Abstract
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Background
As part of a program of the first National Population Health Study of Neurological Conditions launched in 2009, a series of microsimulation models of neurological conditions (called POHEM-Neurological meta-model) was developed to project health and economic impacts of seven neurological conditions (NCs)—Alzheimer’s disease and other dementias, cerebral palsy, epilepsy, multiple sclerosis, Parkinson’s disease, traumatic brain injury, and traumatic spinal cord injury—over a 20-year horizon.
Data and methods
The common framework of the seven models allows for dynamic, continuous-time, discrete-event simulation of synthetic large populations in which persons are subject to the risk of developing the NC under study and are assigned a value of functional health and a probability of receiving a caregiver and of entering long-term care. Calculations for transitions are done every year over the life course, and costs are accumulated throughout the life of the synthetic person. The need to reconcile empirical estimates of incidence and mortality with prevalence required implementation of “cure” parameters for two of the NCs.
Results
The POHEM-Neurological meta-model integrates the latest Canadian microdata on neurological conditions and satisfies most criteria for validation of microsimulation models, including conceptualization, computer implementation, assessment of output plausibility, and comparison with external data. Limitations include an absence of risk factors and the lack of uncertainty measures.
Interpretation
The POHEM-Neurological meta-model has been useful for projections of health and economic impacts of NCs on persons affected and their caregivers, and allows for comparison of specific scenarios to the base case.
Keywords
Alzheimer’s disease and other dementias, cerebral palsy, epilepsy, health costs, microsimulation, multiple sclerosis, Parkinson’s disease, traumatic brain injury, traumatic spinal cord injury
Findings
Prompted by growing attention to population aging and the potential health burden of neurological conditions (diseases, disorders and injuries to the brain and nervous system), in June 2009, the federal Minister of Health announced the government’s commitment to a four-year study of neurological conditions, the National Population Health Study of Neurological Conditions (NPHSNC). The goal of the NPHSNC, co-led by Neurological Health Charities Canada and the Public Health Agency of Canada (PHAC), was to build an understanding of neurological conditions and their impact on Canadians. One of its components is a set of microsimulation models, POHEM-Neurological, that project the health and economic impacts of neurological conditions over a 20-year horizon. [Full Text]
Authors
Philippe Finès (philippe.fines@canada.ca), Rochelle Garner, Julie Bernier and Douglas G. Manuel are with the Health Analysis Division at Statistics Canada. Douglas G. Manuel is also with the Ottawa Hospital Research Institute, the Bruyère Research Institute, and the Institute for Clinical Evaluative Sciences. Christina Bancej is with the Public Health Agency of Canada.
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What is already known on this subject?
- The anticipated increase in the prevalence of neurological conditions (NCs) is a major concern for future population health.
- Microsimulation models are useful to assess the present and future impact of diseases.
- A series of microsimulation models, POHEM-Neurological, was developed to analyse the prevalence, effects on population health, and costs of NCs.
What does this study add?
- A description of the methods and data that led to the development of the microsimulation models of NCs is provided.
- The NC microsimulation models are deemed valid and useful for their objectives.
- Further studies are recommended to better assess model validity and the consequences of model-based decisions.
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