Incorporation of uncertainty in health economic modelling studies
Identifieur interne : 000425 ( PascalFrancis/Curation ); précédent : 000424; suivant : 000426Incorporation of uncertainty in health economic modelling studies
Auteurs : Anthony O'Hagan [Royaume-Uni] ; Christopher Mccabe [Royaume-Uni] ; Ron Akehurst [Royaume-Uni] ; Alan Brennan [Royaume-Uni] ; Andrew Briggs [Royaume-Uni] ; Karl Claxton [Royaume-Uni] ; Elisabeth Fenwick [Royaume-Uni] ; Dennis Fryback [États-Unis] ; Mark Sculpher [Royaume-Uni] ; David Spiegelhalter [Royaume-Uni] ; Andrew Willan [Canada]Source :
- PharmacoEconomics : (Auckland) [ 1170-7690 ] ; 2005.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Modèle économique, Homme, Santé publique.
English descriptors
- KwdEn :
Abstract
In a recent leading article in PharmacoEconomics, Nuijten described some methods for incorporating uncertainty into health economic models and for utilising the information on uncertainty regarding the cost effectiveness of a therapy in resource allocation decision-making. His proposals are found to suffer from serious flaws in statistical and health economic reasoning. Nuijten's suggestions for incorporating uncertainty: (a) wrongly interpret the p-value as the probability that the null hypothesis is true; (b) represent this probability wrongly by truncating the input distribution; and (c) in the specific example of an antiparkinsonian drug uses a completely inappropriate p-value of 0.05 when the null hypothesis would, in reality, be emphatically disproved by the data. His suggestions regarding minimum important differences in cost effectiveness: (a) introduce areas of indifference that suggest inappropriate reliance on cost minimisation while failing to recognise that decisions should be based on expected costs versus benefits; and (b) offer no guidance on how the probabilities associated with these areas could be used in decision-making. Furthermore, Nuijten's model for Parkinson's disease is over-simplified to the point of providing a bad example of modelling practice, which may mislead the readers of PharmacoEconomics. The rationale for this paper is to ensure that readers do not apply inappropriate analyses as a result of following the proposals contained in Nuijten's paper. In addition to a detailed critique of Nuijten's proposals, we provide brief summaries of the currently accepted best practice in cost-effectiveness decision-making under uncertainty.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Incorporation of uncertainty in health economic modelling studies</title><author><name sortKey="O Hagan, Anthony" sort="O Hagan, Anthony" uniqKey="O Hagan A" first="Anthony" last="O'Hagan">Anthony O'Hagan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Mccabe, Christopher" sort="Mccabe, Christopher" uniqKey="Mccabe C" first="Christopher" last="Mccabe">Christopher 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aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Briggs, Andrew" sort="Briggs, Andrew" uniqKey="Briggs A" first="Andrew" last="Briggs">Andrew Briggs</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Health Economics Research Centre, University of Oxford</s1><s2>Oxford</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Claxton, Karl" sort="Claxton, Karl" uniqKey="Claxton K" first="Karl" last="Claxton">Karl Claxton</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Fenwick, Elisabeth" sort="Fenwick, Elisabeth" uniqKey="Fenwick E" first="Elisabeth" last="Fenwick">Elisabeth Fenwick</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Fryback, Dennis" sort="Fryback, Dennis" uniqKey="Fryback D" first="Dennis" last="Fryback">Dennis Fryback</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Wisconsin Medical School</s1><s2>Madison, Wisconsin</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Sculpher, Mark" sort="Sculpher, Mark" uniqKey="Sculpher M" first="Mark" last="Sculpher">Mark Sculpher</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Spiegelhalter, David" sort="Spiegelhalter, David" uniqKey="Spiegelhalter D" first="David" last="Spiegelhalter">David Spiegelhalter</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>MRC Biostatistics Unit, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Willan, Andrew" sort="Willan, Andrew" uniqKey="Willan A" first="Andrew" last="Willan">Andrew Willan</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Public Health Sciences, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>11 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">05-0340420</idno><date when="2005">2005</date><idno type="stanalyst">PASCAL 05-0340420 INIST</idno><idno type="RBID">Pascal:05-0340420</idno><idno type="wicri:Area/PascalFrancis/Corpus">000898</idno><idno type="wicri:Area/PascalFrancis/Curation">000425</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Incorporation of uncertainty in health economic modelling studies</title><author><name sortKey="O Hagan, Anthony" sort="O Hagan, Anthony" uniqKey="O Hagan A" first="Anthony" last="O'Hagan">Anthony O'Hagan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Mccabe, Christopher" sort="Mccabe, Christopher" uniqKey="Mccabe C" first="Christopher" last="Mccabe">Christopher