| Excerpt of the presentation | |
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Christian Elsner 1, Christian Mazzi 2, Gerhard Hindricks
1 Cost-Effectiveness Analysis becomes an important tool for Providers
and Payers in establishing new therapeutic options for patients. Despite
a huge amount of published Information on Evidence based Data on Cost-Effectiveness
is available over Medical Databases (e.g. MedLine) there is a huge time
gap in "time to provider" and "time to payer" of
this information. Objective of our work was to design a concept and
data structure for easy and semi-automated set up of Cost-Effectiveness
Markovmodels for rhythmologic topics and evaluate those with a portion
of available literature. The Tools for Concept and Data structure were
built using a XML-Designtool from Altova Inc. and a Visual Basic Program.
A first alpha-prototype of a markov node representation layer webfrontend
with condensed reference information was built with a Tomcat / Cocoon
2.0 Framework. For the Evaluation of the Model we used Review / Original
Literature from Carol et al. on Cost-Effectiveness of Ablation for Supraventricular
Tachykardia and Literature from Eckman et al. and Weerasooriya et al.
on Cost-Effectiveness of PAF Treatments. As a result of our Work we
developed two XML-Schemes, one to represent EBM / Cost-Effectiveness
relevant information (Demographic, Clinical, Costs, Utilities and Disutilities)
from Publications ( = MedEc-XML-REF) and a second to map and weight
this information to defined markov nodes (MedEc-XML-MAP). With the System
60 References could be mapped into the new Data structure. With the
prototype in Tomcat / Cocoon 2.0 we could rebuild the models from the
literature graphically. The System could then give a web-enabled fast
overview of the underlying referenced information and Clinical Evidence
of the Data per node (for the Evidence Rating we used a modified model
from U.S. Preventive Services Task Force). At least new data could be
added fast through the integration of XML-structured data from a number
of (fictive) new publications for evaluation purposes and validation
of the system. The developed data scheme seems to be feasible to extract
relevant information from the publications. Mapping the Information
from the references still needs sort of interpretation which needs to
be commented in both the schemes. A further granulation of the XML schemes
may therefore be necessary. The process of mapping reference information
to the markov nodes is highly enhanced due to semi-automation by the
use of common classification codes for procedures and outcomes. The
principle of the graphical representation may be useful for consecutive
literature search / investigations being performed for further evidence
of Cost-Effectiveness at certain points. |