Titre :
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Expert panel vs decision-analysis recommendations for postdischarge coronary angiography after myocardial infarction. (1999)
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Auteurs :
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K.M. KUNTZ ;
L. GOLDMAN ;
J. TSEVAT ;
M.C. WEINSTEIN ;
Program on the Economic Evaluation of Medical Technology. Department of Health Policy and Management. Harvard School of Public Health. Boston. MA. USA
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Type de document :
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Article
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Dans :
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JAMA - Journal of the american medical association (vol. 282, n° 23, 1999)
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Pagination :
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2246-2251
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Langues:
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Anglais
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Mots-clés :
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Infarctus
;
Myocarde
;
Etude comparée
;
Expert
;
Analyse coût efficacité
;
Recommandation
;
Homme
;
Appareil circulatoire [pathologie]
;
Cardiopathie coronaire
;
Myocarde [pathologie]
;
Radiodiagnostic
;
Economie santé
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Résumé :
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[BDSP. Notice produite par INIST flLryR0x. Diffusion soumise à autorisation]. Context Expert panels and decision-analytic techniques are increasingly used to determine the appropriateness of medical interventions, but these 2 approaches use different methods to process evidence. Objective To compare expert panel appropriateness ratings of coronary angiography after myocardial infarction (from the time of hospital discharge to 12 weeks after infarction) with the health gains and cost-effectiveness predicted by a decision-analytic model. Design Comparison of the degree of importance of the clinical variables considered in expert panel appropriateness ratings vs a previously published decision-analytic model. Identification of 36 clinical scenarios from the expert panel that could be simulated by the decision-analytic model. Main Outcome Measures Appropriateness score and appropriateness classification (expert panel) vs gain in quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (decision-analytic model). Results The most important clinical variables were similar in the 2 approaches, with the exercise tolerance test result exerting the greatest leverage on strength of recommendation for angiography. Among the expert panel clinical scenarios considered to be appropriate for coronary angiography that could be simulated in the decision-analysis model, the median (interquartile range) health gain and incremental cost-effectiveness ratio were 0.59 (0.41-0.76) QALYs and $27 000 ($23 000-$35 000) per QALY gained, respectively. (...)
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