Mccabe</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Akehurst, Ron" sort="Akehurst, Ron" uniqKey="Akehurst R" first="Ron" last="Akehurst">Ron Akehurst</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Brennan, Alan" sort="Brennan, Alan" uniqKey="Brennan A" first="Alan" last="Brennan">Alan Brennan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Briggs, Andrew" sort="Briggs, Andrew" uniqKey="Briggs A" first="Andrew" last="Briggs">Andrew Briggs</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Health Economics Research Centre, University of Oxford</s1><s2>Oxford</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Claxton, Karl" sort="Claxton, Karl" uniqKey="Claxton K" first="Karl" last="Claxton">Karl Claxton</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Fenwick, Elisabeth" sort="Fenwick, Elisabeth" uniqKey="Fenwick E" first="Elisabeth" last="Fenwick">Elisabeth Fenwick</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Fryback, Dennis" sort="Fryback, Dennis" uniqKey="Fryback D" first="Dennis" last="Fryback">Dennis Fryback</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Wisconsin Medical School</s1><s2>Madison, Wisconsin</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Sculpher, Mark" sort="Sculpher, Mark" uniqKey="Sculpher M" first="Mark" last="Sculpher">Mark Sculpher</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Spiegelhalter, David" sort="Spiegelhalter, David" uniqKey="Spiegelhalter D" first="David" last="Spiegelhalter">David Spiegelhalter</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>MRC Biostatistics Unit, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Willan, Andrew" sort="Willan, Andrew" uniqKey="Willan A" first="Andrew" last="Willan">Andrew Willan</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Public Health Sciences, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>11 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author></analytic><series><title level="j" type="main">PharmacoEconomics : (Auckland)</title><title level="j" type="abbreviated">PharmacoEconomics : (Auckl. )</title><idno type="ISSN">1170-7690</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">PharmacoEconomics : (Auckland)</title><title level="j" type="abbreviated">PharmacoEconomics : (Auckl. )</title><idno type="ISSN">1170-7690</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiparkinson agent</term><term>Cost efficiency analysis</term><term>Decision making</term><term>Economic model</term><term>Health economy</term><term>Human</term><term>Parkinson disease</term><term>Public health</term><term>Uncertainty</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Economie santé</term><term>Analyse coût efficacité</term><term>Prise décision</term><term>Modèle économique</term><term>Incertitude</term><term>Parkinson maladie</term><term>Antiparkinsonien</term><term>Homme</term><term>Santé publique</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Modèle économique</term><term>Homme</term><term>Santé publique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In a recent leading article in PharmacoEconomics, Nuijten described some methods for incorporating uncertainty into health economic models and for utilising the information on uncertainty regarding the cost effectiveness of a therapy in resource allocation decision-making. His proposals are found to suffer from serious flaws in statistical and health economic reasoning. Nuijten's suggestions for incorporating uncertainty: (a) wrongly interpret the p-value as the probability that the null hypothesis is true; (b) represent this probability wrongly by truncating the input distribution; and (c) in the specific example of an antiparkinsonian drug uses a completely inappropriate p-value of 0.05 when the null hypothesis would, in reality, be emphatically disproved by the data. His suggestions regarding minimum important differences in cost effectiveness: (a) introduce areas of indifference that suggest inappropriate reliance on cost minimisation while failing to recognise that decisions should be based on expected costs versus benefits; and (b) offer no guidance on how the probabilities associated with these areas could be used in decision-making. Furthermore, Nuijten's model for Parkinson's disease is over-simplified to the point of providing a bad example of modelling practice, which may mislead the readers of PharmacoEconomics. The rationale for this paper is to ensure that readers do not apply inappropriate analyses as a result of following the proposals contained in Nuijten's paper. In addition to a detailed critique of Nuijten's proposals, we provide brief summaries of the currently accepted best practice in cost-effectiveness decision-making under uncertainty.