected randomly within all provinces of country. Then we
categorized sample hospitals based on three factors: general or specialty,
located in deprived or prosperous provinces, and teaching or non-teaching
activities. Sample sizes of three categories were small and, hence, we
excluded these categories from study and examined 122 remaining hospitals
in five categories. We used “medical staff”, “nursing staff”, “administrative
& support staff” and “number of beds” as input variables. “Number of
patient days” and “income” were considered as output variables.
Results: The average of total technical efficiency ranged from 0.458
(general-deprived-nonteaching group) to 0.809 (specialty-prosperous-
nonteaching group). This range for average of pure technical efficiency was
between 0.73 (specialty-prosperous-teaching) to 0.959 (specialty-
prosperous-nonteaching). The average of scale efficiency ranged from
0.621(general-deprived-nonteaching) to 0.844 (general-prosperous-
teaching).
Conclusion: Results showed that hospitals do not use efficiently from 19-54
percentages of their resources and this shows a considerable resource-
wasting in hospital sector of Iran. This study emphasizes the urgent
conducting of reforms (such as basing payment on performance, merging of
hospitals, changing of input-mix in hospitals) in health system in Iran.
138
MOTIVATION TO UNDERGO PSA TEST AND WILLINGNESS TO
PAY OF SCREENING FOR PROSTATE CANCER
N. Koinuma, M. Ito
Tohoku University Graduate School of Medicine, Sendai, Japan
Background and Purposes: Consensus has not yet been obtained among
medical professionals on the value of PSA screening for prostate cancer,
while results of ERSPC and PLCO screening trials were published most
recently. Japanese Urological Association insists its usefulness and Study
Group of Ministry of Health, Labour and Welfare reports that mass
screening is not recommended so far. This study clarifies the factors leading
decision to undergo PSA test and examines the meaning of screening from
the viewpoint of cancer economics.
Method: Using the Internet, we grasp the attitude toward the PSA test of
males aged 40 and over (less than 80) all over the country.
Results: We obtained reply from 26,186 respondents and those who have
had PSA test are only 19%. As for the opportunity, 64% were "for their
health", 27% followed the screening menu" and 15% were "recommended
by the doctor". 72% did not know "PSA test is simple and has few burdens".
72% replied that this knowledge might influence their future action. Only
9% know the enlightenment movement ("blue clover"), whereas 58% know
"pink ribbon" against breast cancer. WTP (n=26,183) of the screening for
prostate cancer was €406 on average and that of consultation when worrying
about the disease was €431. In case of screening for gastric cancer, those are
€361 and €383 (€1=\130).
Conclusion: WTP of prostatic cancer is higher than that of gastric cancer,
and its positive educational campaign on the method and the evidence of
screening would be effective to improve the motivation to undergo PSA test.
139
A DISCRETE EVENT SIMULATION APPROACH IN
MODELING THE HEALTH AND ECONOMIC IMPACT OF
HPV VACCINATION AND CERVICAL CANCER SCREENING
P. Quon 1 , D.Vanness 1 , P. Hillemanns 2 , N. Largeron 3 , V. Rémy 3
1
United BioSource Corporation, Bethesda, MD, USA, 2 Medizinische
Hochschule Hannover, Germany, 3 Sanofi Pasteur MSD, Lyon, France
Background: Several health-economic models have been developed to

evaluate the cost-effectiveness of HPV vaccination for prevention of
cervical cancer. However existing models are limited in their evaluation of
variability in cervical cancer screening practices. Our objective was to
develop a mathematical model simulating the clinical and economic impact
of different screening options for German females alongside HPV
vaccination.
Methods: We developed a discrete event simulation model, describing the
natural history of cervical cancer and genital warts. Five HPV types (HPV
16, 18, 6/11, other high risk and other low risks) were considered. The
model includes a detailed screening module with variability of screening
practices based on frequency distributions of tests. To create a realistic
baseline population, an aging-up process simulated girls beginning with no
infection and exposed to disease risks as they age. The model then captured
patients matching German population data.
Results: Predicted overall and type-specific HPV-prevalence are close to
German epidemiological data, differing from reported prevalence by less
than 1.25% for each 5yr age group above 25 and 3% for women less than 25
for HPV 16, 18, and other high risk HPV. Predicted genital warts, cervical
cancer incidence and mortality, however, are currently underestimates and
are continuing to be calibrated.
Discussion: We developed a very flexible individual-based model. Provided
that the calibration is improved, it will be useful for decision makers in the
future to evaluate the impact and the cost-effectiveness of HPV vaccination
in combination with potential new screening strategies.
140
COMPARISON OF TWO DATA COLLECTION PROCESSES IN
CLINICAL TRIALS: ELECTRONIC AND PAPER CASE REPORT
FORMS
C. Alberti1, A. Le Jeannic2, I. Durand-Zaleski3
1
U.E.C., Hôpital Robert Debré, Paris, France, 2URC Eco Ile de France,
Paris, France, 3AP-HP-Hôpital Henri Mondor, Service de Recherche
Clinique et Sant Publique, Créteil, France
Pen-and-paper data collection is no longer the only way to collect patient

data in a clinical trial. Electronic Case Report Forms (eCRFs) are
increasingly chosen by investigators and sponsors. They present several
advantages: avoiding mistakes when copying data from paper to an
electronic database, shortening the duration of clinical trials, and reducing
data collection costs, especially in multicenter and international trials.
However, French investigators are often reluctant to use eCRFs. Our
objective was to compare the efficiency of paper and eCRFs by measuring
costs, effectiveness and professionals’ satisfaction.
Endpoints considered were: data collection costs, data quality, delay to
implementation of the trial. We built a comparative retrospective study,
using finished clinical trials with electronic or paper CRFs. The satisfaction
of investigators and others was obtained using questionnaires and other data
at clinical research units. Opinions are clearly still very different on CRFs,
however, the answer to the questionnaires will allow us to determine which
aspects should be improved for a wider diffusion of eCRFs. Furthermore,
eCRFs appeared to be more economical for multi-centric trials and those
with more than 200-250 patients, and their use would allow a more accurate
prediction of trial costs. No other differences actually emerge, but this is
likely due to the existing pro-paper context, in which the eCRFs cannot
demonstrate their full potential.
141
DECISION MAKING ON PARTICIPATION IN A RANDOMIZED
CONTROLLED TRIAL IN TRAUMATIC BRAIN INJURY: THE
VALIDITY OF DEFERRED PROXY CONSENT
H.F. Lingsma1, B. Roozenbeek1,2, E.W. Steyerberg1, A.I.R. Maas2,
E.J.O. Kompanje3
1
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands,
2
Department of Neurosurgery, University Hospital Antwerp, Antwerp,
Belgium,3Department of Intensive Care, Erasmus MC, Rotterdam, The
Netherlands
Background: Incapacity of patients for giving informed consent, and proxies

being too emotionally distressed to make informed decisions, are ethical
aspects of consent procedures in acute care research. A substitute for
informed patient consent might be deferred proxy consent; the patient is
included in the study and proxies are asked for consent as soon as possible
afterwards.
Aim: Assess the validity of deferred proxy consent for decision making on
participation in a randomized controlled trial (RCT) in traumatic brain
injury (TBI).
Methods: The Pharmos RCT assessed the effect of dexanabinol in patients
with moderate and severe TBI, using a proxy consent procedure. We sent
proxies of 91 patients included in Pharmos in Belgium and the Netherlands
a written questionnaire containing 28 questions on the decision making
process such as ‘Where you informed by a physician?’ and ‘Did you had
enough time to decide?’
Results: Response rate was 37 of 91 (41%). Proxies were most often partner
(51%) or parent (41%) of the patient, and their median age was 50 years.
Most proxies (92%) indicated they were well informed about the study and
89% said they understood the information. Nevertheless 19% did not know
the study drug was additional to standard treatment and 41% did not know it
could have side effects. The majority (94%) felt they were the right person
to give consent, but 40% indicated they were unable to think clearly in the
acute phase.
Conclusion: Since proxies seem unable of making informed decisions in the
acute phase, deferred proxy consent is a valid procedure in RCTs in TBI.
142
COST OF EARLY RHEUMATOID PATIENTS BY TYPE OF
TREATMENT: IS IT WORTH PRESCRIBING EXPENSIVE NEW
DRUGS EARLIER IN THE HISTORY OF THE DISEASE?
K. Chevreul1, S. Lucier1, M. De Rosa1, F. Guillemin2, I. Durand-Zaleski1,
B. Fautrel3
1
URC Eco IdF AP-HP, Paris, France, 2Rheumotology, CHU Nancy, Nancy,
France, 3Rheumotology, CHU Pitié-Salpétrière, AP-HP, Paris, France
Little information is available on the impact of new generation more

powerful and costly drugs (biologics) on the cost of early rheumatoid
arthritis (ERA). Used for severe patients, these are currently not
recommended in early stages of the disease mainly for cost concern.
Objectives: We studied the cost of ERA patients’ care during the three first
years of the disease, with a particular focus on biologics and the economic
consequences if prescribe early in the history of the disease (first year after
suspicion).
Methods: The cost of care of 520 patients of the ESPOIR cohort of ERA
(2002-2005) was calculated by valuing consultations, tests, hospitalizations,
medicine and transports with 2007 statutory tariffs. We compared 3
patients’ groups depending on their drug treatment: older drugs (428), early
biologic treatment (42) and late biologic treatment (50). After adjustment on
disease severity, we compared cost of the treatment of the consequences of
the disease on a patient’s health status.
Results: Annual mean cost was €2,561 per patient. It varies from €1,238 for
less severe patients with older drugs, €6,942 for late biologics and €11,095
for early biologics treatment. However, for early treatment patients, cost of
treating disease consequences is only 35% over less severe patients while
for the late treatment patients this reaches 200%, showing a positive impact
on patients’ health status.
Conclusion: The average cost of treating disease consequences reflecting a
patient’s health status is smaller in early biologic practice and advocate for a
more effective treatment if biologics are used earlier.
143
PATIENT AUTONOMY AND EDUCATION IN MEDICAL
KNOWLEDGE
D. Lukas
Technische Universität Dresden, Dresden, Germany
The asymmetry between patient as a layman and physician as an expert is a key

element in health economics. However, a change to a higher degree of patient
autonomy has taken place till this day. Furthermore, there is a consensus about
a positive correlation between education and productivity of medical care. This
paper focuses on individual investments of laymen in specific medical
education as a decision problem whereby the ex-post strategies of a patient are
consultation and self-care. The paper analyzes the incentives an individual has
to invest in specific education.
In a time of an increasing individual responsibility and out-of-pocket payment
this topic becomes significant. The choice between the health–care system and
self-care becomes more relevant than between different providers within the
system, specifically for banal illnesses.
A medical educated individual/patient has been discussed extensively in the
medical/ethical literature, however, with a focus on shared decision making
within the patient-physician relationship (PPR). Little is done in the economical
literature which discusses education as productivity increasing but not more
specified. The asymmetric relation of a PPR can be extended by an ethical
position with two extremities - paternalism and autonomy - characterized by
two dimensions: 1. alternative, 2. liability. Alternative means the choice
between strategy consultation and self-care and liability the competence of self-
diagnosis and the self-care-productivity. These dimensions must be
strengthened to increase patient autonomy.
The discussion is based on a decision-tree framework, divided into two cases:
1. no ex-post knowledge about probabilities, 2. ex-post knowledge about
conditional probabilities. The individual can suffer a severe or a banal illness.
Self-care can produce a higher net-utility than consultation only for banal
illnesses. There is a risk of a false self-diagnosis. Education decreases the error
probabilities and increases the self-care-productivity.
Effort in education depends on its effectiveness to increase self-care
productivity and to improve self-diagnosis competence, a potential utility loss
through a false self-diagnosis and on illness severity. Risk aversion is
ambiguous in its impact. Furthermore, education is inhibited if consultation is a
dominant strategy. Education is able to eliminate this dominance, however,
with an inducement of a potential loss in the case of a false self-diagnosis. The
implementation of conditional probabilities allows the calculation of a
threshold level according to the strategy choice and to an individual welfare
gain through education. An information value is generated extended by
education. Education can raise welfare through self-care for a higher range of
probability of a severe illness.
Furthermore, an incentive to invest in education remains if an insurance is
implemented. It depends on observability of education and self-care whether
the incentive is shifted to a decrease of premium more than an ex-post income
loss based on a partially cost coverage in the case of non-observability. There is
no full insurance due to non-insurable values as non-monetary costs under
consultation and self-care. In addition, education is inhibited if consultation
becomes dominant through insurance and a non-binding contract.
144
ETHICAL DIMENSIONS IN THE DEMAND AND THE SUPPLY OF
VACCINES
J. Luyten, P. Beutels
Centre for Health Economics Research and Modeling of Infectious Diseases
(CHERMID), Centre for the Evaluation of Vaccinations (CEV), Vaccine
and Infectious Disease Institute (VAXINFECTIO), University of Antwerp,
Belgium
Vaccines have saved more lives than any other medical technology. The
future success of vaccination is however largely dependent on how the
involved ethical problems are dealt with. We discuss five relevant ethical
dimensions in the demand and supply of vaccines that may increase in
importance towards the (near) future.
In vaccine demand we discern first the justifiability of compulsory or
prohibited vaccination and second the determination of equitable
distributions of burdens and benefits. Compulsion can generate equitable
and efficient outcomes. Prohibition, e.g. during periods of scarcity of
pandemic influenza vaccines, can be a necessary measure in public health
strategies. Both question the scope of fundamental individual rights and
freedoms. The second dimension, equity, relates to the individual right to
vaccines, the distribution of burdens and benefits of herd immunity, the role
of personal responsibility and so on.
In vaccine supply we discuss three different ethical aspects. First, with the
application of vaccine technologies to new areas such as obesity or drug
addiction, more ethical discussion will arise towards the moral acceptability
of technical fixes like vaccines. Second, situations of vaccine scarcity
emphasise our dependence on private industry providers on matters
potentially of life and death. Third, clinical trials of vaccines remain
controversial. The current practice of rewarding test-subjects financially
may pull trial enrolment towards groups with lower socio-economic status
while the benefits of a new vaccine are for everyone.
145
DEVELOPING A FLEXIBLE DECISION SUPPORT SYSTEM FOR
MEDICAL APPLICATIONS BASED ON A NEURO-FUZZY
APPROACH
M. Gyimesi, J. Mayerhofer, M. Wastian, A. Zimmermann
Vienna University of Technology, Institute for Analysis and Scientific
Computing, Vienna, Austria
In medical image processing the process from an image to its classification

