Weiner Mark G, Sheikh Wasiq, Lehmann Harold P
Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
The Johns Hopkins University School of Medicine, Baltimore, MD.
AMIA Annu Symp Proc. 2018 Dec 5;2018:1076-1083. eCollection 2018.
Clinical implementation of predictive analytics that assess risk of high-cost outcomes are presumed to save money because they help focus interventions designed to avert those outcomes on a subset patients who are most likely to benefit from the intervention. This premise may not always be true. A cost-benefit analysis is necessary to show if a strategy of applying the predictive algorithm is truly favorable to alternative strategies. We designed and implemented an interactive web-based cost-benefit calculator, enabling specification of accuracy parameters for the predictive model and other clinical and financial factors related to the occurrence of an undesirable outcome. We use the web tool, populated with real-world data to illustrate a cost-benefit analysis of a strategy of applying predictive analytics to select a cohort of high-risk patients to receive interventions to avert readmissions for Congestive Heart Failure (CHF). Application of predictive analytics in clinical care may not always be a cost-saving strategy compared with intervening on all patients. Improving the accuracy of a predictive model may lower costs, but other factors such as the prevalence and cost of the outcome, and the cost and effectiveness of the intervention designed to avert the outcome may be more influential in determining the favored strategy. An interactive cost-benefit analyses provides insights regarding the financial implications of a clinical strategy that implements predictive analytics.
评估高成本结局风险的预测分析在临床中的应用被认为能够节省资金,因为它们有助于将旨在避免这些结局的干预措施集中于最有可能从干预中受益的一部分患者身上。但这一前提并非总是成立。有必要进行成本效益分析,以表明应用预测算法的策略是否真的优于其他替代策略。我们设计并实现了一个基于网络的交互式成本效益计算器,可设定预测模型的准确性参数以及与不良结局发生相关的其他临床和财务因素。我们使用这个填充了真实世界数据的网络工具,来说明对应用预测分析策略以选择一组高危患者接受干预以避免充血性心力衰竭(CHF)再入院的策略进行成本效益分析的情况。与对所有患者进行干预相比,在临床护理中应用预测分析可能并不总是一种节省成本的策略。提高预测模型的准确性可能会降低成本,但其他因素,如结局的发生率和成本,以及旨在避免该结局的干预措施的成本和效果,在确定首选策略时可能更具影响力。交互式成本效益分析为实施预测分析的临床策略的财务影响提供了见解。