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>1170-7690</s0></fA01><fA03 i2="1"><s0>PharmacoEconomics : (Auckl. )</s0></fA03><fA05><s2>23</s2></fA05><fA06><s2>6</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Incorporation of uncertainty in health economic modelling studies</s1></fA08><fA11 i1="01" i2="1"><s1>O'HAGAN (Anthony)</s1></fA11><fA11 i1="02" i2="1"><s1>MCCABE (Christopher)</s1></fA11><fA11 i1="03" i2="1"><s1>AKEHURST (Ron)</s1></fA11><fA11 i1="04" i2="1"><s1>BRENNAN (Alan)</s1></fA11><fA11 i1="05" i2="1"><s1>BRIGGS (Andrew)</s1></fA11><fA11 i1="06" i2="1"><s1>CLAXTON (Karl)</s1></fA11><fA11 i1="07" i2="1"><s1>FENWICK (Elisabeth)</s1></fA11><fA11 i1="08" i2="1"><s1>FRYBACK (Dennis)</s1></fA11><fA11 i1="09" i2="1"><s1>SCULPHER (Mark)</s1></fA11><fA11 i1="10" i2="1"><s1>SPIEGELHALTER (David)</s1></fA11><fA11 i1="11" i2="1"><s1>WILLAN (Andrew)</s1></fA11><fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ></fA14><fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="04"><s1>Health Economics Research Centre, University of Oxford</s1><s2>Oxford</s2><s3>GBR</s3><sZ>5 aut.</sZ></fA14><fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></fA14><fA14 i1="06"><s1>University of Wisconsin Medical School</s1><s2>Madison, Wisconsin</s2><s3>USA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="07"><s1>MRC Biostatistics Unit, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>10 aut.</sZ></fA14><fA14 i1="08"><s1>Public Health Sciences, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>11 aut.</sZ></fA14><fA20><s1>529-536</s1></fA20><fA21><s1>2005</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>26124</s2><s5>354000132198380010</s5></fA43><fA44><s0>0000</s0><s1>© 2005 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>33 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>05-0340420</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>PharmacoEconomics : (Auckland)</s0></fA64><fA66 i1="01"><s0>NZL</s0></fA66><fC01 i1="01" l="ENG"><s0>In a recent leading article in PharmacoEconomics, Nuijten described some methods for incorporating uncertainty into health economic models and for utilising the information on uncertainty regarding the cost effectiveness of a therapy in resource allocation decision-making. His proposals are found to suffer from serious flaws in statistical and health economic reasoning. Nuijten's suggestions for incorporating uncertainty: (a) wrongly interpret the p-value as the probability that the null hypothesis is true; (b) represent this probability wrongly by truncating the input distribution; and (c) in the specific example of an antiparkinsonian drug uses a completely inappropriate p-value of 0.05 when the null hypothesis would, in reality, be emphatically disproved by the data. His suggestions regarding minimum important differences in cost effectiveness: (a) introduce areas of indifference that suggest inappropriate reliance on cost minimisation while failing to recognise that decisions should be based on expected costs versus benefits; and (b) offer no guidance on how the probabilities associated with these areas could be used in decision-making. Furthermore, Nuijten's model for Parkinson's disease is over-simplified to the point of providing a bad example of modelling practice, which may mislead the readers of PharmacoEconomics. The rationale for this paper is to ensure that readers do not apply inappropriate analyses as a result of following the proposals contained in Nuijten's paper. In addition to a detailed critique of Nuijten's proposals, we provide brief summaries of the currently accepted best practice in cost-effectiveness decision-making under uncertainty.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC02 i1="02" i2="X"><s0>002B02B06</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Economie santé</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Health economy</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Economía salud</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Analyse coût efficacité</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Cost efficiency analysis</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Análisis costo eficacia</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Prise décision</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Decision making</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Toma decision</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Modèle économique</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Economic model</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Modelo económico</s0><s5>04</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Incertitude</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Uncertainty</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Incertidumbre</s0><s5>05</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>06</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Antiparkinsonien</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Antiparkinson agent</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Antiparkinsoniano</s0><s5>07</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Homme</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Human</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Hombre</s0><s5>08</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Santé publique</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Public health</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Salud pública</s0><s5>09</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>41</s5></fC07><fN21><s1>241</s1></fN21></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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