can be described as follows: An image is scanned for particular shapes of
interest. Every one detected peculiarity (depending on the application)
results into a feature vector containing the numerical values to describe its
qualities. The total of distinguishable objects is then represented by a set of
feature vectors which has to be aggregated to a classification result
respectively an interpretation of the biomedical image.
In an example application the crystallization patterns of dried native blood
drops (clots) on a common medical slide should give information about
pathological disorders. Geometrical and color features are extracted out of
scanned images from these clots, but only the accumulation of all these
varying features of different regions of the blood spot gives clues, whether
the patient has some pathological disorder.
To emulate experts’ decisions about an image the classification system must
be trainable. After providing a representative sample of images with the
matching diagnoses it should be able to mimic the decisions made on the
training examples. For being able to merge expert knowledge the system
must be able to deal with contradicting training examples, vague knowledge
and inputs of varying size.
To meet the above described requirements we used combinations of
recurrent neural networks and fuzzy logic and built a fast and flexible tool
for various image classification problems.
We will present results concerning the quality of classification in a medical
application.
146
IMPACT OF EXENATIDE, PEN INSULIN AND VIAL INSULIN ON
PATIENT OUTCOMES IN A DIABETES POPULATION IN THE
UNITED STATES: A RETROSPECTIVE DATABASE ANALYSIS
OF PERSISTENCE AND FIRST-YEAR COSTS
N. Rashid1, J.M. McCombs1, S.A. Foster2, L.A. Miller2
1
University of Southern California, School of Pharmacy, Department of
Pharmaceutical Economics and Policy, Los Angeles, CA, USA
2
Eli Lilly and Company, US Outcomes Research, Indianapolis, IN, USA
Objective: Compare the impact of exenatide and pen insulin (PI) to vial
insulin (VI) on persistence and first-year treatment costs.
Methods: Commercial health plan data from 2004 to 2008 were used to
identify 213,701 episodes of drug therapy initiated by 147,327 patients with
diabetes. Persistence was defined as >90-day gap in drug availability.
Episodes were classified as: first observed, restarting previous, switching,
and augmenting therapies. Differences in persistence and first-year costs
were estimated comparing 704 PI episodes and 7,142 exenatide episodes to
24,238 VI episodes using OLS and logistic regression adjusting for
demographics, drug use history, prior medical utilization, and comorbid
conditions.
Results: Relative to VI, PI was associated with reductions in persistence on
initial therapy (OLS estimate: -95 days, p<0.0001) and on all diabetes
medications (-36 days, p<0.01). PI was not associated with significant
differences in post-treatment costs. Treatment with exenatide was
associated with a significant decrease in persistence on initial therapy (-18
days, p<0.01), but increased likelihood of persistence on some form of
diabetes therapy for more than 360 days by 42% relative to VI (p<0.0001).
Exenatide was also associated with a reduction in average total cost per
patient over the first year of $5252 (p<0.0001), primarily due to estimated
savings of $3,120 in hospital cost (p<0.0001).
Conclusions: Relative to VI, PI may offer no advantage for post-treatment
first-year costs and significantly decreases persistence. Conversely,
exenatide was associated with significant reductions in post-treatment first-
year costs and persistence on initial therapy, while improving persistence
with all other diabetes medications.
147
WATCHFULLY WAITING: MEDICAL INTERVENTION AS AN
OPTIMAL INVESTMENT DECISION
E. Meyer1, R. Rees2
1
Helmholtz Zentrum München, Neuherberg, Germany, 2Center for
Economic Studies (CES), University of Munich, Munich, Germany
Watchfully waiting involves monitoring a patient's health state over time

and deciding whether to undertake a medical intervention, or to delay the
decision and continue waiting. This process is characterized by the three
essential properties of an investment decision: the existence of uncertainty,
in this case concerning the development of the patient's health state;
irreversibility; and flexibility of timing. Recent developments in the theory
of investment under uncertainty (Dixit & Pindyck, 1994) have greatly
increased our understanding of how such decisions should be taken, and this
paper is concerned with the application of this theory to the watching and
waiting process.
A key result concerns the option value of waiting. Since information about
the inherently uncertain costs and benefits of the intervention is revealed
over time, the opportunity to wait has a value per se. Thus for the
intervention to be optimal, its net present value may have to be - possibly
substantially - greater than zero. Decision rules for switching from
watchfully waiting to direct intervention are derived. This corresponds to an
optimal stopping problem: the patient’s health state evolves according to a
stochastic process (Geometric Brownian Motion with or without Poisson
Jumps), and medical intervention terminates this process and restores the
patient's health. As a distinctive feature, the model also allows for the
possibility that the patient's condition may improve spontaneously. We
derive extensive comparative statics results, some of which are non-
standard, and discuss the applicability of our approach to concrete decision
situations.
148
MODELING VARIOUS VACCINATION STRATEGIES AGAINST
STREPTOCOCCUS PNEUMONIAE
F. Breitenecker2, G. Endel3, F. Miksch1, N. Popper1, C. Urach1, G. Zauner1
1
Streptococcus Pneumoniae is a bacterium that causes pneumonia, sepsis,

otitis media and meningitis. Today, due to vaccination against many other
epidemics, these are one of the most common and dangerous sicknesses for
young children. The simulation is based on a modular dynamic agent based
model which consists of a dynamic population model, a social model and an
infection model. This modular implementation provides the possibility to
simulate different scenarios easily. An advantage of such a model is that
unknown values like herd immunity and serotype replacement are part of
the result and don't need to be presumed.
An appropriate simplification for examining vaccination strategies is to
consider two concurrent serotypes while people can be immunized against
one serotype only.
The first scenario simulates the vaccination of infants. Considering a
possible 10 year immunization effect we have immunized children up to the
age of 10 years. Comparing 10%, 50% and 100% immunized children we
receive a very low global effect and a high serotype replacement in every
case. A decrease of the carrier rate for immunized children stays within a
range of 42% to 58% in all three cases.
The other scenario simulates vaccination of people independent of their age.
When immunizing 50% of the whole population the serotype included in the
vaccination is being exterminated whereas the other one expands drastically
among the population. The immunization of 10% of the population behaves
similar to the first scenario with a low global effect and a strong serotype
replacement.
149
MODELING OF HOUSEHOLDS IN AN AGENT BASED
POPULATION MODEL AND RESULTS FOR EPIDEMICS
F. Breitenecker2, M. Götzinger2, F. Miksch1, N. Popper1
I. Schiller-Frühwirt3, C. Urach1, D. Wetter2, G. Zauner1
1
An important factor for the spreading of epidemics is the social behavior of

people. For example, if everyone stays at home and frequency of meeting
other people is reduced infection rate is low. The task of this publication is
the implementation of households into an agent based epidemic model and
examining their impact to the spreading of a pathogen like the influenza
virus. Simulation is based on a modular agent based model, consisting of a
population part, a social part and an infection part.
Adding households to the model requires an intervention in the social
model. “Statistik Austria” provides appropriate statistical data about
composition of Austrian households. At first people are categorized into
male adults, female adults and children. Every household can either be
owned by a single adult or a married adult couple. After defining the
household the algorithm assigns children and remaining adults to it so that
the system of households corresponds with real data.
In the base run all parameters are adjusted to correspond with existing data.
We receive a typical result of an SIR model with an epidemic duration of 38
days and a rate of 40% resistant people who got infected during the
epidemic. Variations of social parameters show that bigger households
encourage a higher number of infected people while the duration of the
epidemic remains almost the same.
The future opportunity offered by this model is to simulate scenarios like
quarantining people or higher transmission probabilities within households..
150
DOC, WHAT WOULD YOU DO IF YOU WERE ME?
ON SELF-OTHER DISCREPANCIES IN DECISION MAKING
ABOUT HEALTH
R. Garcia-Retamero1,2, S. Müller2, Y. Okan2
1
Center for Adaptive Behavior and Cognition, Max Planck Institute for
Human Development, Berlin, Germany, 2Department of Experimental
Psychology, University of Granada, Spain
Shared decision-making is a beautiful, democratic ideal. Very often,

however, doctors make decisions for their patients. Even when patients are
willing to be involved in decision making about their health, doctors must
accurately predict their patients’ risk preferences and decisions to be able to
customize advice to their particular situation. In a study involving a sample
of doctors (N=40) and their patients (N=80), we investigated whether
doctors make different decisions for themselves and their patients, and
whether doctors’ predictions of their patients’ decisions differ from the
decisions that doctors make for themselves. We further investigated whether
they doctors make accurate decisions for their patients and predict their
patients’ decisions precisely. Finally, we investigated the processes
underlying self-other discrepancies in medical decision making (i.e.,
whether they emerge due to differences in cognitive processes⎯amount
and/or type of information that doctors use to make the decisions⎯or
whether they are determined by doctors’ feelings towards risk). Results in
the study are promising and are interpreted in line with the current debate on
defensive medicine. We conclude that our findings could have important
implications for medical practice.
151
DOES VISUAL REPRESENTATION OF STATISTICAL
INFORMATION IMPROVE DIAGNOSTIC INFERENCES?
R. Garcia-Retamero1, U. Hoffrage2, S. Müller1, Y. Okan1
1
Department of Experimental Psychology, University of Granada, Spain
2
Faculty of Business and Economics, University of Lausanne, Switzerland
Physicians and patients have difficulties inferring the positive predictive

value from information about the prevalence of a disease and the sensitivity
and false-alarm rate of a medical test. Previous research has established that
communicating such information in a format the human mind is adapted to
(namely natural frequencies instead of probabilities) improves such
inferences considerably. With the present study, we want to explore to what
extent diagnostic inferences can be improved, beyond such format effects,
by providing visual aids. Our study involved a sample of doctors (N=60)
and their patients (N=60). We used three tasks: inferring breast cancer from
a positive mammogram, colon cancer from a positive hemoccult test, and
insulin-dependent diabetes from a genetic test. Half of the participants
received the information about prevalence, sensitivity and false-positive
rates in natural frequencies, while the other half received the information in
probabilities. In addition, half of the participants only received numerical
information, while the other half additionally received a visual display
representing the numerical information. We controlled for participants’
numeracy and graph literacy skills. Our results showed that visual aids are
very effective and boost Bayesian performance even in the group that
received natural frequency information.
152
ARE MEDICAL DECISIONS SHAPED BY THE MEDIA?
AN INTERCULTURAL COMPARISON ON THE VACCINATION
AGAINST CERVICAL CANCER (VPH)
S. Müller1, R. Garcia-Retamero1,2, N. Bodemer2, Y. Okan 1,
A. Neumeyer-Gromen3
1
Departamento de Psicologia Experimental, University of Granada, Spain
2
Max Planck Institute for Human Development, Berlin, Germany
3
Federal Agency for Occupational Health and Safety, Berlin, Germany
People often refer to many sources of information when making decisions

