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Glynn D, Gc VS, Claxton K, Littlewood C, Rothery C. Rapid Assessment of the Need for Evidence: Applying the Principles of Value of Information to Research Prioritisation. PHARMACOECONOMICS 2024; 42:919-928. [PMID: 38900241 DOI: 10.1007/s40273-024-01403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
We propose a short-cut heuristic approach to rapidly estimate value of information (VOI) using information commonly reported in a research funding application to make a case for the need for further evaluative research. We develop a "Rapid VOI" approach, which focuses on uncertainty in the primary outcome of clinical effectiveness and uses this to explore the health consequences of decision uncertainty. We develop a freely accessible online tool, Rapid Assessment of the Need for Evidence (RANE), to allow for the efficient computation of the value of research. As a case study, the method was applied to a proposal for research on shoulder pain rehabilitation. The analysis was included as part of a successful application for research funding to the UK National Institute for Health and Care Research. Our approach enables research funders and applicants to rapidly estimate the value of proposed research. Rapid VOI relies on information that is readily available and reported in research funding applications. Rapid VOI supports research prioritisation and commissioning decisions where there is insufficient time and resources available to develop and validate complex decision-analytic models. The method provides a practical means for implementing VOI in practice, thus providing a starting point for deliberation and contributing to the transparency and accountability of research prioritisation decisions.
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Affiliation(s)
- David Glynn
- Centre for Health Economics, University of York, York, UK.
| | - Vijay S Gc
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
| | - Chris Littlewood
- Allied Health, Social Work & Wellbeing, Edgehill University, Ormskirk, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
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Cruz LJ, Grullón-Rodríguez HM, López-Bencosme Y, Gresse S, Feng YC, Gutiérrez-Martínez A. Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean: Análisis Parcial de Costos e Impacto Económico de la Angioplastia Coronaria Ambulatoria en un Hospital Privado del Caribe. Value Health Reg Issues 2024; 42:100988. [PMID: 38701698 DOI: 10.1016/j.vhri.2024.100988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/13/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022. METHODS This study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a "first-come-first-served" approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient. RESULTS PCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference. CONCLUSIONS PCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.
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Affiliation(s)
- Licurgo J Cruz
- Hospital Metropolitano de Santiago, Autopista Juan Pablo Duarte Km 28, Santiago De Los Caballeros, 51000 Santiago, República Dominicana.
| | - Helio M Grullón-Rodríguez
- Escuela de medicina, Facultad Ciencias de la Salud, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Santiago, República Dominicana
| | - Yanely López-Bencosme
- Escuela de medicina, Facultad Ciencias de la Salud, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Santiago, República Dominicana
| | - Sergio Gresse
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - Yinny Cen Feng
- Escuela de medicina, Facultad Ciencias de la Salud, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Santiago, República Dominicana
| | - Anthony Gutiérrez-Martínez
- Escuela de medicina, Facultad Ciencias de la Salud, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Santiago, República Dominicana
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Heath A, Baio G, Manolopoulou I, Welton NJ. Value of Information for Clinical Trial Design: The Importance of Considering All Relevant Comparators. PHARMACOECONOMICS 2024; 42:479-486. [PMID: 38583100 DOI: 10.1007/s40273-024-01372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
Value of Information (VOI) analyses calculate the economic value that could be generated by obtaining further information to reduce uncertainty in a health economic decision model. VOI has been suggested as a tool for research prioritisation and trial design as it can highlight economically valuable avenues for future research. Recent methodological advances have made it increasingly feasible to use VOI in practice for research; however, there are critical differences between the VOI approach and the standard methods used to design research studies such as clinical trials. We aimed to highlight key differences between the research design approach based on VOI and standard clinical trial design methods, in particular the importance of considering the full decision context. We present two hypothetical examples to demonstrate that VOI methods are only accurate when (1) all feasible comparators are included in the decision model when designing research, and (2) all comparators are retained in the decision model once the data have been collected and a final treatment recommendation is made. Omitting comparators from either the design or analysis phase of research when using VOI methods can lead to incorrect trial designs and/or treatment recommendations. Overall, we conclude that incorrectly specifying the health economic model by ignoring potential comparators can lead to misleading VOI results and potentially waste scarce research resources.
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Affiliation(s)
- Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Statistical Science, University College London, London, UK.
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
| | | | - Nicky J Welton
- Bristol Medical School, University of Bristol, Bristol, UK
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Houy N, Flaig J. Value of information dynamics in Disease X vaccine clinical trials. Vaccine 2024; 42:1521-1533. [PMID: 38311534 DOI: 10.1016/j.vaccine.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Solutions have been proposed to accelerate the development and rollout of vaccines against a hypothetical disease with epidemic or pandemic potential called Disease X. This may involve resolving uncertainties regarding the disease and the new vaccine. However the value for public health of collecting this information will depend on the time needed to perform research, but also on the time needed to produce vaccine doses. We explore this interplay, and its effect on the decision on whether or not to perform research. METHOD We simulate numerically the emergence and transmission of a disease in a population using a susceptible-infected-recovered (SIR) compartmental model with vaccination. Uncertainties regarding the disease and the vaccine are represented by parameter prior distributions. We vary the date at which vaccine doses are available, and the date at which information about parameters becomes available. We use the expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) to measure the value of information. RESULTS As expected, information has less or no value if it comes too late, or (equivalently) if it can only be used too late. However we also find non trivial dynamics for shorter durations of vaccine development. In this parameter area, it can be optimal to implement vaccination without waiting for information depending on the respective durations of dose production and of clinical research. CONCLUSION We illustrate the value of information dynamics in a Disease X outbreak scenario, and present a general approach to properly take into account uncertainties and transmission dynamics when planning clinical research in this scenario. Our method is based on numerical simulation and allows us to highlight non trivial effects that cannot otherwise be investigated.
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Affiliation(s)
- Nicolas Houy
- University of Lyon, Lyon F-69007, France; CNRS, GATE Lyon Saint-Etienne, F-69007, France.
| | - Julien Flaig
- Epidemiology and Modelling of Infectious Diseases (EPIMOD), Lyon F-69002, France.
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Jiao B. Estimating the Potential Benefits of Confirmatory Trials for Drugs with Accelerated Approval: A Comprehensive Value of Information Framework. PHARMACOECONOMICS 2023; 41:1617-1627. [PMID: 37490206 DOI: 10.1007/s40273-023-01303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The US Food and Drug Administration's Accelerated Approval (AA) policy provides a pathway for patients to access potentially life-saving drugs rapidly. However, the use of surrogate endpoints, single-arm designs, and small sample sizes in preliminary trials that support AAs can lead to uncertainty regarding the clinical benefits of such drugs. This study aims to develop a comprehensive value of information (VOI) framework for assessing the potential benefits of future confirmatory trials, accounting for the various uncertainties inherent in preliminary trials. METHODS I formulated an expected value of information from confirmatory trial (EVICT) metric, which evaluates the potential benefits of a confirmatory trial that would reduce those uncertainties by using a clinically meaningful endpoint, a randomized control, and increased sample size. The EVICT metric can quantify the expected benefits of a well-designed confirmatory trial or an inadequately designed one that continues to use surrogate endpoints or single-arm design. The framework was illustrated using a hypothetical AA drug for metastatic breast cancer. RESULTS The case study demonstrates that a highly uncertain preliminary trial of an AA drug was associated with a substantial EVICT. A confirmatory trial with an increased sample size for this AA drug, utilizing a clinically meaningful endpoint and randomized control, yielded a population-level EVICT of $12.6 million. Persistently using a surrogate endpoint and single-arm trial design would reduce the EVICT by 60%. CONCLUSIONS This framework can provide accurate VOI estimates to guide coverage policies, value-based pricing, and the design of confirmatory trials for AA drugs.
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Affiliation(s)
- Boshen Jiao
- Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA.
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Chaudhuri SE, Ben Chaouch Z, Hauber B, Mange B, Zhou M, Christopher S, Bardot D, Sheehan M, Donnelly A, McLaughlin L, Caldwell B, Benz HL, Ho M, Saha A, Gwinn K, Sheldon M, Lo AW. Use of Bayesian decision analysis to maximize value in patient-centered randomized clinical trials in Parkinson's disease. J Biopharm Stat 2023:1-20. [PMID: 36861942 DOI: 10.1080/10543406.2023.2170400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/15/2023] [Indexed: 03/03/2023]
Abstract
A fixed one-sided significance level of 5% is commonly used to interpret the statistical significance of randomized clinical trial (RCT) outcomes. While it is necessary to reduce the false positive rate, the threshold used could be chosen quantitatively and transparently to specifically reflect patient preferences regarding benefit-risk tradeoffs as well as other considerations. How can patient preferences be explicitly incorporated into RCTs in Parkinson's disease (PD), and what is the impact on statistical thresholds for device approval? In this analysis, we apply Bayesian decision analysis (BDA) to PD patient preference scores elicited from survey data. BDA allows us to choose a sample size (n ) and significance level (α ) that maximizes the overall expected value to patients of a balanced two-arm fixed-sample RCT, where the expected value is computed under both null and alternative hypotheses. For PD patients who had previously received deep brain stimulation (DBS) treatment, the BDA-optimal significance levels fell between 4.0% and 10.0%, similar to or greater than the traditional value of 5%. Conversely, for patients who had never received DBS, the optimal significance level ranged from 0.2% to 4.4%. In both of these populations, the optimal significance level increased with the severity of the patients' cognitive and motor function symptoms. By explicitly incorporating patient preferences into clinical trial designs and the regulatory decision-making process, BDA provides a quantitative and transparent approach to combine clinical and statistical significance. For PD patients who have never received DBS treatment, a 5% significance threshold may not be conservative enough to reflect their risk-aversion level. However, this study shows that patients who previously received DBS treatment present a higher tolerance to accept therapeutic risks in exchange for improved efficacy which is reflected in a higher statistical threshold.
