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acessibilidade

http://hdl.handle.net/10071/7387
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acessibilidade
DC FieldValueLanguage
dc.contributor.authorSampayo, F.-
dc.date.accessioned2014-05-23T14:29:33Z-
dc.date.available2014-05-23T14:29:33Z-
dc.date.issued2014-03-
dc.identifier.issn1098-3015por
dc.identifier.urihttp://dx.doi.org/10.1016/j.jval.2013.12.008en_US
dc.identifier.urihttps://ciencia.iscte-iul.pt/public/pub/id/16107en_US
dc.identifier.urihttp://hdl.handle.net/10071/7387-
dc.descriptionWOS:000333346600008 (Nº de Acesso Web of Science)-
dc.description.abstractBackground: Cost fluctuations render the outcome of any treatment switch uncertain, so that decision makers might have to wait for more information before optimally switching treatments, especially when the incremental cost per quality-adjusted life year (QALY) gained cannot be fully recovered later on Objective: To analyze the timing of treatment switch under cost uncertainty. Methods: A dynamic stochastic model for the optimal timing of a treatment switch is developed and applied to a problem in medical decision taking, i.e. to patients with unresectable gastrointestinal stromal tumour (GIST). Results: the theoretical model suggests that cost uncertainty reduces expected net benefit. In addition, cost volatility discourages switching treatments. the stochastic model also illustrates that as technologies become less cost competitive, the cost uncertainty becomes more dominant. With limited substitutability, higher quality of technologies will increase the demand for those technologies disregarding the cost uncertainty. The results of the empirical application suggest that the first-line treatment may be the better choice when considering lifetime welfare. Conclusions: Under uncertainty and irreversibility, low-risk patients must begin the second-line treatment as soon as possible, which is precisely when the second-line treatment is least valuable. As the costs of reversing current treatment impacts fall, it becomes more feasible to provide the option-preserving treatment to these low-risk individuals later on.por
dc.language.isoengpor
dc.publisherElsevierpor
dc.rightsopenAccesspor
dc.subjectCost uncertaintypor
dc.subjectDecision analysispor
dc.subjectEconomic evaluationpor
dc.subjectHealth economicspor
dc.subjectSwitch treatmentspor
dc.titleThe Timing and Probability of Treatment Switch under Cost Uncertainty: An Application to Patients with Gastrointestinal Stromal Tumorpor
dc.typearticleen_US
dc.pagination215-222por
dc.publicationstatusPublicadopor
dc.peerreviewedSimpor
dc.relation.publisherversionThe definitive version is available at: http://dx.doi.org/10.1016/j.jval.2013.12.008por
dc.journalValue in Healthpor
dc.distributionInternacionalpor
dc.volume17por
dc.number2por
degois.publication.firstPage215por
degois.publication.lastPage222por
degois.publication.issue2por
degois.publication.titleValue in Healthpor
dc.date.updated2014-05-23T14:27:36Z-
Appears in Collections:BRU-RI - Artigos em revistas científicas internacionais com arbitragem científica

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