about health. Among those sources, the media increasingly addresses
prevention programs, treatments, and risk factors. Although the mission of
the media coverage is to provide information transparently and offer critical
evaluations, the question remains open whether they can keep up with this
aim in the medical domain. Following Gigerenzer, Mata, and Frank (2009),
for instance, the benefits of prevention programs are often overestimated by
the public – did the media contribute to this misconception? To answer this
question, we conducted a media analysis of the widely promoted
vaccination against cervical cancer. Since the vaccination was officially
released (Germany: 2006; Spain: 2007), a public discussion emerged
doubting the scientific evidence to proof its benefit. We therefore analysed
newspaper reports, information brochures, and internet sources about the
vaccination against cervical cancer to test whether the information in the
media supports the public opinion. We focussed on two countries, Germany
and Spain, because a thorough literature search showed important cross-
cultural differences in the media environment. For instance, according to the
World Health Organization, computer and Internet use in Spain is more than
twice as low as in Germany. Similarly, while independent health-related
websites are relatively scarce in Spain, Germany has a wide range of web-
based health support systems, often sponsored by the government or by
insurance providers. Our results have important implications for risk
communication pointing out to what extent the media can potentially shape
the public’s decision and perception.
153
CLINICAL BENEFIT AND COST-EFFECTIVENESS OF
SCREENING STRATEGIES FOR CARDIOVASCULAR DISEASES
AMONG HIV-INFECTED PATIENTS IN THE DEVELOPED
WORLD
J. Nolte1,2, T. Neumann3, U. Siebert 1,4,5, P. Schnell-Inderst4,
N. Muehlberger4, A. Neumann2, E.F. Halpern1, G.S. Gazelle1,5,6,
J. Wasem2, A. Goehler1,4
1
Institute for Technology Assessment and Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA, 2Institute for Health Care Management, Faculty for Business and
Economics, University Duisburg-Essen, Essen, Germany, 3Clinic for
Cardiology, University Hospital Essen, Essen, Germany, 4Department of
Public Health, Information Systems and Health Technology Assessment,
UMIT - University for Health Sciences, Medical Informatics and
Technology, Hall i.T., Austria, 5Department of Health Policy and
Management, Harvard School of Public Health, Boston, MA, USA
6
Department of Radiology, Massachusetts General Hospital, Boston,
MA, USA
Purpose: The advent of highly active antiretroviral therapy has resulted in

increased longevity of HIV patients requiring an integrated therapeutic
approach that includes chronic diseases, in particular coronary artery disease
(CAD). The purpose of this analysis was to evaluate clinical benefit and
cost-effectiveness of CAD screening in HIV patients by comparing one-time
stress-ECG or stress-echocardiography with the current standard of care
(SOC), i.e., no screening.
Methods: Design: CEA using a 5-state Markov model representing
diagnostic phase, CAD progression, and death. Data sources: CAD status,
risk factors, and HIV treatment from patient-level data of HIV-HEART
study; CAD progression and test diagnostic data from literature; cost from
health insurance databases. Target population: HIV-positive men. Time
horizon: Diagnostic phase, lifetime. Discount rate: 3%. Perspective:
Societal. Interventions: Stress-ECG, stress-echocardiography, no screening.
Outcomes: Diagnostic results, life expectancy, lifetime medical costs,
incremental cost-effectiveness ratio (ICER).
Results: In men aged 44, the estimated CAD prevalence was 15%. Per 1,000
patients stress-ECG identified 103 out of 149 CAD patients at €20/person;
stress-echocardiography identified 115 patients at €75/person. The model
projected a mean life expectancy of 19.19 years for SOC, 19.21 years for
stress-ECG, and 19.22 years for stress-echocardiography. Mean discounted
lifetime costs per patient were €459,600 for SOC, €461,100 for stress-ECG,
and €461,000 for stress-echocardiography. Stress-ECG was dominated by
stress-echocardiography. The discounted ICER of stress-echocardiography
vs. SOC was €46,300 per life-year gained.
Conclusion: Preliminary results indicate that screening HIV patients for
cardiovascular diseases could be clinically and economically attractive.
Extending the model to screenings beyond CAD is necessary.
154
GUIDELINES FOR CARRYING OUT LEGAL REGULATIONS FOR
PRIORITY SETTING IN NORWAY
E. Nygaard, B. Guldvog, H.P. Aarseth
Norwegian Directorate of Health, Oslo, Norway
Hospitals in Norway are mainly publicly owned. Legal regulations states

that each patient referred to public hospitals shall be judged individually
according to the severity of the patient’s health, the expected benefit and
cost-effectiveness of treatment. However, evidence shows politically
unacceptable variations in the priority setting.
The Ministry of Health mandated the Norwegian Directorate of Health to
cooperate with the regional health authorities in developing national
guidelines. Regional representatives from 30 specialities together with
general practitioners and user representatives worked in groups to develop
the guidelines. The project was divided in three rounds of 5 month’s work,
each round having three two days’ workshops.
Each speciality described and evaluated the most common medical
conditions within their speciality according to criteria for priority setting
using a structured questionnaire and listed references in support of their
views. After a month with reflections and peer discussions, they concluded
whether a “typical” patient within each condition group should be
recommended prioritised health care, and if so, a maximum waiting time
was given. To ensure individual judgement of each patient, the groups
supplemented the descriptions of the “typical” patient with additional
characteristics of relevance. These have to be taken into consideration
before concluding on the legal rights of the individual patient.
An expert group reviewed the work. Four guidelines were tested in five
hospitals and adjustments were made. The guidelines have been on a
national consulting round and were published in 2009. The implementation
of the guidelines is the responsibility of the regional health authorities.
155
GRAPH COMPREHENSION IN MEDICAL CONTEXTS:
AN EYE-TRACKING STUDY
Y. Okan1, M. Galesic2, R. Garcia-Retamero1,2
1
2
Human Development, Berlin, Germany
Graphical displays are often used to communicate important medical

information to patients, and they have been shown to improve risk
understanding. In the population, however, there is a significant variability
in graph literacy (the ability to understand information presented in graphs),
which has been shown to be related to the level of education. A precise
understanding of how people with different levels of education explore
graphs is thus crucial in order to design effective graphs. In an experiment,
we recorded people’s eye movements while they completed a graph literacy
scale (Galesic & Garcia-Retamero, 2009). This scale includes various
questions regarding line plots, bar charts, and pie charts presenting
numerical information regarding the medical domain. The complexity of the
graphs was manipulated by modifying the number of data series displayed
on the same graph, and a set of items was also presented in which important
information (e.g. axes or scale labels) was removed or misplaced. Results
revealed differences in the ways in which participants explored these graphs
as a function of their level of education. These differences were larger for
questions that required inferring information that could not be directly read-
off from the graphs. We discuss the implication of these findings in the
context of current theories of graph comprehension and we highlight
practical implications for the design of graphs to convey medical
information adapted to the user’s needs.
156
FRAMING EFFECTS IN THE COMMUNICATION OF
TREATMENT RISK REDUCTION
Y. Okan1, R. Garcia-Retamero1,2, A. Maldonado1
1
2
Human Development, Berlin, Germany
Many people have difficulties grasping a host of numerical concepts that are
prerequisites for understanding medical risks, including treatment risk
reduction. A prominent example is denominator neglect, or the focus on the
number of treated and non-treated patients who die, without considering the
overall number of treated and non-treated patients. Denominator neglect has
exclusively been studied by presenting information about treatment risk
reduction in negative terms (e.g., the number of patients who die after taking
a treatment). The structure and the content of the health messages, however,
can have a substantial influence on people’s attitudes and behaviors. In a
study, we investigated the effect of denominator neglect when information
was framed both in positive (i.e., number of patients who survive after
taking the treatment) and negative terms. We further investigated whether
denominator neglect can be countered or eliminated by using visual displays
and controlled for participants’ numeracy and graph literacy. Results
showed that the way in which information was framed influenced the effect
of denominator neglect on the perception of treatment risk reduction. We
consider that our findings can have important implications for medical
practice as they suggest suitable ways to communicate quantitative medical
data to patients.
157
GUIDELINES FOR THE USE OF BIOLOGIC DRUGS IN
RHEUMATOID ARTHRITIS AND ITS RATIONAL BASIS IN
SELECTED CENTRAL AND EASTERN EUROPEAN COUNTRIES
E. Orlewska1, I. Ancuta2, B. Anic3, C. Codrenau4, N. Damjanov5,
P. Djukic6, L. Gulácsi7, R. Ionescu8, L. Marinchev9, T. Peets10,
M. Pentek7,11, S. Praprotnik12, R. Rashkov9, J. Skoupa13,
W. Tlustochowicz14, M. Tlustochowicz14, M. Tomsic15, T. Veldi16,
J. Vojinovic17, P. Wiland18
1
Centre for Pharmacoeconomics, Warsaw, Poland, 2Clinical Institute Ion
Catacuzino, Bucharest, Romania, 3Clinical Hospital Zagreb, Zagreb, Croatia
4
Methodical Rheumatology Center, Bucharest, Romania, 5Institut za
Reumatologiju, Beograd, Serbia, 6Consultant for Health Economics and
Management, Beograd, Serbia, 7Health Economics and Health Technology
Assessment Research Centre, Corvinus University of Budapest, Budapest,
Hungary, 8University of Medicine, Saint Maria UMF Carol Davila Hospital,
Bucharest, Romania, 9University Hospital St. Ivan Rilski, Sofia, Bulgaria
10
Department of Rheumatology, East Tallinn Central Hospital, Tallinn,
Estonia, 11Department of Rheumatology, Flór Ferenc County Hospital,
Kistarcsa, Hungary, 12University Medical Centre, Ljubljana, Slovenia
13
Pharma Projects s.r.o., Prague, Czech Republic, 14Military Medical
Institute, Warsaw, Poland, 15University Medical Centre, Ljubljana, Slovenia
16
East Tallin Central Hospital, Tallin, Estonia, 17Klinieki Centar Nis, Nis,
Serbia, 18Medical University of Wroclaw, Poland
Objective: Treatment guidelines are developed to promote consistent access

to effective therapy. The aim of our study was to trace rationales supporting
guidelines for eligibility for biologic therapy in rheumatoid arthritis (RA) in
10 Central and Eastern European (CEE) countries.
Methods: Combination of literature review and direct contact with national
RA stakeholders. From each country information on RA epidemiology, cost,
treatment guidelines were gathered.
Results: DAS28 of over 5.1. and failure of 2 or more disease-modifying
anti-RA drugs (DMARDs), are commonly used eligibility criteria, but there
are exceptions to this rule, e.g. in Estonia failure of combined therapy with
four DMARDs, while in Czech, Hungary and Serbia inefficacy of one
DMARD is required. The minimum time on previous DMARDs varies from
3 months (Hungary) to 6 months for each of two DMARDs (Poland). All
countries declared that health technology assessment (HTA) supports
decision-making in healthcare and has a strong influence on the uptake of
innovative treatments, but there are only few HTA evaluations of biological
treatments in RA (Hungary, Poland) and huge gaps in basic information
needed for HTA. Epidemiological studies have been performed in Czech,
Estonia and Hungary only, data on cost of RA are limited to Hungary and
Serbia, ccountry - specific data on quality of life of RA patients derived
from Hungary only.
Conclusion: Investments need to be made in the collection of relevant data
to ensure that guidelines for the use of biologic drugs in RA in CEE are
based on evidence rather than the financial situation.
158
PRIORITY PREFERENCES CONCERNING MEDICAL
TREATMENT IN ONCOLOGY BY DIFFERENT STAKEHOLDER
GROUPS: AN EXPLORATORY STUDY
M. Otten, M. Schreier, A. Diederich
Jacobs University Bremen, Bremen, Germany
Introduction and Purpose: With recent demographic changes and medical

innovations the costs of health care have been increasing, and a situation has
arisen where all that is medically possible can no longer be financed by the
public health care system. This is especially the case in oncology, with high
mortality rates, increasing morbidity, and especially costly new treatment
options. In this situation, priority setting has become a necessity. In this
study, opinions and decisions of different stakeholders regarding priority
setting in oncology will be explored. The focus will be on the German
public health care system.
Method: 16 semi-structured interviews with different stakeholders (patients,
medical practitioners, nurses, administrative officer, and representative of
health insurance companies) were conducted. The participants were
purposefully sampled for heterogeneity. The interview guide comprised
both non-directional questions and vignettes adapted from oncological
practice. The interviews were fully transcribed and subjected to content
analysis.
Results: The results show some areas where the interviewees’ preferences
converge across stakeholder groups. Many interviewees, for instance,
suggest allocating more funds to palliative care, medication, psychological
counseling, staff, and integrated care. In addition, some stakeholder-specific
preferences also emerge, e.g. only patients suggested that more funds should
be allocated to research, individual support, or psychological counseling for
staff.
Conclusions: Especially the divergences between stakeholders show that it
is necessary to explore opinions and decisions of different stakeholder
groups in developing recommendations or guidelines for priority setting in
oncology.
159
DIFFERENCE-IN-DIFFERENCES AND ORDINARY LEAST
SQUARES METHODS: A STUDY OF THE COVERAGE GAP IN
THE MEDICARE PART D PROGRAM ON STATIN MEDICATION
ADHERENCE
J. Pai1, F. Zeng2, J.M. McCombs1, B.V. Patel2, R.J. Sanchez3
1
USC School of Pharmacy, Los Angeles, CA, USA, 2MedImpact Healthcare
Systems, San Diego, CA, USA, 3Pfizer Inc., New York, NY, USA
Objective: Compare difference-in-differences and standard ordinary least