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Affiliation(s)
- Shomesh E Chaudhuri
- Laboratory for Financial Engineering, MIT Sloan School of Management, Cambridge, MA, USA
| | - Zied Ben Chaouch
- Laboratory for Financial Engineering, MIT Sloan School of Management, Cambridge, MA, USA
- Electrical Engineering and Computer Science Department, MIT, Cambridge, MA, USA
| | - Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
- CHOICE Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Mo Zhou
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Dawn Bardot
- Medical Device Innovation Consortium, Arlington, VA, USA
| | - Margaret Sheehan
- Patient Council, The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Anne Donnelly
- Patient Council, The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Lauren McLaughlin
- Strategy and Planning, The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Brittany Caldwell
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Heather L Benz
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Martin Ho
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Anindita Saha
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Katrina Gwinn
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Murray Sheldon
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew W Lo
- Laboratory for Financial Engineering, MIT Sloan School of Management, Cambridge, MA, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
- Santa Fe Institute, Santa Fe, NM, USA
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Using early health economic modeling to inform medical innovation development: a soft robotic sock in poststroke patients in Singapore. Int J Technol Assess Health Care 2023; 39:e4. [PMID: 36628458 DOI: 10.1017/s026646232200335x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Based on a real-world collaboration with innovators in applying early health economic modeling, we aimed to offer practical steps that health technology assessment (HTA) researchers and innovators can follow and promote the usage of early HTA among research and development (R&D) communities. METHODS The HTA researcher was approached by the innovator to carry out an early HTA ahead of the first clinical trial of the technology, a soft robotic sock for poststroke patients. Early health economic modeling was selected to understand the potential value of the technology and to help uncover the information gap. Threshold analysis was used to identify the target product profiles. Value-of-information analysis was conducted to understand the uncertainties and the need for further research. RESULTS Based on the expected price and clinical effectiveness by the innovator, the new technology was found to be cost-saving compared to the current practice. Risk reduction in deep vein thrombosis and ankle contracture, the incidence rate of ankle contracture, the compliance rate of the new technology, and utility scores were found to have high impacts on the value-for-money of the new technology. The value of information was low if the new technology can achieve the expected clinical effectiveness. A list of parameters was recommended for data collection in the impending clinical trial. CONCLUSIONS This work, based on a real-world collaboration, has illustrated that early health economic modeling can inform medical innovation development. We provided practical steps in order to achieve more efficient R&D investment in medical innovation moving forward.
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Predictive validity in drug discovery: what it is, why it matters and how to improve it. Nat Rev Drug Discov 2022; 21:915-931. [PMID: 36195754 DOI: 10.1038/s41573-022-00552-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Abstract
Successful drug discovery is like finding oases of safety and efficacy in chemical and biological deserts. Screens in disease models, and other decision tools used in drug research and development (R&D), point towards oases when they score therapeutic candidates in a way that correlates with clinical utility in humans. Otherwise, they probably lead in the wrong direction. This line of thought can be quantified by using decision theory, in which 'predictive validity' is the correlation coefficient between the output of a decision tool and clinical utility across therapeutic candidates. Analyses based on this approach reveal that the detectability of good candidates is extremely sensitive to predictive validity, because the deserts are big and oases small. Both history and decision theory suggest that predictive validity is under-managed in drug R&D, not least because it is so hard to measure before projects succeed or fail later in the process. This article explains the influence of predictive validity on R&D productivity and discusses methods to evaluate and improve it, with the aim of supporting the application of more effective decision tools and catalysing investment in their creation.
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Kirwin E, Round J, Bond K, McCabe C. A Conceptual Framework for Life-Cycle Health Technology Assessment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1116-1123. [PMID: 35779939 DOI: 10.1016/j.jval.2021.11.1373] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Health technology assessment (HTA) uses evidence appraisal and synthesis with economic evaluation to inform adoption decisions. Standard HTA processes sometimes struggle to (1) support decisions that involve significant uncertainty and (2) encourage continued generation of and adaptation to new evidence. We propose the life-cycle (LC)-HTA framework, addressing these challenges by providing additional tools to decision makers and improving outcomes for all stakeholders. METHODS Under the LC-HTA framework, HTA processes align to LC management. LC-HTA introduces changes in HTA methods to minimize analytic time while optimizing decision certainty. Where decision uncertainty exists, we recommend risk-based pricing and research-oriented managed access (ROMA). Contractual procurement agreements define the terms of reassessment and provide additional decision options to HTA agencies. LC-HTA extends value-of-information methods to inform ROMA agreements, leveraging routine, administrative data, and registries to reduce uncertainty. RESULTS LC-HTA enables the adoption of high-value high-risk innovations while improving health system sustainability through risk-sharing and reducing uncertainty. Responsiveness to evolving evidence is improved through contractually embedded decision rules to simplify reassessment. ROMA allows conditional adoption to obtain additional information, with confidence that the net value of that adoption decision is positive. CONCLUSIONS The LC-HTA framework improves outcomes for patients, sponsors, and payers. Patients benefit through earlier access to new technologies. Payers increase the value of the technologies they invest in and gain mechanisms to review investments. Sponsors benefit through greater certainty in outcomes related to their investment, swifter access to markets, and greater opportunities to demonstrate value.
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Affiliation(s)
- Erin Kirwin
- Institute of Health Economics, Edmonton, AB, Canada; Health Organisation, Policy, and Economics, School of Health Sciences, University of Manchester, Manchester, England, UK.
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ken Bond
- Institute of Health Economics, Edmonton, AB, Canada
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, AB, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Dane A, Rex JH, Newell P, Stallard N. The Value of the Information That Can Be Generated: Optimizing Study Design to Enable the Study of Treatments Addressing an Unmet Need for Rare Pathogens. Open Forum Infect Dis 2022; 9:ofac266. [PMID: 35854983 PMCID: PMC9290570 DOI: 10.1093/ofid/ofac266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
In traditional phase 3 trials confirming safety and efficacy of new treatments relative to a comparator, a one-sided type I error rate of 2.5% is traditionally used, and typically leads to minimum sizes of 300-600 subjects per study. However, for rare pathogens, it may be necessary to work with data from as few as 50–100 subjects. For areas with a high unmet need, there is a balance between traditional type I error and power and enabling feasible studies. In such cases, an alternative one-sided alpha level of 5% or 10% should be considered and we review herein the implications of such approaches. Resolving this question requires engagement of patients, the medical community, regulatory agencies, and trial sponsors.
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Lindenberg M, Kramer A, Kok E, Retèl V, Beets G, Ruers T, van Harten W. Image-guided navigation for locally advanced primary and locally recurrent rectal cancer: evaluation of its early cost-effectiveness. BMC Cancer 2022; 22:504. [PMID: 35524234 PMCID: PMC9074374 DOI: 10.1186/s12885-022-09561-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A first pilot study showed that an image-guided navigation system could improve resection margin rates in locally advanced (LARC) and locally recurrent rectal cancer (LRRC) patients. Incremental surgical innovation is often implemented without reimbursement consequences, health economic aspects should however also be taken into account. This study evaluates the early cost-effectiveness of navigated surgery compared to standard surgery in LARC and LRRC. METHODS A Markov decision model was constructed to estimate the expected costs and outcomes for navigated and standard surgery. The input parameters were based on pilot data from a prospective (navigation cohort n = 33) and retrospective (control group n = 142) data. Utility values were measured in a comparable group (n = 63) through the EQ5D-5L. Additionally, sensitivity and value of information analyses were performed. RESULTS Based on this early evaluation, navigated surgery showed incremental costs of €3141 and €2896 in LARC and LRRC. In LARC, navigated surgery resulted in 2.05 Quality-Adjusted Life Years (QALYs) vs 2.02 QALYs for standard surgery. For LRRC, we found 1.73 vs 1.67 QALYs respectively. This showed an Incremental Cost-Effectiveness Ratio (ICER) of €136.604 for LARC and €52.510 for LRRC per QALY gained. In scenario analyses, optimal utilization rates of the navigation technology lowered the ICER to €61.817 and €21.334 for LARC and LRRC. The ICERs of both indications were most sensitive to uncertainty surrounding the risk of progression in the first year after surgery, the risk of having a positive surgical margin, and the costs of the navigation system. CONCLUSION Adding navigation system use is expected to be cost-effective in LRRC and has the potential to become cost-effective in LARC. To increase the probability of being cost-effective, it is crucial to optimize efficient use of both the hybrid OR and the navigation system and identify subgroups where navigation is expected to show higher effectiveness.
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Affiliation(s)
- Melanie Lindenberg
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Division of Psychosocial Research and Epidemiology Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Astrid Kramer
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Esther Kok
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Valesca Retèl
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Division of Psychosocial Research and Epidemiology Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geerard Beets
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Faculty TNW, Group Nanobiophysics, Twente University, Enschede, The Netherlands
| | - Wim van Harten
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
- Division of Psychosocial Research and Epidemiology Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Economic evaluations for intensive care unit randomised clinical trials in Australia and New Zealand: Practical recommendations for researchers. Aust Crit Care 2022; 36:431-437. [PMID: 35341668 DOI: 10.1016/j.aucc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Economic evaluations of intensive care unit (ICU) interventions have specific considerations, including how to cost ICU stays and accurately measure quality of life in survivors. The aim of this article was to develop best practice recommendations for economic evaluations alongside future ICU randomised controlled trials (RCTs). REVIEW METHODS We collated our experience based on expert consensus across several recent economic evaluations to provide best-practice, practical recommendations for researchers conducting economic evaluations alongside RCTs in the ICU. Recommendations were structured according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Task Force Report. RESULTS We discuss recommendations across the components of economic evaluations, including: types of economic evaluation, the population and sample size, study perspective, comparators, time horizon, choice of health outcomes, measurement of effectiveness, measurement and valuation of quality of life, estimating resources and costs, analytical methods, and the increment cost-effectiveness ratio. We also provide future directions for research with regard to developing more robust economic evaluations for the ICU. CONCLUSION Economic evaluations should be built alongside ICU RCTs and should be designed a priori using appropriate follow-up and data collection to capture patient-relevant outcomes. Further work is needed to improve the quality of data available for linkage in Australia as well as developing costing methods for the ICU and appropriate quality of life measurements.
