Neubauer A S, Hirneiss C, Kampik A
Augenklinik der Ludwig-Maximilians-Universität, München, Deutschland.
Ophthalmologe. 2010 Mar;107(3):228-34. doi: 10.1007/s00347-009-2038-6.
Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.
建模在基于价值的医学（VBM）中发挥着重要作用。它通过预测潜在的临床和经济后果来提供决策支持，通常会整合不同来源的证据。基于聚焦眼科的相关出版物和实例，对关键的经济建模方法进行了解释并给出了定义。最常应用的模型类型是决策树、马尔可夫模型和离散事件模拟（DES）模型。模型验证除了要验证内部有效性外，还包括与其他模型进行比较（外部有效性），理想情况下还要验证其预测特性。任何建模中存在的不确定性都应明确说明。这在VBM中的经济建模以及使用疾病风险模型支持临床决策时都是如此。在经济建模中，通常会应用单变量和多变量敏感性分析；这里的关键概念是龙卷风图和成本效益可接受性曲线。鉴于存在的不确定性，与没有这些额外信息相比，建模有助于做出更明智的决策。