squares regression methods in estimating the impact of entering the Part D
coverage gap on adherence to statin therapy.
Methods: Pharmacy claims from a national pharmacy benefit management
company were used to identify 26,686 Medicare patients 65 years and older
who used statins and entered the Part D coverage gap (donut hole) in 2008.
Adherence was measured by the proportion of days covered (PDC). A
difference-in-differences (DID) analysis was used to compare adherence
with statin therapy before and after entering the donut hole. The DID
method was compared to an ordinary least squares (OLS) model which used
the change in PDC as the outcome variable.
Results: The two-way fixed affect DID and OLS models gave equivalent
estimates for the effect on adherence of entering the donut hole and the type
of coverage in the donut hole. The restrictive DID assumptions that the
effects of most covariates on compliance were fixed in both pre and post-
donut hole periods were tested and verified by re-entering these variables
into the OLS model. Moreover, adding baseline PDC into the OLS model,
which is not possible in the DID approach, did not significantly alter the
coverage parameter estimates even though baseline PDC was negatively
correlated with the change in PDC.
Conclusion: If patient characteristics have a fixed effect on adherence before
and after entering the donut hole, the DID and OLS models are equivalent.
However, the OLS approach provides more flexibility in model
specification than the DID approach.
160
DECISION-MAKING IN EMERGENCY MEDICINE: DOES
COMPUTER MEDIATED COMMUNICATION FACILITATES A
SHARED SITUATION AWARENESS?
G. Pravettoni, C. Lucchiari, G. Vago
Università degli Studi di Milano, Milano, Italy
This study’s aim was to anlyze decision-making processes in emergency

medicine and the role of shared situation awareness (SA).
We performed systematic non-participant observations during several work
sessions in the emergency departments of two Italian hospitals. We also
collected data through semi-structured interviews of physicians and nurses
after the observations. To understand situation awareness, transcript extracts
that related (positively or negatively) to SA were further analysed.
Our observations showed that information management in emergency
departments is a multifarious task. The information flow is nominally
organized by the physician in charge, who has control of the overall
situation and thus must develope a situation awareness. Nevertheless, many
factors interfere with this process, contributing to a partial or misleading
representation of the situation. In particular, we have analyzed the role of
technological media (electronic data base and computer mediated
communication) in giving rise to and sustaining SA and share SA. Our data
showed that in one ED, electronic media were systematically used, and
situation awareness was easily and rapidly constructed by the physician in
charge. Conversely, in the second ED computer assisted data managment
was only marginal, with reliance on human memory instead of recording
devices. However, the systematic use of electronic media interferred with
intra-staff communcation, limiting a actually shared SA.
In conclusion, a balance between computer mediated communication and
face to face communication need to be found. Clinical workers’ mental
models and situation awareness arise in physical spaces, which features may
support or limit cognitive and communication processes.
161
THE ECONOMIC BURDEN OF MENTAL ILLNESS IN FRANCE
K. Chevreul1, A. Prigent1, A. Bourmaud1, M. Leboyer2, I. Durand-Zaleski1
1
URC Eco Ile-de-France (AP-HP), Créteil, France, 2Fondation
FondaMental, Créteil, France
Mental illness represents a large burden for society in terms of prevalence,

affecting more than 25% of the population at some point during their life. In
order to better understand the economic burden of mental illness in France,
we undertook a study to estimate the cost of mental illness in 2007
regarding four dimensions: cost for the health care system; cost for social
services; cost of productivity loss; cost of quality of life loss.
Health care and social services costs were calculated using a top-down
approach based on data issued from national health accounts and social
services expenditure. A share of these was attributed to mental health using
information from data sources on health care and social services
consumption by diagnoses. Cost of quality of life losses used prevalence and
national survey data on quality of life. Losses of productivity were estimated
through sickness leaves, disability and unemployment figures based on the
French mean wage. Health care cost was €13.4 billion which represents
8.2% of total health expenditures, twice as much as social services cost that
was €6.3 billion. Altogether, the cost of mental illness was estimated at
€109.2 billion of which productivity losses represented €24.4 billion
(22.3%) and quality of life losses €65.1 billion (59.6%). Within these costs,
one-fifth represented formal costs borne by public expenditure, while four-
fifths are informal costs, incurred by individuals, their relatives or society.
Measures to diminish the burden of mental illness by investing in health are
very likely to have a positive economic impact.
162
PRACTICE INNOVATIONS IN PSYCHIATRY: ESTIMATION OF
OUTPUTS USING PATIENTS’ QUALITY OF LIFE
A. Prigent1,2, S. Simon1,2, K. Chevreul1,2
1
URC Eco Ile-de-France, Université Paris 12, Paris, France, 2Fondation
FondaMental, Paris, France
Most of the mental illnesses are chronic and disabling diseases. Therefore,
estimating the patients’ quality of life appears to be the main way to
evaluate the burden of mental health as well as the impact of new practices
and health care organizations in psychiatry. The aim of this study is to
estimate the quality of life of outpatients and inpatients according to their
pathologies in France.
Quality of life was estimated for patients living at home based on a national
household survey including the administration of the SF-36 scale.
Furthermore, we estimate the quality of life of patients in psychiatric
hospitals through a field study using generic Quality of Life instruments
(SF-36 and EQ-5D), summarised as single scores through the utility theory.
Then, we analyse the level of quality of life among types of care and
pathologies by matching the quality of life scores obtained with data
extracted from institutions’ information systems (diagnosis, severity,
interventions undertaken).
The first results highlight an important burden due to mental health
conditions as a whole, with 30% of quality of life lost compared to people
free of mental illness. Differences among pathology groups and between
types of care and structures are expected.
These results will serve as a baseline of the situation in France. They will
facilitate the identification of areas where positive outputs are achieved.
Further, they could allow recommending specific interventions or allocation
of resources to certain care settings or diseases on a basis of needs.
163
EFFECTIVENESS OF SHORT MESSAGING SERVICE
OF CRITICALLY APPRAISED TOPIC CONCLUSIONS
AS A CONTINUING MEDICAL EDUCATION STRATEGY
G.Z. Racaza, L.M. Palileo, A.L. Dans, R.N. Delgado
Department of Medicine, Philippine General Hospital, Manila,
The Philippines
Background: Doctors in third world countries find it arduous to keep abreast

medical advances. Short Messaging Service (SMS) or text message is cheap
and highly accessible information delivery means through mobile phones.
Objectives: To determine:
- effectiveness of SMS in increasing knowledge and changing prescription
practices of physicians
- physicians’ perceived usefulness of information.
Methods: A before and after study was conducted among 60 Medicine
residents of the Philippine General Hospital. The ALLHAT trial was
critically appraised after performing a systematic search. Conclusions
favoring diuretics were sent via SMS to all residents twice, 10 weeks apart.
Prescription-recording for 2 weeks was done before, 2 and 4 weeks after the
first SMS, and 2 weeks after the second SMS. Knowledge gain was
assessed through pre- and post-tests. Questionnaires determined perceived
usefulness and acceptability. Number of residents who requested access to
full article was recorded.
Results: There were statistically insignificant increases in diuretic
prescription from baseline of 23% to 28% and 30% after the first and second
SMS, respectively.
There was increase in knowledge scores for 3 out of 4 questions; 2 were
statistically significant.
Most respondents (92%) perceived the SMS useful and 45% claimed it
changed their prescription practice. Half read the article’s appraisal after
receiving the SMS. Everyone wanted to receive SMS of CAT conclusions.
Conclusions: SMS can be effective in improving physicians’ knowledge.
All desired to receive it. SMS seems to effect change in practice among
physicians, however this should be tested in larger trials to reach statistical
significance.
164
POTENTIAL NUMBER OF FATAL AND NON FATAL INJURIES
AVOIDED THANKS TO THE INTRODUCTION OF THE 50 MG/100
ML BAC LAW IN ENGLAND AND WALES
R. Rafia, A. Brennan, A. Killoran
University of Sheffield, Sheffield, UK
Objective: This study aimed at estimating what impact lowering the Blood
Alcohol Concentration (BAC) limit to 50 mg/100 ml would have on the
number of alcohol-related deaths and injuries in England and Wales.
Method: A model was developed, using the best evidence identified during
the systematic review. The bulk of the modelling work employed an indirect
approach to model a shift in the BAC distribution among drivers which may
translate into savings in fatal or non fatal casualties. Benefits to other road
users were extrapolated from benefits observed among drivers. There was
limited evidence on the pattern of drink-driving in the UK, as measured by
BAC levels among the driving population. There was also a lack of UK
evidence on how reducing the legal limit might change drink-driving
behaviour. Consequently, unknown parameters had to be calibrated or
estimated from the international literature.
Results: Assuming the policy produces the same relative effect on the BAC
distribution as observed in Australia, 144 (303) deaths and 2,929 (6,423)
injuries were estimated to be avoidable after one (six) year(s). A set of
sensitivity analysis was also conducted and showed that results were
sensitive to the method used to model the ongoing shift in the BAC
distribution without policy or the effectiveness of the policy.
Conclusion: Given uncertainties related to the data and assumptions used in
the modelling, estimates should be interpreted with caution. However, this
study confirms that considerable benefits could be achieved by lowering the
legal BAC limit in England and Wales.
165
RELATIVE IMPORTANCE OF EQ-5D DIMENSIONS IN
EXPERIENCED AND HYPOTHETICAL HEALTH VALUATIONS
K. Rand-Hendriksen1, 2, L.A. Augestad1, I.S. Kristiansen3,
K. Stavem1, 4, 5
1
Health Services Research Centre, Akershus University Hospital,
Lørenskog, Norway, 2Institute of Psychology, University of Oslo, Oslo,
Norway, 3Institute of Health Management and Health Economics,
University of Oslo, Oslo, Norway,4Department of Pulmonary Medicine,
Akershus University Hospital, Lørenskog, Norway, 5Medical Faculty,
Faculty Division, Akershus University Hospital, University of Oslo,
Lørenskog, Norway
Background: EQ-5D tariffs are typically based on general population

valuations studies, but it is disputed whether valuation of experienced or
hypothetical health is more appropriate. The relative importance attributed
to the 5 dimensions is likely to influence resource allocation between
different health care programs (for instance, high importance for the
pain/discomfort dimension means more QALYs gained by pain relief, at the
expense of other programs). Previous comparisons have focused primarily
on absolute differences in dimension-specific regression coefficients. This
study examined differences in the relative weights of EQ-5D dimensions in
hypothetical and experienced valuations.
Methods: We used several regression models on self-ratings (VAS) from the
Medical Expenditure Panel Survey (MEPS) from 2000-2003 and ratings of
hypothetical states (VAS and TTO) from the US EQ-5D valuation study in
2001. We compared the patterns of relative magnitudes of coefficients
corresponding to the 5 dimensions.
Results: As compared to experienced health (range .71, 1.44), hypothetical
valuations displayed relatively small differences in dimension importance
(range .83, 1.1), with usual activities having the smallest regression
coefficients of the 5 dimensions. In MEPS valuations, usual activities had
roughly twice the weight of mobility and self care. Coefficients capturing
“discounts” in utility loss by multiple dimensions of imperfect health were
larger in hypothetical valuations than experienced health.
Discussion: This contradicts previous comparisons focusing on absolute
differences (Mann, R. et al. 2009), and indicate that usual activities is the
most important dimension for experienced HRQoL. Thus, use of general
population tariffs may result in disadvantageous deprioritization of
rehabilitation programs.
166
SYSTEMATIC ASSESSMENT OF DECISION MODELS IN
CHRONIC MYELOID LEUKEMIA
U. Rochau1,2 , R. Schwarzer1,2 , G. Sroczynski1,2 , B. Jahn1,2 , D. Wolf3 ,
G. Gastl3 , U. Siebert1,2,4,5
1
Assessment, UMIT - University for Health Sciences, Medical Informatics
and Technology, Hall i.T., Austria, 2 Oncotyrol - Center for Personalized
Cancer Medicine, Innsbruck, Austria, 3 Internal Medicine V, Haematology
and Oncology, Medical University Innsbruck, Austria, 4 Center for Health
Decision Science, Department of Health Policy and Management, Harvard
School of Public Health, Boston, MA, USA, 5 Institute for Technology
Assessment and Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, USA
Objectives: To provide an overview on published decision-analytic models