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Jackson CH, Baio G, Heath A, Strong M, Welton NJ, Wilson EC. Value of Information Analysis in Models to Inform Health Policy. ANNUAL REVIEW OF STATISTICS AND ITS APPLICATION 2022; 9:95-118. [PMID: 35415193 PMCID: PMC7612603 DOI: 10.1146/annurev-statistics-040120-010730] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Value of information (VoI) is a decision-theoretic approach to estimating the expected benefits from collecting further information of different kinds, in scientific problems based on combining one or more sources of data. VoI methods can assess the sensitivity of models to different sources of uncertainty and help to set priorities for further data collection. They have been widely applied in healthcare policy making, but the ideas are general to a range of evidence synthesis and decision problems. This article gives a broad overview of VoI methods, explaining the principles behind them, the range of problems that can be tackled with them, and how they can be implemented, and discusses the ongoing challenges in the area.
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Affiliation(s)
| | - Gianluca Baio
- Department of Statistical Science, University College London, London WC1E 6BT, United Kingdom
| | - Anna Heath
- The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, United Kingdom
| | - Nicky J. Welton
- Bristol Medical School (PHS), University of Bristol, Bristol BS8 1QU, United Kingdom
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Murphy P, Glynn D, Dias S, Hodgson R, Claxton L, Beresford L, Cooper K, Tappenden P, Ennis K, Grosso A, Wright K, Cantrell A, Stevenson M, Palmer S. Modelling approaches for histology-independent cancer drugs to inform NICE appraisals: a systematic review and decision-framework. Health Technol Assess 2022; 25:1-228. [PMID: 34990339 DOI: 10.3310/hta25760] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The first histology-independent marketing authorisation in Europe was granted in 2019. This was the first time that a cancer treatment was approved based on a common biomarker rather than the location in the body at which the tumour originated. This research aims to explore the implications for National Institute for Health and Care Excellence appraisals. METHODS Targeted reviews were undertaken to determine the type of evidence that is likely to be available at the point of marketing authorisation and the analyses required to support National Institute for Health and Care Excellence appraisals. Several challenges were identified concerning the design and conduct of trials for histology-independent products, the greater levels of heterogeneity within the licensed population and the use of surrogate end points. We identified approaches to address these challenges by reviewing key statistical literature that focuses on the design and analysis of histology-independent trials and by undertaking a systematic review to evaluate the use of response end points as surrogate outcomes for survival end points. We developed a decision framework to help to inform approval and research policies for histology-independent products. The framework explored the uncertainties and risks associated with different approval policies, including the role of further data collection, pricing schemes and stratified decision-making. RESULTS We found that the potential for heterogeneity in treatment effects, across tumour types or other characteristics, is likely to be a central issue for National Institute for Health and Care Excellence appraisals. Bayesian hierarchical methods may serve as a useful vehicle to assess the level of heterogeneity across tumours and to estimate the pooled treatment effects for each tumour, which can inform whether or not the assumption of homogeneity is reasonable. Our review suggests that response end points may not be reliable surrogates for survival end points. However, a surrogate-based modelling approach, which captures all relevant uncertainty, may be preferable to the use of immature survival data. Several additional sources of heterogeneity were identified as presenting potential challenges to National Institute for Health and Care Excellence appraisal, including the cost of testing, baseline risk, quality of life and routine management costs. We concluded that a range of alternative approaches will be required to address different sources of heterogeneity to support National Institute for Health and Care Excellence appraisals. An exemplar case study was developed to illustrate the nature of the assessments that may be required. CONCLUSIONS Adequately designed and analysed basket studies that assess the homogeneity of outcomes and allow borrowing of information across baskets, where appropriate, are recommended. Where there is evidence of heterogeneity in treatment effects and estimates of cost-effectiveness, consideration should be given to optimised recommendations. Routine presentation of the scale of the consequences of heterogeneity and decision uncertainty may provide an important additional approach to the assessments specified in the current National Institute for Health and Care Excellence methods guide. FURTHER RESEARCH Further exploration of Bayesian hierarchical methods could help to inform decision-makers on whether or not there is sufficient evidence of homogeneity to support pooled analyses. Further research is also required to determine the appropriate basis for apportioning genomic testing costs where there are multiple targets and to address the challenges of uncontrolled Phase II studies, including the role and use of surrogate end points. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 76. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Murphy
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Glynn
- Centre for Health Economics, University of York, York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lindsay Claxton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Beresford
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Kate Ennis
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
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15
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Caron A, Vandewalle V, Marcilly R, Rochat J, Dervaux B. The Optimal Sample Size for Usability Testing, From the Manufacturer's Perspective: A Value-of-Information Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:116-124. [PMID: 35031090 DOI: 10.1016/j.jval.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES For medical devices, a usability assessment is mandatory for market access; the objective is to detect potentially harmful use errors that stem from the device's design. The manufacturer assesses the final version of the device and determines the risk-benefit ratio for remaining errors. Nevertheless, the decision rule currently used to determine the sample size for this testing has statistical limitations and the lack of a clear decision-making perspective. METHODS As an alternative, we developed a value-of-information analysis from the medical device manufacturer's perspective. The consequences of use errors not detected during usability testing and the errors' probability of occurrence were embedded in a loss function. The value of further testing was assessed as a reduction in the expected loss for the manufacturer. The optimal sample size was determined using the expected net benefit of sampling (ENBS) (the difference between the value provided by new participants and the cost of their inclusion). RESULTS The value-of-information approach was applied to a real usability test of a needle-free adrenaline autoinjector. The initial estimate (performed on the first n = 20 participants) gave an optimal sample size of 100 participants and an ENBS of €255 453. This estimation was updated iteratively as new participants were included. After the inclusion of 90 participants, the ENBS was null for any sample size; hence, the cost of adding more participants outweighed the expected value of information, and therefore, the study could be stopped. CONCLUSIONS On the basis of these results, our method seems to be highly suitable for sample size estimation in the usability testing of medical devices before market access.
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Affiliation(s)
| | - Vincent Vandewalle
- ULR 2694, CHU Lille, University of Lille, Lille, France; Inria, Lille, France
| | - Romaric Marcilly
- ULR 2694, CHU Lille, University of Lille, Lille, France; CIC-IT 1403 - Investigation center, CHU Lille, INSERM, Lille, France
| | - Jessica Rochat
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benoit Dervaux
- University Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1167, Lille, France; Direction de la Recherche et de l'Innovation, CHU Lille, Lille, France
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16
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Sharples L, Sastry P, Freeman C, Gray J, McCarthy A, Chiu YD, Bicknell C, McMeekin P, Vallabhaneni SR, Cook A, Vale L, Large S. Endovascular stent grafting and open surgical replacement for chronic thoracic aortic aneurysms: a systematic review and prospective cohort study. Health Technol Assess 2022; 26:1-166. [DOI: 10.3310/abut7744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The management of chronic thoracic aortic aneurysms includes conservative management, watchful waiting, endovascular stent grafting and open surgical replacement. The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA) study investigates timing and intervention choice.
Objective
To describe pre- and post-intervention management of and outcomes for chronic thoracic aortic aneurysms.
Design
A systematic review of intervention effects; a Delphi study of 360 case scenarios based on aneurysm size, location, age, operative risk and connective tissue disorders; and a prospective cohort study of growth, clinical outcomes, costs and quality of life.
Setting
Thirty NHS vascular/cardiothoracic units.
Participants
Patients aged > 17 years who had existing or new aneurysms of ≥ 4 cm in diameter in the arch, descending or thoracoabdominal aorta.
Interventions
Endovascular stent grafting and open surgical replacement.
Main outcomes
Pre-intervention aneurysm growth, pre-/post-intervention survival, clinical events, readmissions and quality of life; and descriptive statistics for costs and quality-adjusted life-years over 12 months and value of information using a propensity score-matched subsample.
