A methodology for protocol design and specification based on an extended state transition model

1984 ◽  
Author(s):  
Richard Chung
Keyword(s):  
State Transition ◽  
Protocol Design ◽  
Transition Model ◽  
Extended State ◽  
State Transition Model

Experience with Formal Specifications Using an Extended State Transition Model

1982 ◽  
Vol 30 (12) ◽  
pp. 2506-2513 ◽  
Author(s):  
G. Bochmann ◽  
E. Cerny ◽  
M. Gagne ◽  
C. Jard ◽  
A. Leveille ◽  
...  
Keyword(s):  
State Transition ◽  
Transition Model ◽  
Formal Specifications ◽  
Extended State ◽  
State Transition Model

scholarly journals Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

2020 ◽  
Vol 40 (8) ◽  
pp. 1003-1019
Author(s):  
Ingrid E. H. Kremer ◽  
Mickael Hiligsmann ◽  
Josh Carlson ◽  
Marita Zimmermann ◽  
Peter J. Jongen ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Shared Decision Making ◽  
State Transition ◽  
Transition Model ◽  
Shared Decision ◽  
Relapsing Remitting ◽  
State Transition Model ◽  
The Cost ◽  
Relapsing Remitting Multiple Sclerosis

Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.

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