evaluating various treatment strategies in chronic myeloid leukemia (CML).
We sought to describe and analyze the structural and methodological
approaches used and to derive recommendations for future CML models.
Methods: We performed a systematic literature review in electronic
databases (Medline/PreMedline, EMBASE, and others) to identify
published studies evaluating CML treatment strategies using mathematical
decision models. The models were required to compare different treatment
strategies and to comprise relevant clinical health outcomes such as life-
years gained or QALYs over a defined time horizon and population. We
used standardized forms for data extraction, description of study design,
methodological framework, and data sources.
Results: We identified 15 studies among which 14 included economic
evaluations. The modeling approaches varied substantially and comprised
decision trees, Markov models, Monte Carlo simulations, and mathematical
equations. Time horizons ranged from two years to lifetime. Health
outcomes included survival, life expectancy, and QALYs. Compared
treatment strategies comprised bone or blood marrow transplantation,
conventional chemotherapy, interferon-alpha, and first generation tyrosine
kinase inhibitor (TKI) imatinib. None of the models evaluated
comprehensive personalized medicine strategies or second generation TKI
(e.g., nilotinib, dasatinib). Only few models were validated using
independent data.
Conclusions: We found several well-designed models for different CML
treatment strategies. However, the quality of reporting varied substantially.
We recommend that future models should include novel treatment options,
subgroup evaluations for a more personalized decision making, and
validation using independent data. Already available models with a short
time horizon could be up-dated with new survival data.
167
DO FAMILY DOCTORS AND THEIR PATIENTS DISCUSS THE
TREATMENT OPTIONS? A STUDY ON BEHAVIORS
ASSESSMENT AND PATIENT PERCEPTION
R. Ruiz-Moral1, L.A. Pérula de Torres1, L. Peralta Munguía2,
A. Alba Dios1, M. Martínez3, M.T. Carrión4
1
Cordoba Family Medicine Vocational Training Unit and Department of
Medicine, Cordoba School of Medicine, Spain, 2Cantabria Health Service,
Primary Care Department, Spain, 3Jaen Family Medicine Vocational
Training Unit, Spain, 4Málaga Family Medicine Vocational Training
Unit, Spain
Objectives: To explore patient participation and their perception of the

proposals for action in primary health care consultations. To know how
some particular aspects of the consultation may influence physicians to
foster this kind of participation.
Design. Cross-sectional study. Setting. 97 general practices. Patients. 658
patients attending their doctors for unselected reasons. Measurements. All
the encounters were videoed, patient participation in decision-making (DM)
was assessed by a rater with two tools. After the consultation patients filled
in one questionnaire exploring their preferences and perception of
participation.
Results: encounters were successfully videoed: 638. Out of these, only 90
interviews clearly showed patient participation. In other 161 interviews
patient participation was considered possible. In 60% of the situations (390
encounters), patients wished they could have stated their views about the
proposed option(s), but they perceived this did not happen. In 235 (almost
60%) out of these 390 encounters with such patients the external evaluation
of the consultation did not show any participation, either. These patients
were younger and better educated than the rest.
Conclusions: GPs ask patients for their opinion and promote discussion
about the suggested plan very infrequently. Patients perceive this, especially
those who wish to share decisions with their doctors, and therefore, there is
an important mismatch between what they wish and they perceive. Doctors
should bear this in mind and should at least invite their patients to contribute
their opinions when suggesting any action plans.
168
COMPARISION OF PATIENTS’ AND PHYSICIANS’ VIEWS ON
THE DECISION MAKING PROCESS IN MEDICAL ENCOUNTERS
I. Scholl, L. Kriston, J. Dirmaier, M. Härter
Department of Medical Psychology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
Background: The interaction of physician and patient is one of the basic

requirements for shared decision making in medical encounters. However,
little research examines and compares physicians’ and patients’ perceptions
of the decision making process. The aim of the present study is to
investigate the interrelation of patients’ and physicians’ views on decision
making in medical encounters.
Methods: In a current study, patients’ and physicians’ views of the decision
making process in N=312 outpatient medical encounters are assessed with
the 9-item Shared Decision-Making Questionnaire [1] (patient and physician
versions; SDM-Q-9 and SDM-Q-Doc). Spearman correlation coefficients
are calculated.
Preliminary Results: At present, 54 consultations have been rated by 4
physicians and 54 patients. Analyses of this first data indicate a moderate
correlation (Spearman r=.41, P=.003) between physicians’ and patients’
overall rating of the decision making process. Final results including
correlations of single items will be presented and discussed at the
conference.
Conclusions: These first results indicate a certain agreement of physicians
and patients on how they perceive the decision making process in the
consultation. However, this result also shows that there is a certain
discrepancy between both participants’ views. Further research is necessary
to clarify these results.
169
SYSTEMATIC CLINICAL PRACTICE GUIDELINE ANALYSES TO
ASSIST POLITICAL DECISION-MAKERS IN THEIR
DECISION-MAKING
U. Siering, M. Eikermann, C. Bartel, W. Hoffmann, N. Holzmann,
A. Ruether
Institute for Quality and Efficiency in Health Care (IQWiG), Cologne,
Germany
Background: Clinical practice guidelines (CPGs) are systematically-

developed decision aids for service providers and patients on appropriate
methods for specific health problems. Besides their use in clinical decision-
making, they can also be used for health policy decisions.
Aim: Using the report types for “DMP updating” and “Topic searches and
prioritization for quality assurance measures (QAM)” as an example, we
presented IQWiG’s methods for developing systematic CPG analyses
showing how the latter are used in assisting political decision-makers in
making decisions.
Methods: CPG analyses were based on a systematic search for current
evidence-based CPGs (German/English) in CPG and bibliographic
databases. After assessing the methodological quality of the CPGs, their
recommendations were extracted using a standardized procedure. By
comparing the CPG recommendations, care standards are then identified
across the whole care chain. To identify the potential need for DMP
updating, the identified care standards were compared with DMP
recommendations (report type 1). For topic search and prioritization for
QAM, the identified care standards were supplemented by additional
information (for example, from systematic reviews, structural and care data)
(report type 2).
Results: Report type 1: By comparing care standards with clinical DMP
specifications, it was systematically possible to identify aspects of the DMP
that required supplementing. Appropriate changes were discussed by the
political decision-makers and partially adopted.
Report type 2: On the basis of these reports for QAM, 2 out of 4 topics were
prioritized by the decision-making body and given as commissions.
Conclusions: CPG analyses are a viable way of assisting political decision-
makers in decision-making. There are methodological challenges in, for
instance, the optimization of the CPG search, the debate over transferability
of international CPG recommendations, and the evaluation of the content
quality of individual CPG recommendations.
170
COMPARING DIFFERENT HEALTH STATUS VALUATION
METHODS: HOW CAN WE TEST WHETHER COVARIATES
IMPACT THE STRUCTURAL RELATIONSHIP?
B. Stollenwerk1, R. Leidl1,2, R. Stark1, H.H. König3, R. Holle1
1
Helmholtz Zentrum München (GmbH), Institute of Health Economics and
Health Care Management, Neuherberg, Germany, 2Institute of Health
Economics and Management, Ludwig-Maximilians-University Munich,
Munich, Germany, 3Department of Psychiatry, Health Economics Research
Unit, University of Leipzig, Leipzig, Germany
Background: Valuing health status on the basis of preferences is a key issue

in economic evaluation. Several authors have analyzed whether and how
covariates (e.g., socio-demographic factors) impact the relationship between
valuation methods, but an effective method remains to be developed.
Objective: To compare patient and population based valuations by different
statistical approaches including a new proposal.
Methods: We characterise the relationship between two valuation methods
as a one-to-one mapping between their expected values. The aim is to test,
whether differences in covariates lead to an up- or down-shift of this
mapping. One way to perform such tests is to calculate a comparative
measure (e.g., the difference) between both measured values and to use it as
dependent variable within a regression analysis. However, bias may occur,
especially if corresponding covariates are associated with health status. To
investigate the practical relevance of this kind of bias we apply different
comparative measures and compare which covariates are identified as
significant. Furthermore, we present a more flexible procedure as an
alternative: performing an errors-in-variables regression on the logit scale
with covariates included in the regression equation. Methods discussed are
applied to a real data example. Patient values result from the EQ-VAS,
population values from the Greiner EQ-5D index.
Results: The choice of comparative measure has a strong impact on which
covariates are found to influence the relationship between both valuation
methods. Since none of the one-to-one mappings implied by the regarded
comparative measures sufficiently fits the data, the errors-in-variables
approach on the logit scale seems to be more appropriate.
Conclusion: The errors-in-variables approach on the logit scale seems to be
the most appropriate method to identify covariates that impact the
relationship between the patient and population-based method of valuing
health status.
171
WILL TIME TELL? – FEASIBLITY OF A NEW APPROACH FOR
ASSESSING THE VALUE OF FURTHER RESEARCH IN A
MULTI-TREATMENT, INFORMATION VALUE ORIENTED AND
INFORMATION ACCRUING ENVIRONMENT
P. Storz
GKV-Spitzenverband, Berlin, Germany
Background: Temporary reimbursement arrangements when additional

evidence is expected currently attract attention to possibly overcome
"stalemates" in reimbursement decisions. To what degree will research "as
is", in time, lead to sufficient evidence? Matters are complicated in the
presence of multiple treatment options, the time needed to generate evidence
and the need for a reliable criterion of the value expected from further
research. Methods: Retrospective, cumulative meta-analysis for relevant
outcomes are conducted employing a mixed-treatment comparison (MTC)
approach. MTC-analysis are cumulatively conducted for discrete time points
(whenever the evidence base has changed) and the development of results
over time is observed. The criterion of the probability of a particular
treatment being best at a particular time is used to compute the "expected
value of further information". For each time point the contribution of
subsequent trials to its change is assessed. Results: Results from exploratory
analysis suggest shortcomings of actual research "as is", e.g. comparisons
actually investigated might not address most relevant questions. It is also,
however, revealed that the relevance of subsequently conducted research
might depend on the perspective of those conducting and funding trials.
Discussion: The method seems useful as a "diagnostic" tool to assess
research endeavors over time. Results suggest that relying too much on a
"time will tell" approach might not be warranted. Due to a number of
limitations (retrospection, single outcome, limited sample), it is, however,
unclear if this "diagnostic" capacity will also contribute to better "outcomes"
for the healthcare system-patient. Further research is, as always, needed.
172
JUDGEMENT STRATEGIES IN THE DIAGNOSIS OF POSSIBLE
PNEUMONIA
T.G. Tape, B. Mirivosky, D. Nickol, R.S. Wigton
University of Nebraska Medical Center College of Medicine, Omaha,
Nebraska, NE, USA
Conventional judgment analysis assumes simultaneous weighting of

multiple cues. Judgment may be better, however, in conditions of partial
ignorance using only a few best cues in sequence (fast and frugal). We
studied 26 medical students and physicians who judged the probability of
pneumonia from a series of 20 clinical vignettes by selecting cues to view,
one-at-a-time, from a total of 16. After each selection, the subject estimated
the likelihood of pneumonia before selecting another cue. We instructed
subjects to select cues in the order of importance and to select no more than
necessary to make a diagnosis. We analyzed how probability estimates
changed over the series of cue selections and how well the estimates
correlated with probabilities computed from a 5-cue validated clinical
decision rule. A best-cue strategy should use few cues and achieve accuracy
comparable to complete cue utilization. Also, probability estimates should
be stable if additional cues are considered beyond the best.
Subjects selected a median of 9 cues per vignette (IQR: 7-11). Estimates
made after the first cue selection differed from subjects’ final estimates by
an average of 23 percentage points. This gap declined in a roughly linear
fashion as more cues were considered, suggesting equal weighting of cues.
Judgment accuracy after the fifth selected cue was only 0.10 and did not
reach its maximal level of 0.27 until the 10th cue. Thus, subjects’ strategy
was more consistent with equal weighting of multiple cues than with the
best-cue approach that they were instructed to use.
173
FACTORIAL SURVEY OF PROFESSIONAL JUDGEMENTS ON
RECOGNISING AND REPORTING ELDER ABUSE
B.J. Taylor1, C. Killick2
1
University of Ulster, Northern Ireland, UK, 2South Eastern Health and
Social Care Trust, Northern Ireland, UK
Policy guidelines in the UK require the standardisation of services to protect

vulnerable adults from abuse. However the concepts of abuse and
vulnerability are ambiguous. Little is understood about the factors
influencing professionals to identify possible abuse and report this for
investigation.
A systematic review and a panel of experienced professionals were used to
identify factors that might influence professional recognition and reporting
of elder abuse. Twelve factors with between two and five levels were
incorporated into a questionnaire that included 12 randomised vignettes in a
factorial survey design and six standard vignettes to test for variance and
reliability. Based on a census, data were collected from 190 social workers,
nurses and other professional care managers providing community care to
older people across Northern Ireland giving responses to 2261 randomised
vignettes. Regression analysis using proportion of variance explained (R2)
provided a measure of the impact of each independent variable on
judgements about recognition and reporting.
Recognition and reporting were influenced by case factors specific to the
abuse (frequency, type and victim wishes) but not by contextual case factors
(age, gender, condition). While there was consistency in recognition and
referring in extreme cases, there was disparity in more ambiguous vignettes.
The majority of respondents provided identical ratings on recognition and
reporting scales but a sizable minority differentiated between these.
The factorial survey proved a useful design to study decision policies of this
class of decision makers because the large number and levels of factors in
the vignettes give high external validity.
174
DISTANCE DEPENDENCE ON THE WILLINGNESS OF PATIENTS
TO PARTICIPATE IN AMBULATORY HEART REHABILITATION
PROGRAMS
C. Urach1, F. Miksch1, N. Popper1, G. Zauner1, F. Breitenecker2,
I. Wilbacher3
1
dwh Simulation Services, Vienna University of Technology, Vienna
Austria, 2Vienna University of Technology, Institute for Analysis and
Scientific Computing, Vienna, Austria, 3Evidence Based Economic
Healthcare, Main Association of Austrian Social Insurance Institutions,
Vienna, Austria
After a myocardial infarct and its initial treatment in hospital people in