Results
The review identified five comparative cohort studies (endovascular stent grafting patients, n = 3955; open surgical replacement patients, n = 21,197). Pooled short-term all-cause mortality favoured endovascular stent grafting (odds ratio 0.71, 95% confidence interval 0.51 to 0.98; no heterogeneity). Data on survival beyond 30 days were mixed. Fewer short-term complications were reported with endovascular stent grafting. The Delphi study included 20 experts (13 centres). For patients with aneurysms of ≤ 6.0 cm in diameter, watchful waiting was preferred. For patients with aneurysms of > 6.0 cm, open surgical replacement was preferred in the arch, except for elderly or high-risk patients, and in the descending aorta if patients had connective tissue disorders. Otherwise endovascular stent grafting was preferred. Between 2014 and 2018, 886 patients were recruited (watchful waiting, n = 489; conservative management, n = 112; endovascular stent grafting, n = 150; open surgical replacement, n = 135). Pre-intervention death rate was 8.6% per patient-year; 49.6% of deaths were aneurysm related. Death rates were higher for women (hazard ratio 1.79, 95% confidence interval 1.25 to 2.57; p = 0.001) and older patients (age 61–70 years: hazard ratio 2.50, 95% confidence interval 0.76 to 5.43; age 71–80 years: hazard ratio 3.49, 95% confidence interval 1.26 to 9.66; age > 80 years: hazard ratio 7.01, 95% confidence interval 2.50 to 19.62; all compared with age < 60 years, p < 0.001) and per 1-cm increase in diameter (hazard ratio 1.90, 95% confidence interval 1.65 to 2.18; p = 0.001). The results were similar for aneurysm-related deaths. Decline per year in quality of life was greater for older patients (additional change –0.013 per decade increase in age, 95% confidence interval –0.019 to –0.007; p < 0.001) and smokers (additional change for ex-smokers compared with non-smokers 0.003, 95% confidence interval –0.026 to 0.032; additional change for current smokers compared with non-smokers –0.034, 95% confidence interval –0.057 to –0.01; p = 0.004). At the time of intervention, endovascular stent grafting patients were older (age difference 7.1 years; 95% confidence interval 4.7 to 9.5 years; p < 0.001) and more likely to be smokers (75.8% vs. 66.4%; p = 0.080), have valve disease (89.9% vs. 71.6%; p < 0.0001), have chronic obstructive pulmonary disease (21.3% vs. 13.3%; p = 0.087), be at New York Heart Association stage III/IV (22.3% vs. 16.0%; p = 0.217), have lower levels of haemoglobin (difference –6.8 g/l, 95% confidence interval –11.2 to –2.4 g/l; p = 0.003) and take statins (69.3% vs. 42.2%; p < 0.0001). Ten (6.7%) endovascular stent grafting and 15 (11.1%) open surgical replacement patients died within 30 days of the procedure (p = 0.2107). One-year overall survival was 82.5% (95% confidence interval 75.2% to 87.8%) after endovascular stent grafting and 79.3% (95% confidence interval 71.1% to 85.4%) after open surgical replacement. Variables affecting survival were aneurysm site, age, New York Heart Association stage and time waiting for procedure. For endovascular stent grafting, utility decreased slightly, by –0.017 (95% confidence interval –0.062 to 0.027), in the first 6 weeks. For open surgical replacement, there was a substantial decrease of –0.160 (95% confidence interval –0.199 to –0.121; p < 0.001) up to 6 weeks after the procedure. Over 12 months endovascular stent grafting was less costly, with higher quality-adjusted life-years. Formal economic analysis was unfeasible.
Limitations
The study was limited by small numbers of patients receiving interventions and because only 53% of patients were suitable for both interventions.
Conclusions
Small (4–6 cm) aneurysms require close observation. Larger (> 6 cm) aneurysms require intervention without delay. Endovascular stent grafting and open surgical replacement were successful for carefully selected patients, but cost comparisons were unfeasible. The choice of intervention is well established, but the timing of intervention remains challenging.
Future work
Further research should include an analysis of the risk factors for growth/rupture and long-term outcomes.
Trial registration
Current Controlled Trials ISRCTN04044627 and NCT02010892.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Priya Sastry
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carol Freeman
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Joanne Gray
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Andrew McCarthy
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Yi-Da Chiu
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Medical Research Council (MRC) Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Colin Bicknell
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - S Rao Vallabhaneni
- Liverpool Vascular & Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Large
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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17
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Wang Y, Rattanavipapong W, Teerawattananon Y. Using health technology assessment to set priority, inform target product profiles, and design clinical study for health innovation. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2021; 172:121000. [PMID: 34732945 PMCID: PMC8524319 DOI: 10.1016/j.techfore.2021.121000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 05/29/2023]
Abstract
Early health technology assessment (early HTA) is a useful tool in guiding the innovation development process in medical technology development. However, the application of early HTA is sub-optimal amongst research and development (R&D) communities due to several challenges. In this paper, we presented a case study of application of early HTA by drawing on the experience from a workshop conducted for the Singapore government's medical technology innovation agency. The framework developed can help maximise the chance of the newly developed technology being accepted and widely used. By providing step-by-step guidance, this work aims to translate early HTA into a practical tool and promote the application of early HTA amongst R&D communities.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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18
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Heath A, Myriam Hunink MG, Krijkamp E, Pechlivanoglou P. Prioritisation and design of clinical trials. Eur J Epidemiol 2021; 36:1111-1121. [PMID: 34091766 PMCID: PMC8629779 DOI: 10.1007/s10654-021-00761-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Clinical trials require participation of numerous patients, enormous research resources and substantial public funding. Time-consuming trials lead to delayed implementation of beneficial interventions and to reduced benefit to patients. This manuscript discusses two methods for the allocation of research resources and reviews a framework for prioritisation and design of clinical trials. The traditional error-driven approach of clinical trial design controls for type I and II errors. However, controlling for those statistical errors has limited relevance to policy makers. Therefore, this error-driven approach can be inefficient, waste research resources and lead to research with limited impact on daily practice. The novel value-driven approach assesses the currently available evidence and focuses on designing clinical trials that directly inform policy and treatment decisions. Estimating the net value of collecting further information, prior to undertaking a trial, informs a decision maker whether a clinical or health policy decision can be made with current information or if collection of extra evidence is justified. Additionally, estimating the net value of new information guides study design, data collection choices, and sample size estimation. The value-driven approach ensures the efficient use of research resources, reduces unnecessary burden to trial participants, and accelerates implementation of beneficial healthcare interventions.
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Affiliation(s)
- Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Biostatistics, University of Toronto, Toronto, ON, Canada.,Department of Statistical Science, University College London, London, UK
| | - M G Myriam Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands. .,Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands. .,Netherlands Institute for Health Sciences, Erasmus MC, University Medical Center, Rotterdam, Netherlands. .,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Eline Krijkamp
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.,Netherlands Institute for Health Sciences, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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19
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Hill-McManus D, Hughes DA. Combining Model-Based Clinical Trial Simulation, Pharmacoeconomics, and Value of Information to Optimize Trial Design. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2020; 10:75-83. [PMID: 33314752 PMCID: PMC7825194 DOI: 10.1002/psp4.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
The Bayesian decision‐analytic approach to trial design uses prior distributions for treatment effects, updated with likelihoods for proposed trial data. Prior distributions for treatment effects based on previous trial results risks sample selection bias and difficulties when a proposed trial differs in terms of patient characteristics, medication adherence, or treatment doses and regimens. The aim of this study was to demonstrate the utility of using pharmacometric‐based clinical trial simulation (CTS) to generate prior distributions for use in Bayesian decision‐theoretic trial design. The methods consisted of four principal stages: a CTS to predict the distribution of treatment response for a range of trial designs; Bayesian updating for a proposed sample size; a pharmacoeconomic model to represent the perspective of a reimbursement authority in which price is contingent on trial outcome; and a model of the pharmaceutical company return on investment linking drug prices to sales revenue. We used a case study of febuxostat versus allopurinol for the treatment of hyperuricemia in patients with gout. Trial design scenarios studied included alternative treatment doses, inclusion criteria, input uncertainty, and sample size. Optimal trial sample sizes varied depending on the uncertainty of model inputs, trial inclusion criteria, and treatment doses. This interdisciplinary framework for trial design and sample size calculation may have value in supporting decisions during later phases of drug development and in identifying costly sources of uncertainty, and thus inform future research and development strategies.
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Affiliation(s)
- Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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20
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Williams BK, Brown ED. Scenarios for valuing sample information in natural resources. Methods Ecol Evol 2020. [DOI: 10.1111/2041-210x.13487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Eleanor D. Brown
- Science and Decisions Center U.S. Geological Survey Reston VA USA
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21
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Houy N, Flaig J. Informed and uninformed empirical therapy policies. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2020; 37:334-350. [PMID: 31875921 DOI: 10.1093/imammb/dqz015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/16/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022]
Abstract
We argue that a proper distinction must be made between informed and uninformed decision making when setting empirical therapy policies, as this allows one to estimate the value of gathering more information about the pathogens and their transmission and thus to set research priorities. We rely on the stochastic version of a compartmental model to describe the spread of an infecting organism in a health care facility and the emergence and spread of resistance to two drugs. We focus on information and uncertainty regarding the parameters of this model. We consider a family of adaptive empirical therapy policies. In the uninformed setting, the best adaptive policy allowsone to reduce the average cumulative infected patient days over 2 years by 39.3% (95% confidence interval (CI), 30.3-48.1%) compared to the combination therapy. Choosing empirical therapy policies while knowing the exact parameter values allows one to further decrease the cumulative infected patient days by 3.9% (95% CI, 2.1-5.8%) on average. In our setting, the benefit of perfect information might be offset by increased drug consumption.
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Affiliation(s)
- Nicolas Houy
- University of Lyon, Lyon, F-69007, France.,CNRS, GATE Lyon Saint-Etienne, F-69130, France
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22
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Zhang Z, Wong WK, Tan KC. Competitive Swarm Optimizer with Mutated Agents for Finding Optimal Designs for Nonlinear Regression Models with Multiple Interacting Factors. MEMETIC COMPUTING 2020; 12:219-233. [PMID: 33747240 PMCID: PMC7968042 DOI: 10.1007/s12293-020-00305-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/22/2020] [Indexed: 06/12/2023]
Abstract
This paper proposes a novel enhancement for Competitive Swarm Optimizer (CSO) by mutating loser particles (agents) from the swarm to increase the swarm diversity and improve space exploration capability, namely Competitive Swarm Optimizer with Mutated Agents (CSO-MA). The selection mechanism is carried out so that it does not retard the search if agents are exploring in promising areas. Simulation results show that CSO-MA has a better exploration-exploitation balance than CSO and generally outperforms CSO, which is one of the state-of-the-art metaheuristic algorithms for optimization. We show additionally that it also generally outperforms swarm based types of algorithms and an exemplary and popular non-swarm based algorithm called Cuckoo search, without requiring a lot more CPU time. We apply CSO-MA to find a c-optimal approximate design for a high-dimensional optimal design problem when other swarm algorithms were not able to. As applications, we use the CSO-MA to search various optimal designs for a series of high-dimensional statistical models. The proposed CSO-MA algorithm is a general-purpose optimizing tool and can be directly amended to find other types of optimal designs for nonlinear models, including optimal exact designs under a convex or non-convex criterion.
