EmET: Emotion Elicitation and Emotion Transition Model

Among the different theories used to explain social change, the transition theory holds a special place. It has been applied to subjects such as demography, epidemiology, nutrition, etc. and most often from a multidisciplinary perspective. However, beyond the apparent uniqueness of the transition label there are quite different theoretical frameworks and presuppositions, which can be a source of misunderstanding. A first perspective considers change as the transition from one stable state to another and concentrates on the processes at work in the transition phase. It focuses attention on the interactions between cultural and biological variables and tries to take into account the consequences of the fact that they move at different rates. A second perspective conceives change as a series of stages (more or less stable situations) and proceeds to analyse the structural transformation of the organisation at each stage. The emphasis is placed on the transformations that take place during these stages. This brings us closer to the theory of stages. Finally, a third perspective combines stages and transitions. Change is seen as part of an evolutionary and progressive movement and as being reversible or not. This article studies the cognitive organisation of the different theoretical variants of the transition model in which food plays a more or less important role.

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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

Medical Decision Making ◽

10.1177/0272989x20961091 ◽

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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