Austria can participate in an ambulatory rehabilitation program. There are
only thirteen locations where this rehabilitation program is carried out.
Patients have to travel to the hospital for every single session. We want to
visualize the correlation between the distances of the patient’s home to the
hospital and their willingness to take part in the rehabilitation program.
We received a database with all myocardial infarct patients who participated
in the so called AGAKAR or ZAR program. As not all of the patients attend
the full rehabilitation program, which has two parts, we reduced the
examined datasets to those who took part in the ambulatory phase. We
calculated the actual distances of the patients from the hospitals from their
postal codes. For each ambulatory we examined the number of patients in
certain radiuses as well as the quantiles. Postal codes provide a discrete
fragmentation of Austria. Therefore the calculated distances are not exact
but averages for all patients in one postal code area and we investigated
whether this discretization has an influence on our results.
To get a better view of the outcomes we visualized them on several maps.
The threshold distance where the furthest away patients come from is about
one hundred kilometer. In general people’s willingness to participate in the
rehabilitation program is decreasing drastically as soon as they are more
than twenty kilometers away from the out carrying ambulatory.
175
DEALING WITH HEALTH CARE DATA OF THE AUSTRIAN
SOCIAL SECURITY SYSTEM
F. Breitenecker3, F. Miksch1, N. Popper1, C. Urach1, A. Weisser2
1
dwh Simulation Services, 2Evidence Based Economic Healthcare, Main
Association of Austrian Social Insurance Institutions, 3Vienna University of
Austria
Introduction: Austria’s public expenses for health care are constitute over
ten percent of the gross domestic product and so the financial situation of
the social security system is a matter of both public and political interest.
Evaluating costs, efficiency and quality of the health insurance system
requires analysis of existing data.
Concepts: Information about treatments and expenses for prescriptions is
stored in different databases with different granularity and details by every
single of the nineteen Sickness funds. Several problems occur when
researchers need to gather data from different sources. We are going to
display such common problems, categorize them and propose strategies how
to deal with them.
The fist category contains problems with missing data. The task is to find
out the reason for the empty fields and if the affected datasets shall remain
in the database.
The second category describes wrong data. One has to decide whether the
wrong information can be corrected, has to be deleted shall be left
unchanged.
The third category contains structural problems and incompatibilities.
Existing data structures have to be normalized, then compared and
converted into an appropriate level of aggregation until it is possible to
connect datasets from different sources.
The fourth category describes content incompatibilities and formatting
problems. This category contains several small issues like different
encoding for the same information, incompatible character sets and missing
standards for naming rules.
Conclusion: The presented concepts provide an approach for structural and
efficient work with data from the Austrian social security system.
176
BIASES IN SECOND-OPINION CONSULTATIONS
G. Vashitz, N. Davidovitch, J. Pliskin
Ben-Gurion University of the Negev, Beer Sheba, Israel
Background: Discrepancies in diagnosis, treatment or prognosis may

emerge among physicians. A known decision-making bias is the tendency to
shift personal opinion either towards or away from a previous opinion. We
sought to evaluate such biases in the context of second-opinion medical
consultations.
Methods: We distributed questionnaires to a nationwide sample of
orthopedic surgeons and neurologists. The questionnaires presented eight
scenarios, each with conventional treatment options with no clear-cut
preference. In four scenarios the physicians were told that a previous
opinion had already been given by another physician, or that a second-
opinion will be given, and the other four scenarios were used as controls.
The physicians' responses were coded according to the level of intervention
(conservative to interventional).
Results: 172 orthopedic surgeons and 160 neurologists filled out the
questionnaires, which represent about 50% of these specialties in Israel. In
the orthopedic questionnaire, when a first opinion had already been given,
there was a shift towards a more interventionist treatment (p<0.05). This
was especially prominent when the first opinion was known to the second
physician. When the patient intended to seek a second-opinion, there was a
shift towards a more conservative treatment. No such effect was found
among neurologists.
Conclusions: A physician's judgment may be affected by another
physician’s opinion (compared to their choices without a first opinion). This
bias mainly tends towards a more interventionist treatment. Due to the
immense impact of any decision on patient health and resource use, further
research should address such biases and develop tools to address them.
177
FAILURE TO ACCUMULATE PERCEIVED CARDIOVASCULAR
RISKS AND DENIAL OF SOLIDARITY: A VIGNETTE STUDY
AMONG THE AUSTRIAN PUBLIC
W. Wiedermann1,2, O. Kada1, J. Rehm3,4,5, U. Frick1,6
1
Carinthia University of Applied Sciences, School of Health and Care,
Feldkirchen, Austria, 2University of Klagenfurt, Department of Psychology,
Klagenfurt, Austria, 3University of Toronto, Dalla Lana School of Public
Health, Toronto, Canada, 4Center for Addiction and Mental Health, Toronto,
Canada, 5TU Dresden, Dresden, Germany, 6Psychiatric University Hospital,
University of Regensburg, Germany
Little is known about how multiple risk factors jointly affect the perception
of cardiovascular risks. Vignette techniques were used to investigate how
risk behaviors (smoking, heavy episodic drinking, obesity) and
uncontrollable risk factors (work-related stress, genetic predisposition),
alone and in combination, affect the perceived likelihood of a major
cardiovascular event (either myocardial infarction or stroke). Additionally,
we explored whether these factors provoke a denial of solidarity
(operationalized via willingness to impose an increased risk premium on a
person). A random sample from the general population (n= 265) was
presented one vignette of an incomplete 5+2 factorial design during a
telephone interview. If risk factors were presented alone, participants highly
overestimated the likelihood of a major cardiovascular event, but displayed
a close solidarity with the described person of the vignette. If two risk
factors were given simultaneously (“genetic predisposition and obesity”,
“heavy episodic drinking and work-related stress”), the subjective
probability of incidence declined. Probands erroneously assumed a
compensative effect especially if binge drinking was perceived as a kind of
self medication. If “genetic predisposition” was combined with the
modifiable risk factor “obesity” a high odds ratio in favor of increasing
health insurance premiums could be observed (OR = 7.3; 95% CI: 1.75–
30.50). This might be seen as an adverse effect of unwarily promoting
concepts of individual responsibility towards health perfection and
“healthism”. Future health promotion campaigns may better communicate
the cumulative nature of multiple risk factors to eliminate health myths such
as “beneficial binge-drinking” and might be aware of potential unintended
effects of intolerance and decreasing solidarity.
178
HOW DO COMMUNITY PRACTITIONERS DIAGNOSE AND
TREAT ACUTE RESPIRATORY INFECTIONS? A CASE WHERE
CUE INTERACTIONS MATTER
R.S. Wigton1, C.A. Darr2, K.K. Corbett3, D. Nickol1, R. Gonzales4
1
University of Nebraska Medical Center College of Medicine, Omaha,
Nebraska, NE, USA, 2University of Colorado at Denver, CO, USA,
3
Simon Fraser University Burnaby, BC, Canada, 4University of California
San Francisco, CA, USA
In studies of physicians’ weighting of clinical cues (judgment analysis), cue

interactions are often not reported. Based on previous studies and interviews
with clinicians, we hypothesized that cue interactions may be important in
clinicians’ judgments. Thus, in this study of how community practitioners
diagnose and treat acute respiratory tract infection (ARI), we paid special
attention to all first order interactions among clinical factors.
We presented 101 community practitioners with 20 case vignettes of
possible ARI. and asked them to estimate the likelihood of each of 4 clinical
diagnoses (viral ARI, pneumonia, bronchitis, strep throat), to indicate how
likely they were to start antibiotics and whether the illness was bacterial in
each case For each practitioner we identified the cue or interaction of cues
that received the greatest weight in making these judgments. We found that
in the decision to prescribe antibiotics, cue interactions outweighed main
effects for 38% of the practitioners. In diagnosing the cause of the illness,
interactions outweighed the main effects for 50-60% of practitioners. The
interaction of temperature and duration of illness was particularly strong and
dominated in many cases. Thus, interactions effects may play an important
role in experienced clinicians’ judgments and should not be ignored.
179
CONTROVERSIAL PRIORITY PREFERENCES OF DIFFERENT
SOCIAL STATUS GROUPS
J. Winkelhage, A. Diederich, M. Schreier
Jacobs University Bremen gGmbh, Bremen, Germany
Introduction: Like many countries of the OECD, Germany is confronted

with an increasing demand for health care services. However, the question
arises whether it is possible to develop criteria for priority setting in
medicine which will be accepted by the whole population. This presentation
focuses on identifying possible conflicts between medical laypersons
differing in social status regarding their priority preferences.
Methods: A conjoint analysis was conducted. Each of the 120 participants
received 16 cards describing hypothetical patients by the following
attributes: ‘age’, ‘lifestyle’, ‘type of illness’, ‘severity of illness’,
‘improvement of state of health’, and ‘treatment costs’. The participants’
task was to rank order these patient profiles by priority of treatment.
Using SPSS 17.0 the part worth utilities and relative importance of the
attributes was calculated with the participants’ social status as covariate as
measured by educational background.
Results: The attributes ‘age’, ‘severity of illness’ and ‘improvement of state
of health’ received the highest weights. There were statistically significant
differences between the weighting of some attributes between social status
groups. For instance, older patients were less preferred by participants with
higher as compared to lower education.
Conclusion: Social status groups differ in their preferences regarding
medical supply. Therefore it will be difficult to develop criteria for priority
setting in medicine which will be accepted by the whole population.
180
METHODOLOGICAL PROBLEMS IN CAUSAL INTERPRETATION OF
RETROSPECTIVE DATABASE ANALYSIS – FINDING FACTORS OF
TEMPORARY WORK DISABILITY IN THE SWISS INFLAMMATORY
BOWEL DISEASE STUDY
J. Wurm1, R. Matteucci Gothe1, M. Arvandi1, M. Sagmeister2, U. Siebert1,2,3
1
Assessment – UMIT - University for Health Sciences, Medical Informatics and
Technology, Hall i.T., Austria, 2Kantonsspital, St. Gallen, Switzerland
3
Institute for Technology Assessment and Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA, 4Center for Health
Decision Science, Department of Health Policy and Management, Harvard School
of Public Health, Boston, MA, USA
Purpose: Inflammatory bowel disease (IBD) is a group of inflammatory