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Affiliation(s)
- Zizhao Zhang
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, California 90095-1772, U.S.A
| | - Weng Kee Wong
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, California 90095-1772, U.S.A
| | - Kay Chen Tan
- Department of Computer Science, City University of Hong Kong, Hong Kong
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23
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How simulation modeling can support the public health response to the opioid crisis in North America: Setting priorities and assessing value. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:102726. [PMID: 32359858 DOI: 10.1016/j.drugpo.2020.102726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/13/2020] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
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24
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Rothery C, Strong M, Koffijberg HE, Basu A, Ghabri S, Knies S, Murray JF, Sanders Schmidler GD, Steuten L, Fenwick E. Value of Information Analytical Methods: Report 2 of the ISPOR Value of Information Analysis Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:277-286. [PMID: 32197720 PMCID: PMC7373630 DOI: 10.1016/j.jval.2020.01.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 05/19/2023]
Abstract
The allocation of healthcare resources among competing priorities requires an assessment of the expected costs and health effects of investing resources in the activities and of the opportunity cost of the expenditure. To date, much effort has been devoted to assessing the expected costs and health effects, but there remains an important need to also reflect the consequences of uncertainty in resource allocation decisions and the value of further research to reduce uncertainty. Decision making with uncertainty may turn out to be suboptimal, resulting in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to better inform resource decisions. This value can be quantified using value of information (VOI) analysis. This report from the ISPOR VOI Task Force describes methods for computing 4 VOI measures: the expected value of perfect information, expected value of partial perfect information (EVPPI), expected value of sample information (EVSI), and expected net benefit of sampling (ENBS). Several methods exist for computing EVPPI and EVSI, and this report provides guidance on selecting the most appropriate method based on the features of the decision problem. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing VOI analyses. The software needed to compute VOI is discussed, and areas for future research are highlighted.
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Affiliation(s)
- Claire Rothery
- Centre for Health Economics, University of York, York, England, UK.
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Hendrik Erik Koffijberg
- Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle, Washington, DC, USA
| | - Salah Ghabri
- French National Authority for Health, Paris, France
| | - Saskia Knies
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | | | - Gillian D Sanders Schmidler
- Duke-Margolis Center for Health Policy, Duke Clinical Research Institute and Department of Population Health Sciences, Duke University, Durham, NC, USA
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25
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Fenwick E, Steuten L, Knies S, Ghabri S, Basu A, Murray JF, Koffijberg HE, Strong M, Sanders Schmidler GD, Rothery C. Value of Information Analysis for Research Decisions-An Introduction: Report 1 of the ISPOR Value of Information Analysis Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:139-150. [PMID: 32113617 DOI: 10.1016/j.jval.2020.01.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 05/22/2023]
Abstract
Healthcare resource allocation decisions made under conditions of uncertainty may turn out to be suboptimal. In a resource constrained system in which there is a fixed budget, these suboptimal decisions will result in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to make better resource allocation decisions. This value can be quantified using a value of information (VOI) analysis. This report, from the ISPOR VOI Task Force, introduces VOI analysis, defines key concepts and terminology, and outlines the role of VOI for supporting decision making, including the steps involved in undertaking and interpreting VOI analyses. The report is specifically aimed at those tasked with making decisions about the adoption of healthcare or the funding of healthcare research. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing the results of VOI analyses.
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Affiliation(s)
| | | | - Saskia Knies
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Salah Ghabri
- French National Authority for Health, Paris, France
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - James F Murray
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Hendrik Erik Koffijberg
- Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Gillian D Sanders Schmidler
- Duke-Margolis Center for Health Policy, Duke Clinical Research Institute and Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Claire Rothery
- Centre for Health Economics, University of York, York, England, UK
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Jones DA, Smith J, Mei XW, Hawkins MA, Maughan T, van den Heuvel F, Mee T, Kirkby K, Kirkby N, Gray A. A systematic review of health economic evaluations of proton beam therapy for adult cancer: Appraising methodology and quality. Clin Transl Radiat Oncol 2020; 20:19-26. [PMID: 31754652 PMCID: PMC6854069 DOI: 10.1016/j.ctro.2019.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE With high treatment costs and limited capacity, decisions on which adult patients to treat with proton beam therapy (PBT) must be based on the relative value compared to the current standard of care. Cost-utility analyses (CUAs) are the gold-standard method for doing this. We aimed to appraise the methodology and quality of CUAs in this area. MATERIALS AND METHODS We performed a systematic review of the literature to identify CUA studies of PBT in adult disease using MEDLINE, EMBASE, EconLIT, NHS Economic Evaluation Database (NHS EED), Web of Science, and the Tufts Medical Center Cost-Effectiveness Analysis Registry from 1st January 2010 up to 6th June 2018. General characteristics, information relating to modelling approaches, and methodological quality were extracted and synthesized narratively. RESULTS Seven PBT CUA studies in adult disease were identified. Without randomised controlled trials to inform the comparative effectiveness of PBT, studies used either results from one-armed studies, or dose-response models derived from radiobiological and epidemiological studies of PBT. Costing methods varied widely. The assessment of model quality highlighted a lack of transparency in the identification of model parameters, and absence of external validation of model outcomes. Furthermore, appropriate assessment of uncertainty was often deficient. CONCLUSION In order to foster credibility, future CUA studies must be more systematic in their approach to evidence synthesis and expansive in their consideration of uncertainties in light of the lack of clinical evidence.
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Affiliation(s)
- David A. Jones
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Joel Smith
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Xue W. Mei
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Frank van den Heuvel
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
- Department of Haematology/Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas Mee
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Karen Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Norman Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Jutkowitz E, Alarid-Escudero F, Kuntz KM, Jalal H. The Curve of Optimal Sample Size (COSS): A Graphical Representation of the Optimal Sample Size from a Value of Information Analysis. PHARMACOECONOMICS 2019; 37:871-877. [PMID: 30761461 PMCID: PMC6556417 DOI: 10.1007/s40273-019-00770-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Value of information (VOI) analysis quantifies the opportunity cost associated with decision uncertainty, and thus informs the value of collecting further information to avoid this cost. VOI can inform study design, optimal sample size selection, and research prioritization. Recent methodological advances have reduced the computational burden of conducting VOI analysis and have made it easier to evaluate the expected value of sample information, the expected net benefit of sampling, and the optimal sample size of a study design ([Formula: see text]). The volume of VOI analyses being published is increasing, and there is now a need for VOI studies to conduct sensitivity analyses on VOI-specific parameters. In this practical application, we introduce the curve of optimal sample size (COSS), which is a graphical representation of [Formula: see text] over a range of willingness-to-pay thresholds and VOI parameters (example data and R code are provided). In a single figure, the COSS presents summary data for decision makers to determine the sample size that optimizes research funding given their operating characteristics. The COSS also presents variation in the optimal sample size given variability or uncertainty in VOI parameters. The COSS represents an efficient and additional approach for summarizing results from a VOI analysis.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Drug Policy Program, Center for Research and Teaching in Economics (CIDE)-CONACyT, 20313, Aguascalientes, AGS, Mexico.
| | - Karen M Kuntz
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Hawre Jalal
- Division of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Heath A, Manolopoulou I, Baio G. Estimating the Expected Value of Sample Information across Different Sample Sizes Using Moment Matching and Nonlinear Regression. Med Decis Making 2019; 39:346-358. [PMID: 31161867 DOI: 10.1177/0272989x19837983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The expected value of sample information (EVSI) determines the economic value of any future study with a specific design aimed at reducing uncertainty about the parameters underlying a health economic model. This has potential as a tool for trial design; the cost and value of different designs could be compared to find the trial with the greatest net benefit. However, despite recent developments, EVSI analysis can be slow, especially when optimizing over a large number of different designs. Methods. This article develops a method to reduce the computation time required to calculate the EVSI across different sample sizes. Our method extends the moment-matching approach to EVSI estimation to optimize over different sample sizes for the underlying trial while retaining a similar computational cost to a single EVSI estimate. This extension calculates the posterior variance of the net monetary benefit across alternative sample sizes and then uses Bayesian nonlinear regression to estimate the EVSI across these sample sizes. Results. A health economic model developed to assess the cost-effectiveness of interventions for chronic pain demonstrates that this EVSI calculation method is fast and accurate for realistic models. This example also highlights how different trial designs can be compared using the EVSI. Conclusion. The proposed estimation method is fast and accurate when calculating the EVSI across different sample sizes. This will allow researchers to realize the potential of using the EVSI to determine an economically optimal trial design for reducing uncertainty in health economic models. Limitations. Our method involves rerunning the health economic model, which can be more computationally expensive than some recent alternatives, especially in complex models.
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Affiliation(s)
- Anna Heath
- The Hospital for Sick Children, Toronto, Canada and University of Toronto, Canada
| | | | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
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Brown H, D'Amico F, Knapp M, Orrell M, Rehill A, Vale L, Robinson L. A cost effectiveness analysis of maintenance cognitive stimulation therapy (MCST) for people with dementia: examining the influence of cognitive ability and living arrangements. Aging Ment Health 2019. [PMID: 29528689 DOI: 10.1080/13607863.2018.1442410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Identify if cost-effectiveness of Maintenance Cognitive Simulation Therapy (MCST) differs by type of living arrangement and cognitive ability of the person with dementia. Next, a value of information analysis is performed to inform decisions about future research. METHODS Incremental cost-effectiveness analysis applying seemingly unrelated regressions using data from a multicentre RCT of MCST versus treatment as usual in a population which had already received 7 weeks of CST for dementia (ISRCTN: 26286067). The findings from the cost-effectiveness analysis are used to inform a value of information analysis. RESULTS The results are dependent upon how quality adjusted life years (QALYs) are measured. MCST might be cost-effective compared to standard treatment for those who live alone and those with higher levels of cognitive functioning. If a further RCT was to be conducted for this sub-group of the population, value of information analysis suggests a total sample of 48 complete cases for both sub-groups would be required for a two-arm trial. The expected net gain of conducting this future research is £920 million. CONCLUSION Preliminary results suggest that MCST may be most cost-efficient for people with dementia who live alone and/or who have higher cognition. Future research in this area is needed.
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Affiliation(s)
- Heather Brown
- a Health Economics Group, IHS , Newcastle University , UK
| | - Francesco D'Amico
- b Personal Social Service Research Unit , London School of Economics and Political Science , UK
| | - Martin Knapp
- b Personal Social Service Research Unit , London School of Economics and Political Science , UK
| | - Martin Orrell
- c Institute of Mental Health , University of Nottingham , UK
| | - Amritpal Rehill
- b Personal Social Service Research Unit , London School of Economics and Political Science , UK
| | - Luke Vale
- a Health Economics Group, IHS , Newcastle University , UK
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Jackson C, Presanis A, Conti S, De Angelis D. Value of Information: Sensitivity Analysis and Research Design in Bayesian Evidence Synthesis. J Am Stat Assoc 2019; 114:1436-1449. [PMID: 32165869 PMCID: PMC7034331 DOI: 10.1080/01621459.2018.1562932] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
Suppose we have a Bayesian model that combines evidence from several different sources. We want to know which model parameters most affect the estimate or decision from the model, or which of the parameter uncertainties drive the decision uncertainty. Furthermore, we want to prioritize what further data should be collected. These questions can be addressed by Value of Information (VoI) analysis, in which we estimate expected reductions in loss from learning specific parameters or collecting data of a given design. We describe the theory and practice of VoI for Bayesian evidence synthesis, using and extending ideas from health economics, computer modeling and Bayesian design. The methods are general to a range of decision problems including point estimation and choices between discrete actions. We apply them to a model for estimating prevalence of HIV infection, combining indirect information from surveys, registers, and expert beliefs. This analysis shows which parameters contribute most of the uncertainty about each prevalence estimate, and the expected improvements in precision from specific amounts of additional data. These benefits can be traded with the costs of sampling to determine an optimal sample size. Supplementary materials for this article, including a standardized description of the materials available for reproducing the work, are available as an online supplement.
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Bader C, Cossin S, Maillard A, Bénard A. A new approach for sample size calculation in cost-effectiveness studies based on value of information. BMC Med Res Methodol 2018; 18:113. [PMID: 30348087 PMCID: PMC6198488 DOI: 10.1186/s12874-018-0571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/10/2018] [Indexed: 11/27/2022] Open
Abstract
Background Value of information is now recognized as a reference method in the decision process underpinning cost-effectiveness evaluation. The expected value of perfect information (EVPI) is the expected value from completely reducing the uncertainty surrounding the cost-effectiveness of an innovative intervention. Among sample size calculation methods used in cost-effectiveness studies, only one is coherent with this decision framework. It uses a Bayesian approach and requires data of a pre-existing cost-effectiveness study to derive a valid prior EVPI. When evaluating the cost-effectiveness of innovations, no observed prior EVPI is usually available to calculate the sample size. We here propose a sample size calculation method for cost-effectiveness studies, that follows the value of information theory, and, being frequentist, can be based on assumptions if no observed prior EVPI is available. Methods The general principle of our method is to define the sampling distribution of the incremental net monetary benefit (ΔB), or the distribution of ΔB that would be observed in a planned cost-effectiveness study of size n. Based on this sampling distribution, the EVPI that would remain at the end of the trial (EVPIn) is estimated. The optimal sample size of the planned cost-effectiveness study is the n for which the cost of including an additional participant becomes equal or higher than the value of the information gathered through this inclusion. Results Our method is illustrated through four examples. The first one is used to present the method in depth and describe how the sample size may vary according to the parameters’ value. The three other examples are used to illustrate in different situations how the sample size may vary according to the ceiling cost-effectiveness ratio, and how it compares with a test statistic-based method. We developed an R package (EBASS) to run these calculations. Conclusions Our sample size calculation method follows the value of information theory that is now recommended for analyzing and interpreting cost-effectiveness data, and sets the size of a study that balances its cost and the value of its information. Electronic supplementary material The online version of this article (10.1186/s12874-018-0571-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clément Bader
- CHU Bordeaux, Pôle de santé publique, Service d'information médicale, USMR & CIC 1401 EC (Clinical Epidemiology), F-33000, Bordeaux, France
| | - Sébastien Cossin
- CHU Bordeaux, Pôle de santé publique, Service d'information médicale, USMR & CIC 1401 EC (Clinical Epidemiology), F-33000, Bordeaux, France
| | - Aline Maillard
- CHU Bordeaux, Pôle de santé publique, Service d'information médicale, USMR & CIC 1401 EC (Clinical Epidemiology), F-33000, Bordeaux, France
| | - Antoine Bénard
- CHU Bordeaux, Pôle de santé publique, Service d'information médicale, USMR & CIC 1401 EC (Clinical Epidemiology), F-33000, Bordeaux, France. .,Inserm, Bordeaux Population Health Research Center, team EMOS, UMR 1219, University Bordeaux, F-33000, Bordeaux, France.
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Retèl VP, Steuten LMG, Geukes Foppen MH, Mewes JC, Lindenberg MA, Haanen JBAG, van Harten WH. Early cost-effectiveness of tumor infiltrating lymphocytes (TIL) for second line treatment in advanced melanoma: a model-based economic evaluation. BMC Cancer 2018; 18:895. [PMID: 30219040 PMCID: PMC6139174 DOI: 10.1186/s12885-018-4788-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background An emerging immunotherapy is infusion of tumor infiltrating Lymphocytes (TIL), with objective response rates of around 50% versus 19% for ipilimumab. As an Advanced Therapeutic Medicinal Products (ATMP), TIL is highly personalized and complex therapy. It requests substantial upfront investments from the hospital in: expensive lab-equipment, staff expertise and training, as well as extremely tight hospital logistics. Therefore, an early health economic modelling study, as part of a Coverage with Evidence Development (CED) program, was performed. Methods We used a Markov decision model to estimate the expected costs and outcomes (quality-adjusted life years; QALYs) for TIL versus ipilimumab for second line treatment in metastatic melanoma patients from a Dutch health care perspective over a life long time horizon. Three mutually exclusive health states (stable disease (responders)), progressive disease and death) were modelled. To inform further research prioritization, Value of Information (VOI) analysis was performed. Results TIL is expected to generate more QALYs compared to ipilimumab (0.45 versus 0.38 respectively) at lower incremental cost (presently €81,140 versus €94,705 respectively) resulting in a dominant ICER (less costly and more effective). Based on current information TIL is dominating ipilimumab and has a probability of 86% for being cost effective at a cost/QALY threshold of €80,000. The Expected Value of Perfect Information (EVPI) amounted to €3 M. Conclusions TIL is expected to have the highest probability of being cost-effective in second line treatment for advanced melanoma compared to ipilimumab. To reduce decision uncertainty, a clinical trial investigating e.g. costs and survival seems most valuable. This is currently being undertaken as part of a CED program in the Netherlands Cancer Institute, Amsterdam, the Netherlands, in collaboration with Denmark.
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Affiliation(s)
- Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands. .,Department of Health Technology and Services Research, University of Twente, Postbus 217, 7500, AE, Enschede, the Netherlands.
| | - Lotte M G Steuten
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Marnix H Geukes Foppen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Janne C Mewes
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Melanie A Lindenberg
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands.,Department of Health Technology and Services Research, University of Twente, Postbus 217, 7500, AE, Enschede, the Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands.,Department of Health Technology and Services Research, University of Twente, Postbus 217, 7500, AE, Enschede, the Netherlands
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Li L, Uyei J, Nucifora KA, Kessler J, Stevens ER, Bryant K, Braithwaite RS. Using value of information methods to determine the optimal sample size for effectiveness trials of alcohol interventions for HIV-infected patients in East Africa. BMC Health Serv Res 2018; 18:590. [PMID: 30064428 PMCID: PMC6069863 DOI: 10.1186/s12913-018-3356-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Unhealthy alcohol consumption exacerbates the HIV epidemic in East Africa. Potential benefits of new trials that test the effectiveness of alcohol interventions could not be evaluated by traditional sampling methods. Given the competition for health care resources in East Africa, this study aims to determine the optimal sample size given the opportunity cost of potentially re-allocating trial funds towards cost-effective alcohol treatments. Methods We used value of information methods to determine the optimal sample size by maximizing the expected net benefit of sampling for a hypothetical 2-arm intervention vs. control randomized trial, across ranges of policymaker’s willingness-to-pay for the health benefit of an intervention. Probability distributions describing the relative likelihood of alternative trial results were imputed based on prior studies. In the base case, policymaker’s willingness-to-pay was based on a simultaneously resource-constrained priority (routine HIV virological testing). Sensitivity analysis was performed for various willingness-to-pay thresholds and intervention durations. Results A new effectiveness trial accounting for the benefit of more precise decision-making on alcohol intervention implementation would benefit East Africa $67,000 with the optimal sample size of 100 persons per arm under the base case willingness-to-pay threshold and intervention duration of 20 years. At both a conservative willingness-to-pay of 1 x GDP/capita and a high willingness-to-pay of 3 x GDP/capita for an additional health gain added by an alcohol intervention, a new trial was not recommended due to limited decision uncertainty. When intervention duration was 10 or 5 years, there was no return on investment across suggested willingness-to-pay thresholds. Conclusions Value of information methods could be used as an alternative approach to assist the efficient design of alcohol trials. If reducing unhealthy alcohol use is a long-term goal for HIV programs in East Africa, additional new trials with optimal sample sizes ranging from 100 to 250 persons per arm could save the opportunity cost of implementing less cost-effective alcohol strategies in HIV prevention. Otherwise, conducting a new trial is not recommended.