conditions of the colon and small intestine. It can affect any part of the
gastrointestinal tract and might lead to a loss of quality of life, and subsequently
to temporary work disability. The goal of this work is (i) to quantify the burden
of temporary disease-specific disability in patients with IBD and to identify and
quantify predictors for temporary disease-specific disability in patients with
IBD and (ii) to identify and discuss methodological problems related to
retrospective database analysis.
Methods: Data were taken from the Swiss IBD cohort study which started in
2003 and was extended to all of Switzerland in 2006, including six major IBD
university centres. A total of 1187 patients were enrolled and followed up
annually. Data were collected through questionnaires for both patients and
physicians. Among all patients analyzed, 699 had Crohn’s disease and 488
ulcerative colitis. Risk factors and predictors of temporary work disability were
analysed through the use of a binary logistic regression model. For the analysis
of temporary disability, patients who reported at least one day of absence were
counted as temporary disabled. Predictor variables consisted of patient
characteristics (e.g., age, sex), disease characteristics (e.g., disease activity,
location, time from symptoms/diagnosis) and use of medication (e.g., steroids,
biologicals [etanercept, infliximab, adalimumab]). Variables of interest were
chosen through expert interviews and review of relevant literature. Most of the
variables used were taken from the same point in time as the outcome variable,
which is a major limitation. Sensitivity analyses were performed for different
assumptions on causal relationships. Statistical significance was tested through
likelihood-ratio test and Wald test. Significance level was set at p<0.05. All
analyses were performed with SAS/STAT statistical analysis software.
Results: Among all patients suffering from Crohn’s disease, 19.3 % were
absent from work at least once. For ulcerative colitis the figure is 21.3 %. In
patients with Crohn’s disease temporary disability is significantly influenced by
the disease activity (OR: 3.10; 95%CI 1.48-6.48). In patients with ulcerative
colitis, steroids (OR: 4.82; 95%CI 2.49-9.31), biologicals (OR: 2.75; 95%CI
0.97-7.80) and the disease activity (OR: 6.02; 95%CI 2.54-14.26) did have an
effect on the temporary disability. Results and sensitivity analysis will be
presented and discussed.
Conclusion: There is a substantial burden of illness regarding IBD specific
temporary disability. Multiple predictors for days-off could be identified,
though there are only a few predictors for binary outcomes. These are disease
activity and the use of steroids. Next steps might be the calculation of
predictive scores for disability and the calculation of indirect costs due to
temporary working disability.
181
PROSTATA SPECIFIC ANTIGEN DOUBLING TIME AND TUMOR
DETECTION PROBABILITY MODELS USING MATHEMATICAL
CONCEPTS
N. Popper1, G. Zauner1, F. Breitenecker2, A. Ponholzer3
1
DWH Simulation Services, 2Vienna University of Technology, Institute for
Analysis and Scientific Computing, 3Department of Urology and
Andrology, Donauspital Langobardenstraße, Vienna, Austria
Task I: The prostate-specific antigen (PSA) is a protein produced by the

prostate gland. The blood concentration of PSA can easily be measured by a
simple blood test and gives a significant value for tumor activity. The time
sequence of this value can be used to define the time interval between
physicals using a mathematical nonlinear interpolation model.
Task II: Furthermore, to see whether a patient has prostate cancer or not,
samples are taken via a needle out of the prostate gland. The stitches are
done evenly distributed over the whole volume of the prostate gland. The
only possibility to reach the prostate gland is via the colon.
To define the minimal number of stitches necessary to get reliable results
depending on the geometry of the prostate of each patient a mathematical
model is introduced.
All calculations are done with numerical randomly taken out test cylinders
of the whole volume; as the results can not be calculated with Buffon’s Nail
Principle we have to compare the tested volumes with both, the total volume
of the prostate gland and the reachable volume.
Results: For Task I the results are doubling time intervals of the PSA value.
The models in Task II are used to calculate the testable area (note that not
the whole prostate can be tested because the probe needle is not long
enough), and the probabilities to detect a tumor in the tested area and in the
whole area dependent on the number of stitches taken.
182
INDEX
183
184
Program Abstract Program Abstract
Page Page Page Page
A Breitenecker, F. 10,12,23 47,48,58

Aarseth, H.P. 26 155 25,26,28 124,149
Aasland, O.G. 24 131 29 150,175
Aidelsburger, P. 10,21 46,49,99 176,182
100 Brennan, A. 27 165
Alba Dios, A. 28 168 Bresse, X. 21 107
Alberti, C. 25 141 Brezis, M. 11 55
Albin, L. 17 81 Briggs, A.H. 14,18,23 62,83,127
Alfonte, C.R.E. 14 67 Brixi, Z. 19 89
Alsayed, N. 16 75 Brixner, D.I. 12 60
Alzahouri, K. 11 54 Brodszky, V. 15 71
Ancuta, I. 27 158 Brown, K.F. 9,21 43,108,109
Anic, B. 27 158 Brunn, M. 22 110
Antoine, S-L. 19,21 90,101 Brush, J. 21 105,106
Arvandi, M. 29 181 Buchholz, A. 20 92
Assasi, N. 15 73 Bühler, D. 18 86
Asselineau, J. 23 121 Burton, K. 22 111
Atar, D. 11 51 Byron, J. 24 135
Augestad, L.A. 27 166
Auvinen, A. 21 104 C
Calmus, S. 17 79
B Campbell, F. 22 120
Baculea, S. 21 102 Canevet, J.P. 9 42
Bahra, J.P. 15 69 Carrión, M.T. 28 168
Bahrami, S. 11,21 54,103 Catena, A. 15 68
Baji, P. 15 71 Cecil, W.T. 22 112
Bakashvili, L. 18 85 Chambers, M. 14 62
Bal, R. 9 41 Chan, E. 23 122
Bartel, C. 28 170 Chang, C.F. 22 112
Bernhardt, J. 17 80 Chappell, F. 21 105,106
Berthele, A. 20 93 Charrier, N. 22 113
Beutels, P. 9,25 40,145 Chauvin, P. 22 114
Bielza, C. 20 94 Chevreul, K. 11,19,22, 52,89,110
23,25,27 113,121
Birnbaum, M.H. 15 69
122,143
Biskupiak, J. 12 60 162,163
Blackhouse, G. 15 73
Cheyne, H. 22 116
Bodemer, N. 26 153
Chilcott, J. 10,22 45,120
Booth, N. 21 104
Borget, I. 14 61
Bourmaud, A. 22,27 113,162
Boyd, K.A. 21 105,106
Brailsford, S. 11 57
Bravata, D.M. 17 81
185
Page Page Page Page
Codrenau, C. 27 158 E
Cohen, J.T. 9,11 39,56 Eckstein, H.H. 24 132
Cohen, M.J. 11 55 Egger, B. 18 86
Corbett, K.K. 29 179 Eikermann, M. 23,28 123,170
Covey, J. 22 115 Einzinger, P. 23 124
Cowley, N. 21 109 Endel, G. 10,12,23 47,48,58
Craig, L.E. 17 80 25 124,149
Crawford, F. 21 105,106 Engel, J. 10 49
Creeden, J. 23 126 Everson-Hock, E. 10 45
Croitoru, A. 21 102
Culyer, A.J. 18 84 É
Curescu, P. 21 102 Érsek, K. 15 71
D F
Dalgleish, L. 22 116 Fang, J-H. 11 56
Damjanov, N. 27 158 Fautrel, B. 25 143
Dans, A.L. 27 164 Felder, S. 15 70
Darr, C.A. 29 179 Fenwick, E. 9,20,21 105,106
Davidovitch, N. 28 177 Fernandez del Pozo, J.A. 20 94
Davies, L. 19 87 Fletcher, K.E. 14 64
de Groot, I.B. 15,22 72,117,118 Foster, S.A. 25 147
De Rosa, M. 25 143 Fraser, G. 9,21 43,108,109
De Schrijver, K. 9 40 Frick, U. 29 178
Degos, F. 23 121 Friedman, N. 23 125
Del Pozo, S. 14 64
Delgado, R.N. 27 164
G
Derrough, T. 22 119 Gaebel, K. 15 73
Desser, A.S. 9 44 Galesic, M. 27 156
Diederich, A. 27,29 159,180
Gamper, E.M. 24 129,136
Dijs-Elsinga, J. 15,22 72,117,118
Ganchow, P. 14 64
Dirmaier, J. 20,28 92,169
Djukic, P. 27 158 Garcia-Retamero, R. 15,26 68,151
27 152,153
Dominiak-Felden, G. 22 119
156,157
Dozier, M. 21 105,106
Garg, S. 23 126
Drummond, M. 13,16 74
Gartemann, J. 23 126
Duenas, A. 10,22 45,120
Gastl, G. 28 167
Dunlop, M. 21 105,106
Gavaruzzi, T. 24 128
Durand-Zaleski, I. 11,21,22 52,54,103
23 110,113 Gazelle, G.S. 26 154
25,27 121,122 Geiger-Gritsch, S. 17 82
141,143
162
186
Page Page Page Page
Giaquinto, C. 16 75 Hofmarcher-Holzhacker, R. 19 90
Giesinger, J.M. 24 136,129 Holle, R. 28 171
Glanville, J. 21 105,106 Holtorf, A-P. 12 60
Goehler, A. 26 154 Holzmann, N. 23,28 123,170
Goeree, R. 15,17 73 Holzner, B. 24,24 129,136
Goldberg, A. 23 125 Horváth, C. 15 71
Gonzales, R. 29 179 Hosseinpour, R. 24 137
Gothe, H. 17 Hudson, M. 9,21 43,108,109
Götzinger, M. 26 150 Hunink, M.G.M. 8,20
Gouepo, A. 11,22,23 52,113,121
Govan, L. 11 53 I
Goyder, E. 10,22 45,120 Ionescu, R. 27 158
Gray, A. 23 127 Ito, M. 25 139
Green J. 9, 21 43,108,109
Greenberg, D. 9,11 39,56 J
Grepperud, S. 9 44 Jacobs, E. 14 64
Grolier, J. 22 114 Jahn, B. 11,28 57, 167
Guillemin, F. 11,25 54,143 Jones, R. 10 45
Gulácsi, L. 15,27 71,158 Josselin, J-M. 22 114
Gulbrandsen, P. 24 130 Journy, N. 19 89
Guldvog, B. 26 155 Jurkovitz, C.T. 17 78
Gyimesi, M. 23,25 124,146
Gyldmark, M. 17
K
Gyrd-Hansen, D. 9 44 Kada, O. 29 178
Kasper, K. 24 135
H Kasteridis, P. 22 112
Hadker, N. 23 126 Kemmler, G. 24,24 129,136
Halpern, E.F. 26 154 Kemp, T. 23 127
Halvorsen, P.A. 24 131 Kiadaliri, A.A. 24,24 137,138
Hamann, J. 20,24 93,132 Kievit, J. 15,22 72,117
Hamedanizadeh, A. 24 133 Killick, C. 28 174
Hanson, B. 24 134 Killoran, A. 27 165
Hansson, M.G. 18 Kiseliova, T. 18,20 85,95
Härter, M. 20,28 92,169 Kissling, W. 20,24 93,132
Helfand, M 16 74 Knipfer, E. 24 132
Hens, N. 9 40 Koinuma, N. 25 139
Heresbach, D. 22 114 Kolm, P. 17 78
Hernandez, P. 15 73 Kompanje, E.J.O. 25 142
Hess, L.M. 24 135 Koné, V. 17 79
Hillemanns, P. 10,25 49,140 König, H.H. 28 171
Hintringer, K. 17 82 Korinteli, I. 18,20 85,95
Hoffmann, W. 28 170 Korinteli, M. 20 95
Hoffrage, U. 26 152 Kraemer, A. 10 49
Kristiansen, I.S. 9,11,13,14 44, 51,63
19,24,27 131,166
187
Page Page Page Page
Kriston, L. 20,28 92,169 Meier, L. 23 124

Kroll, J.S. 9,21,21 43,108,109 Meladze, J. 18 85
Mendel, R. 20,24 93,132
L Messina, J. 22 120
Lang, K. 10,21 49,100
Meyer, E. 25 148
Langhorne, P. 11,17 53,80
Miksch, F. 25,26,28 149,150
Largeron, N. 25 140 175,176
Lawson, K.D. 18 83 Miller, L.A. 25 147
Le Breton, J. 19 89 Mirivosky, B. 28 173
Le Corvoisier, P. 19 89 Mirvis, D.M. 22 112
Le Jeannic, A. 25 141 Mittendorf, T. 10 49
Learman, L. 24 135 Muehlberger, N. 10,26 49,154
Leboyer, M. 27 162 Müller, S. 15,26 68,151
Leidl, R. 28 171 152,153
Leiter, A. 14 66 N
Lewsey, J. 18 83 Nachtnebel, A. 17 82
Lingsma, H.F. 9,25 41,142 Najafi, B. 24 138
Litwiller, A. 24 135 Neumann, A. 26 154
Lotto, L. 24 128 Neumann, P.J. 9,11 39,56
Lubinski, J. 19 88 Neumann, T. 26 154
Lucas, P.J.F. 20 94 Neumeyer, A. 26 153
Lucchiari, C. 27 161 Nickol, D. 28,29 173,179
Lucier, S. 25 143 Niven, C. 22 116
Lukas, D. 25 144 Nolte, J. 26 154
Luyten, J. 9,25 40,145 Nygaard, E. 26 155
M O
Maas, A.I.R. 25 142 Oberguggenberger, A. 24 129,136
MacIntyre, K. 23 127 Okan, Y. 26,27 151,152
Maldonado, A. 15,27 68, 157 153,156
157
Marais, C. 9 40
Marang-van de, P.J. 15,22 72,117,118 Olsen, J.A. 9 44
Marinchev, L. 27 158 Orlewska, E. 15,19,27 71, 88,158
Martin, M. 21 107 Otten, M. 27 159
Martínez, M. 28 168 Otten, W. 15,22 72,118
Matteucci Gothe, R. 29 181 Owens, D.K. 17 81
Mayerhofer, J. 25 146
Mayrhofer, T. 15 70 P
McAllister, M. 19 87 Padget, M. 21 103
McCombs, J.M. 17,25,27 77,147,160 Pagava, K. 18,20 85,95
McDonald, K.M. 9,17 81 Pai, J. 17,27 77,160
McElwee, N. 16 74 Palileo, L.M. 27 164
McIntosh, H. 21,21 105,106 Pana, B. 21 102
McIvor, A. 15 73 Papageorgiou, M. 21 107
Mégard, Y. 13 Patel, B.V. 27 160
188
Page Page Page Page
Paulden, M. 18 84 Roberts M.S. 8,11,17 57