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Affiliation(s)
- Lingfeng Li
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Jennifer Uyei
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kimberly A Nucifora
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA.
| | - Jason Kessler
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Elizabeth R Stevens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
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Basu A, Meltzer D. Decision Criterion and Value of Information Analysis: Optimal Aspirin Dosage for Secondary Prevention of Cardiovascular Events. Med Decis Making 2018; 38:427-438. [PMID: 29529923 PMCID: PMC11379057 DOI: 10.1177/0272989x17746988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In value of information (VOI) calculations, such as the expected value of perfect information (EVPI), partial perfect information (EVPPI), sample information (EVSI) or implementation (EVIM), the maximum expected value criterion defines the decision making criterion for the adoption of decisions for treatments. However, because decision makers are often risk averse, the uncertainty that accompanies a decision problem may influence adoption decisions. METHODS VOI estimates were studied based on 2 alternate decision making criteria: 1) maximum expected value and 2) 95% credible intervals. These criteria were applied to a probabilistic minimal lifetime model of incident cardiovascular events and mortality among target patients comparing 2 daily doses of aspirin (81 mg and 325 mg). Model parameters were based on literature reviews and data analyses. RESULTS Expected life-years under 81 v. 325 mg of aspirin were estimated to be 14.86 (SE, 0.10) and 14.72 (0.31) respectively, with a difference of 0.14 (0.29). The probability that 81 mg was optimal was estimated to be 67%. Under Decision Criterion 1, EVIM and EVPI were about 233-thousand and 411-thousand years, respectively. Under Criterion 2, EVIM was undefined, as there remains ambiguity about what to implement. Consequently, EVPI becomes the entire 644-thousand years. Also, under Criterion 1, EVSI reaches an asymptote at a sample size of 10,000 per arm, with minimal gains in value beyond a 5,000 person per arm trial. With Criterion 2, a sample size of 10,000 per arm or higher is substantially more valuable than lower sample sizes. CONCLUSION Alternative decision criteria for treatment adoption change the VOI. Decision criteria should be justified for VOI analyses. If multiple criteria may be relevant, analysts should complete VOI estimates using multiple criteria.
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Affiliation(s)
- Anirban Basu
- The Comparative Health Outcome, Policy, and Economics (CHOICE) Institute, Department of Pharmacy and the Departments of Health Services and Economics, University of Washington, Seattle, WA, USA
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, Harris School of Public Policy Studies and the Department of Economics, The University of Chicago, Chicago, IL, USA
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Homer T, Shen J, Vale L, McColl E, Tincello DG, Hilton P. Invasive urodynamic testing prior to surgical treatment for stress urinary incontinence in women: cost-effectiveness and value of information analyses in the context of a mixed methods feasibility study. Pilot Feasibility Stud 2018; 4:67. [PMID: 29588862 PMCID: PMC5865344 DOI: 10.1186/s40814-018-0255-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?) was a mixed methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing (IUT) prior to surgery for stress urinary incontinence (SUI) in women. Here we report one of the study's five components, with the specific objectives of (i) exploring the cost-effectiveness of IUT compared with clinical assessment plus non-invasive tests (henceforth described as 'IUT' and 'no IUT' respectively) in women with SUI or stress-predominant mixed urinary incontinence (MUI) prior to surgery, and (ii) determining the expected net gain (ENG) from additional research. METHODS Study participants were women with SUI or stress-predominant MUI who had failed to respond to conservative treatments recruited from seven UK urogynaecology and female urology units. They were randomised to receive either 'IUT' or 'no IUT' before undergoing further treatment. Data from 218 women were used in the economic analysis. Cost utility, net benefit and value of information (VoI) analyses were performed within a randomised controlled pilot trial. Costs and quality-adjusted life years (QALYs) were estimated over 6 months to determine the incremental cost per QALY of 'IUT' compared to 'no IUT'. Net monetary benefit informed the VoI analysis. The VoI estimated the ENG and optimal sample size for a future definitive trial. RESULTS At 6 months, the mean difference in total average cost was £138 (p = 0.071) in favour of 'IUT'; there was no difference in QALYs estimated from the SF-12 (difference 0.004; p = 0.425) and EQ-5D-3L (difference - 0.004; p = 0.725); therefore, the probability of IUT being cost-effective remains uncertain. The estimated ENG was positive for further research to address this uncertainty with an optimal sample size of 404 women. CONCLUSIONS This is the largest economic evaluation of IUT. On average, up to 6 months after treatment, 'IUT' may be cost-saving compared to 'no IUT' because of the reduction in surgery following invasive investigation. However, uncertainty remains over the probability of 'IUT' being considered cost-effective, especially in the longer term. The VoI analysis indicated that further research would be of value. TRIAL REGISTRATION ISRCTN. ISRCTN71327395. Registered 7 June 2010.
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Affiliation(s)
- Tara Homer
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Jing Shen
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Luke Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul Hilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Pearce M, Hee SW, Madan J, Posch M, Day S, Miller F, Zohar S, Stallard N. Value of information methods to design a clinical trial in a small population to optimise a health economic utility function. BMC Med Res Methodol 2018; 18:20. [PMID: 29422021 PMCID: PMC5806391 DOI: 10.1186/s12874-018-0475-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/14/2018] [Indexed: 01/20/2023] Open
Abstract
Background Most confirmatory randomised controlled clinical trials (RCTs) are designed with specified power, usually 80% or 90%, for a hypothesis test conducted at a given significance level, usually 2.5% for a one-sided test. Approval of the experimental treatment by regulatory agencies is then based on the result of such a significance test with other information to balance the risk of adverse events against the benefit of the treatment to future patients. In the setting of a rare disease, recruiting sufficient patients to achieve conventional error rates for clinically reasonable effect sizes may be infeasible, suggesting that the decision-making process should reflect the size of the target population. Methods We considered the use of a decision-theoretic value of information (VOI) method to obtain the optimal sample size and significance level for confirmatory RCTs in a range of settings. We assume the decision maker represents society. For simplicity we assume the primary endpoint to be normally distributed with unknown mean following some normal prior distribution representing information on the anticipated effectiveness of the therapy available before the trial. The method is illustrated by an application in an RCT in haemophilia A. We explicitly specify the utility in terms of improvement in primary outcome and compare this with the costs of treating patients, both financial and in terms of potential harm, during the trial and in the future. Results The optimal sample size for the clinical trial decreases as the size of the population decreases. For non-zero cost of treating future patients, either monetary or in terms of potential harmful effects, stronger evidence is required for approval as the population size increases, though this is not the case if the costs of treating future patients are ignored. Conclusions Decision-theoretic VOI methods offer a flexible approach with both type I error rate and power (or equivalently trial sample size) depending on the size of the future population for whom the treatment under investigation is intended. This might be particularly suitable for small populations when there is considerable information about the patient population. Electronic supplementary material The online version of this article (10.1186/s12874-018-0475-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Siew Wan Hee
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Posch
- Section of Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - Simon Day
- Clinical Trials Consulting and Training Limited, Buckingham, UK
| | - Frank Miller
- Department of Statistics, Stockholm University, Stockholm, Sweden
| | - Sarah Zohar
- INSERM, U1138, team 22, Centre de Recherche des Cordeliers, Université Paris 5, Université Paris 6, Paris, France
| | - Nigel Stallard
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
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Burt T, Button KS, Thom H, Noveck RJ, Munafò MR. The Burden of the "False-Negatives" in Clinical Development: Analyses of Current and Alternative Scenarios and Corrective Measures. Clin Transl Sci 2017; 10:470-479. [PMID: 28675646 PMCID: PMC6402187 DOI: 10.1111/cts.12478] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/10/2017] [Indexed: 01/26/2023] Open
Abstract
The “false‐negatives” of clinical development are the effective treatments wrongly determined ineffective. Statistical errors leading to “false‐negatives” are larger than those leading to “false‐positives,” especially in typically underpowered early‐phase trials. In addition, “false‐negatives” are usually eliminated from further testing, thereby limiting the information available on them. We simulated the impact of early‐phase power on economic productivity in three developmental scenarios. Scenario 1, representing the current status quo, assumed 50% statistical power at phase II and 90% at phase III. Scenario 2 assumed increased power (80%), and Scenario 3, increased stringency of alpha (1%) at phase II. Scenario 2 led, on average, to a 60.4% increase in productivity and 52.4% increase in profit. Scenario 3 had no meaningful advantages. Our results suggest that additional costs incurred by increasing the power of phase II studies are offset by the increase in productivity. We discuss the implications of our results and propose corrective measures.