Payne, K. 18,19 87 Roberts, N. 14 62
Peeters, Y. 22 117 Robertson, D. 15 73
Peets, T. 27 158 Rochau, U. 28 167
Péntek, M. 15,27 71,158 Rogozinska, E. 12 59
Peralta Munguía, L. 28 168 Roozenbeek, B. 25 142
Perez, P. 23 121 Rosian-Schikutav, I. 19 90
Pérula de Torres, L.A. 28 168 Rowley, J. 23 127
Petry, K.U. 10 49 Ruether, A. 19,23,28 90,123,170
Pfeffer, N. 23 124 Ruiz-Moral, R. 28 168
Pliskin, J. 8,15,20,28 177
Podang, J. 10 50
Ponholzer, A. 29 182
S
Safari, H. 24 137
Pons, H. 9 41
Sagmeister, M. 29 181
Popper, N. 10,12,23 47,48,58
26,28,29 124,150 Sanchez, R.J. 27 160
175,176 Schapira, M.M. 14,19 64,
182 Schauer, C. 14 64
Popper, P. 25 149 Schiller-Frühwirt, I. 26 150
Poses, R. 8,20 91 Schnell-Inderst, P. 10,26 49,154
Praprotnik, S. 27 158 Scholl, I. 20,28 92,169
Pravettoni, G. 27 161 Schreier, M. 27,29 159,180
Prigent, A. 7,19,27 163, 89,162 Schwartz, J.S 13,16 74
Schwarzer, R. 28 167
Q Senand, R. 9 42
Quon, P. 25 140 Sevdalis, N. 9,21 43,108,109
Shanley, R. 21 109
Shaw-Caffrey, E. 23 126
R
Siebert, U. 8,9,10,13,18 49
Racaza, G.Z. 27 164
20,26,28,29 154,167
Radu, P.C. 21 102 181
Radwin, A. 22 120 Siering, U. 28 170
Rafia, R. 27 165 Simon, S. 7 163
Ramsay, M. 9,21 43,108,109 Singweratham, N. 10 50
Rand-Hendriksen, K. 27 166 Sitter, H. 15
Rashid, N. 25 147 Skoupa, J. 27 158
Rashkov, R. 27 158 Smith, W.R. 8
Rat, C. 9 42 Smith-Spangler, C. 17 81
Rees, R. 25 148 Sperner-Unterweger, B. 24 136
Rehm, J. 29 178 Spronk, S. 11
Rémy, V. 25 140 Sroczynski, G. 10,14,28 49,167
Renard, L. 14 61 Stahl, J.E. 10,11 57
Renehan, A. 21,21 105,106 Stark, R. 28 171
Rissanen, P. 21 104 Starkie, H. 14 62
189
Page Page Page Page
Stausberg, J. 17 76 Weir, C.J. 11 53

Stavem, K. 27 166 Weisser, A. 23,28 124,176
Steyerberg, E.W. 9,25 41,142 Weller, D. 21 105,106
Stollenwerk, B. 28 171 Wetter, D. 26 150
Storz, P. 18,28 86,172 Wiedermann, W. 29 178
Stutsman, J. 24 135 Wigton, R.S. 20,28,29 91,173,179
Sundaram, V. 17 81 Wiland, P. 27 158
Wilbacher, I. 28 175
T Wilk, N.M. 12 59
Tammela, T. 21 104 Willett, K. 23 127
Tape, T.G. 20,28 91,173 Winkelhage, J. 29 180
Taylor, B.J. 28 174 Winner, H. 14 66
Thöni, M. 14 66 Wisløff, T. 11 51
Tlustochowicz, M. 27 158 Wolf, D. 28 167
Tlustochowicz, W. 27 158 Wu, O. 17,23 80,127
Toff, P. 21 109 Wurm, J. 29 181
Tomsic, M. 27 158
Tóth, E. 15 71 X
Toumi, M. 16 75 Xie, F. 15 73
U Z
Urach, C. 10,25,26,28 48,149 Zabernigg, A. 24 136
150,175,176 Zauner, G. 10,11,12 47,48,57
25, 26,28,29 149,150
V 58 175,182
Vago, G. 27 161
Zeng, F. 27 160
van den Ende, J. 10
Zimmermann, A. 25 146
van der Helm, W. 23 126
van Wijgerden, J. 21 109
Vanness, D. 25 140
Vashitz, G. 28 177
Veldi, T. 27 158
Vidal-Trécan, G. 17 79
Vincent, C. 9,21 43,108,109
Vojinovic, J. 27 158
W
Walker, M.C. 14 64
Wasem, J. 10,21 46,49,99
26 100,154
Wastian, M. 25 146
Waters, T.M. 22 112
Weinstein, M.C. 11,13
Weintraub, W.S. 17 78
190
09:00 Parallel Short Course 1 SR 107 09:00 Parallel Short Course 2 SR 108 09:00 Parallel Short Course 3 SR109 09:00 Parallel Short Course 4 SR 001
FOCUSED OPERATIONS MANAGEMENT IN HEALTH HOW-TO-WORKSHOP: REVISE AND IMPROVE YOUR INTRODUCTION TO CLINICAL AND ECONOMIC DECISION- ADVANCED DECISION ANALYSIS: PART 1, THEORY
CARE ORGANISATIONS: DOING MORE WITH THE SAME PRESENTATION FOR THE MEETING ANALYTIC MODELING
RESOURCES
(10:30 Coffee Break) (10:30 Coffee Break) (10:30 Coffee Break) (10:30 Coffee Break)
(09:00 – 17:00)
12:00 Lunch
14:00 Parallel Short Course 5 IT 001 14:00 Parallel Short Course 6 IT 101 14:00 Parallel Short Course 7 SR 001
DISCRETE EVENT SIMULATION ADVANCED DECISION ANALYSIS: PART 2, HANDS-ON RECOGNIZING EXTERNAL THREATS TO RATIONAL
DECISION MAKING
(15:30 Coffee Break) (15:30 Coffee Break) (15:30 Coffee Break)
19:00 – 21:00 Get-Together Reception
10:00 Opening Session Hall A
10:30 Plenary Session:
TOP-RANKED ABSTRACTS Hall A
12:00 Lunch
13:30 Parallel Session 1 - A Hall A 13:30 Parallel Session 1 - B Hall B

(10:00 – 19:00)
PUBLIC HEALTH DECISION MAKING COST-EFFECTIVENESS ANALYSIS

15:30 Parallel Workshop 1 Hall B 15:30 Parallel Workshop 2 Hall C 15:30 Parallel Workshop 3 SR 101 15:30 Parallel Workshop 4 SR 001
Modeling approaches for analysing health AGENT BASED MODELING AND THE BENEFITS MARKET ACCESS GOAL & MANAGEMENT OPTIMISATION CURRENT AND FUTURE USE OF
care problems – an introductory overview and REGARDING SIMULATION RESULTS (MAGMO) ANALYSIS AS EVIDENCE-BASED METHOD TO PHARMACOECONOMIC AND PHARMACOTHERAPY
comparison EFFICIENTLY SUPPORT STRATEGIC DECISIONS OUTCOMES RESEARCH DATA IN DECISION MAKING
16:30 Symposium I Hall A
20:30 Evening Get Together: REMINISCENCES OF THE “OLD DAYS” OF MEDICAL DECISION MAKING
METHODS PREFERENCES AND CHOICES
(08:00 - 17:00)
KEY PRINCIPLES FOR TECHNOLOGY ASSESSMENT AN EXAMPLE OF A SUCCESSFUL IMPLEMENTATION OF VACCINATION

PROGRAMS: DEBATE AND NEW DIRECTIONS PROGRAMME: THE PUBLIC HEALTH IMPACT OF ROTAVIRUS
VACCINATION
12:00 Lunch
HEALTH SERVICES AND OUTCOMES RESEARCH TRANSLATIONAL RESEARCH AND OTHER TOPICS
15:30 Symposium II Hall A
17:00 Mounting of Posters for Wednesday, June 2 poster session
19:00 Tour of the Hall Mint Museum, followed by a festive dinner at the Salzlager (optional)

(08:00 – 13:00)
matching HTA for the requirements of national COHERENCE AND CORRESPONDENCE IN MEDICINE: BRINGING
Health Care systems? Lessons learned: the Bismarck NEW LIGHT TO MEDICAL CONTROVERSIES
system, example of Germany and AUSTRIA
CLINICAL DECISION MAKING AND PATIENT-SHARED DECISION MAKING
12:30 Closing Addresses
13:00 Lunch

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09:00 Parallel Short Course 1 SR 107 09:00 Parallel Short Course 2 SR 108 09:00 Parallel Short Course 3 SR109

13:30 Parallel Session 1 - A Hall A 13:30 Parallel Session 1 - B Hall B

PUBLIC HEALTH DECISION MAKING COST-EFFECTIVENESS ANALYSIS

KEY PRINCIPLES FOR TECHNOLOGY ASSESSMENT AN EXAMPLE OF A SUCCESSFUL IMPLEMENTATION OF VACCINATION

WEDNESDAY, JUNE 2, 2010

SMDM Europe 2010

General Information ....................................................................................... 6

Social Program .............................................................................................. 7

- Sunday, May 30 – Short Courses............................................................ 8

- Monday, May 31 ..................................................................................... 9

- Tuesday, June 1 ................................................................................... 14

- Wednesday, June 2 .............................................................................. 19

Poster Presentations ................................................................................... 21

Short Course Descriptions ........................................................................... 30

Abstracts – Oral Presentations .................................................................... 39

Abstracts – Poster Presentations ................................................................. 99

Index .......................................................................................................... 185

Program at a Glance...................................................................... Back Cover

LOCAL ORGANIZING COMMITTEE

Silke Siebert, UMIT, ONCOTYROL, Austria

Concha Bielza, Spain

The Co-Chairs and Organizing Committee wish to acknowledge the following

REGISTRATION / HOSPITALITY / INFORMATION

Monday, May 31 Poster Session – 18:00

SUNDAY, MAY 30, 2010

19:00 GET-TOGETHER RECEPTION (for all registered participants)

MONDAY, MAY 31, 2010

20:30 EVENING GET-TOGETHER (for all registered participants)

TUESDAY, JUNE 1, 2010

19:00 FESTIVE DINNER (optional)

Please meet in the courtyard of Burg Hasegg Castle and

Tickets for accompanying persons may be purchased at the registration desk.

SUNDAY, MAY 30, 2010

PARALLEL SHORT COURSES

09:00 – 12:00 Parallel Short Course 1 SR 107

FOCUSED OPERATIONS MANAGEMENT IN HEALTH

Parallel Short Course 2 SR 108

HOW-TO-WORKSHOP: REVISE AND IMPROVE YOUR

Parallel Short Course 3 SR 109

INTRODUCTION TO CLINICAL AND ECONOMIC

Parallel Short Course 4 SR 001

ADVANCED DECISION ANALYSIS: PART 1, THEORY

14:00 – 17:00 Parallel Short Course 5 IT 001

DISCRETE EVENT SIMULATION

Parallel Short Course 6 IT 101

ADVANCED DECISION ANALYSIS:

Parallel Short Course 7 SR 001

RECOGNIZING EXTERNAL THREATS TO RATIONAL

There will be a coffee break at 10:30 and 15:30

19:00 – 21:00 Get-Together Reception at UMIT

MONDAY, MAY 31, 2010

08:30 Registration desk opens at UMIT

10:00 – 10:30 Opening Session Hall A

U. Siebert, Co-Chair, SMDM Europe Meeting 2010, Austria

10:30 – 12:00 Plenary Session Hall A

10:30 ARE INCREMENTAL BENEFITS FROM NEW TECHNOLOGY

10:45 IMPUTING QALYS FROM SINGLE TIME POINT HEALTH STATE

11:00 HOSPITAL RANKINGS IN THE NETHERLANDS DO NOT PROVIDE

11:15 BENZODIAZEPINES RENEWALS: IS THERE A POSSIBILITY FOR

11:30 MULTIDIMENSIONAL OMISSION BIAS IN PARENTS’ VACCINE

11:45 ORPHAN DRUGS: DOES SOCIETY VALUE RARITY?

13:30 – 15:00 Parallel Session 1 - A Hall A

PUBLIC HEALTH DECISION MAKING