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Affiliation(s)
- T Burt
- Burt Consultancy, LLC., Durham, North Carolina, USA
| | - K S Button
- Department of Psychology, University of Bath, UK
| | - Hhz Thom
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R J Noveck
- Department of Medicine, Division of Clinical Pharmacology, Duke Clinical Research Unit, Durham, North Carolina, USA
| | - M R Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, UK
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Dakin H, Gray A. Economic evaluation of factorial randomised controlled trials: challenges, methods and recommendations. Stat Med 2017; 36:2814-2830. [PMID: 28470760 PMCID: PMC5599939 DOI: 10.1002/sim.7322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/04/2017] [Indexed: 12/03/2022]
Abstract
Increasing numbers of economic evaluations are conducted alongside randomised controlled trials. Such studies include factorial trials, which randomise patients to different levels of two or more factors and can therefore evaluate the effect of multiple treatments alone and in combination. Factorial trials can provide increased statistical power or assess interactions between treatments, but raise additional challenges for trial‐based economic evaluations: interactions may occur more commonly for costs and quality‐adjusted life‐years (QALYs) than for clinical endpoints; economic endpoints raise challenges for transformation and regression analysis; and both factors must be considered simultaneously to assess which treatment combination represents best value for money. This article aims to examine issues associated with factorial trials that include assessment of costs and/or cost‐effectiveness, describe the methods that can be used to analyse such studies and make recommendations for health economists, statisticians and trialists. A hypothetical worked example is used to illustrate the challenges and demonstrate ways in which economic evaluations of factorial trials may be conducted, and how these methods affect the results and conclusions. Ignoring interactions introduces bias that could result in adopting a treatment that does not make best use of healthcare resources, while considering all interactions avoids bias but reduces statistical power. We also introduce the concept of the opportunity cost of ignoring interactions as a measure of the bias introduced by not taking account of all interactions. We conclude by offering recommendations for planning, analysing and reporting economic evaluations based on factorial trials, taking increased analysis costs into account. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.
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Affiliation(s)
- Helen Dakin
- Nuffield Department of Population Health, University of Oxford, U.K
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, U.K
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Yaman A, Chakrabarti S, Sen A, Weng C. How Have Cancer Clinical Trial Eligibility Criteria Evolved Over Time? AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2016; 2016:269-78. [PMID: 27570681 PMCID: PMC5001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Knowledge reuse of cancer trial designs may benefit from a temporal understanding of the evolution of the target populations of cancer studies over time. Therefore, we conducted a retrospective analysis of the trends of cancer trial eligibility criteria between 1999 and 2014. The yearly distributions of eligibility concepts for chemicals and drugs, procedures, observations, and medical conditions extracted from free-text eligibility criteria of 32,000 clinical trials for 89 cancer types were analyzed. We identified the concepts that trend upwards or downwards in all or selected cancer types, and the concepts that show anomalous trends for some cancers. Later, concept trends were studied in a disease-specific manner and illustrated for breast cancer. Criteria trends observed in this study are also validated and interpreted using evidence from the existing medical literature. This study contributes a method for concept trend analysis and original knowledge of the trends in cancer clinical trial eligibility criteria.
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Affiliation(s)
- Anil Yaman
- Department of Biomedical Informatics, Columbia University, New York, NY USA
| | - Shreya Chakrabarti
- Department of Biomedical Informatics, Columbia University, New York, NY USA
| | - Anando Sen
- Department of Biomedical Informatics, Columbia University, New York, NY USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY USA
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40
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Califf RM. Pragmatic clinical trials: Emerging challenges and new roles for statisticians. Clin Trials 2016; 13:471-7. [DOI: 10.1177/1740774516656944] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients, clinicians, and policymakers alike need access to high-quality scientific evidence in order to make informed choices about health and healthcare, but the current national clinical trials enterprise is not yet optimally configured for the efficient creation and dissemination of such evidence. However, new technologies and methods hold significant potential for accelerating the rate at which we are able to translate raw findings gathered from both patient care and clinical research into actionable knowledge. We are now entering a period in which the quantitative sciences are emerging as the critical disciplines for advancing knowledge about health and healthcare, and statisticians will increasingly serve as critical mediators in transforming data into evidence. In this new, data-centric era, biostatisticians not only need to be expert at analyzing data but should also be involved directly in diverse efforts, including the review and analysis of research portfolios in order to optimize the relevance of research questions, the use of “quality by design” principles to improve reliability and validity of each individual trial, and the mining of aggregate knowledge derived from the clinical research enterprise as a whole. In order to meet these challenges, it is imperative that we (1) nurture and build the biostatistical workforce, (2) develop a deeper understanding of the biological and clinical context among statisticians, (3) facilitate collaboration among biostatisticians and other members of the clinical trials enterprise, (4) focus on communication skills in training and education programs, and (5) enhance the quantitative capacity of the research and clinical practice worlds.
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Tuffaha HW, Gordon LG, Scuffham PA. Value of Information Analysis Informing Adoption and Research Decisions in a Portfolio of Health Care Interventions. MDM Policy Pract 2016; 1:2381468316642238. [PMID: 30288400 PMCID: PMC6125050 DOI: 10.1177/2381468316642238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/01/2016] [Indexed: 01/13/2023] Open
Abstract
Background: Value of information (VOI) analysis quantifies the value of additional research in reducing decision uncertainty. It addresses adoption and research decisions simultaneously by comparing the expected benefits and costs of research studies. Nevertheless, the application of this approach in practice remains limited. Objectives: To apply VOI analysis in health care interventions to guide adoption decisions, optimize trial design, and prioritize research. Methods: The analysis was from the perspective of Queensland Health, Australia. It included four interventions: clinically indicated catheter replacement, tissue adhesive for securing catheters, negative pressure wound therapy (NPWT) in caesarean sections, and nutritional support for preventing pressure ulcers. For each intervention, cost-effectiveness analysis was performed, decision uncertainty characterized, and VOI calculated using Monte Carlo simulations. The benefits and costs of additional research were considered together with the costs and consequences of acting now versus waiting for more information. All values are reported in 2014 Australian dollars (AU$). Results: All interventions were cost-effective, but with various levels of decision uncertainty. The current evidence is sufficient to support the adoption of clinically indicated catheter replacement. For the tissue adhesive, an additional study before adoption is worthwhile with a four-arm trial of 220 patients per arm. Additional research on NPWT before adoption is worthwhile with a two-arm trial of 200 patients per arm. Nutritional support should be adopted with a two-arm trial of 1200 patients per arm. Based on the expected net monetary benefits, the studies were ranked as follows: 1) NPWT (AU$1.2 million), 2) tissue adhesive (AU$0.3 milliion), and 3) nutritional support (AU$0.1 million). Conclusions: VOI analysis is a useful and practical approach to inform adoption and research decisions. Efforts should be focused on facilitating its integration into decision making frameworks.
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Affiliation(s)
- Haitham W. Tuffaha
- Haitham W. Tuffaha, Centre for Applied
Health Economics, School of Medicine, Griffith University, Meadowbrook,
Queensland 4131, Australia; telephone: 61 7 338 21156; fax: 61 7 338 21338;
e-mail:
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Abstract
Background The results of the HOPE study, a randomized clinical trial, provide strong evidence that 1) ramipril prevents the composite outcome of cardiovascular death, myocardial infarction or stroke in patients who are at high risk of a cardiovascular event and 2) ramipril is cost-effective at a threshold willingness-to-pay of $10 000 to prevent an event of the composite outcome. In this report the concept of the expected value of information is used to determine if the information provided by the HOPE study is sufficient for decision making in the US and Canada. Methods and results Using the cost-effectiveness data from a clinical trial, or from a meta-analysis of several trials, one can determine, based on the number of future patients that would benefit from the health technology under investigation, the expected value of sample information (EVSI) of a future trial as a function of proposed sample size. If the EVSI exceeds the cost for any particular sample size then the current information is insufficient for decision making and a future trial is indicated. If, on the other hand, there is no sample size for which the EVSI exceeds the cost, then there is sufficient information for decision making and no future trial is required. Using the data from the HOPE study these concepts are applied for various assumptions regarding the fixed and variable cost of a future trial and the number of patients who would benefit from ramipril. Conclusions Expected value of information methods provide a decision-analytic alternative to the standard likelihood methods for assessing the evidence provided by cost-effectiveness data from randomized clinical trials. Clinical Trials 2007; 4: 279—285. http://ctj.sagepub.com
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Affiliation(s)
- Andrew R Willan
- Program in Child Health Evaluation Sciences, SickKids Research Institute and Department of Public Health Sciences, University of Toronto, Toronto, Canada.
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Paleri V, Wood J, Patterson J, Stocken DD, Cole M, Vale L, Franks J, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Rousseau N. A feasibility study incorporating a pilot randomised controlled trial of oral feeding plus pre-treatment gastrostomy tube versus oral feeding plus as-needed nasogastric tube feeding in patients undergoing chemoradiation for head and neck cancer (TUBE trial): study protocol. Pilot Feasibility Stud 2016; 2:29. [PMID: 27965848 PMCID: PMC5154009 DOI: 10.1186/s40814-016-0069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/17/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date, not been compared to assess which leads to a better patient outcome. The purpose of this study is to explore the feasibility of conducting a randomised controlled trial (RCT) comparing these two options with particular emphasis on patient willingness to be randomised and clinician willingness to approach eligible patients. METHODS/DESIGN This is a mixed methods multicentre study to establish the feasibility of a randomised controlled trial comparing oral feeding plus pre-treatment gastrostomy versus oral feeding plus as required nasogastric tube feeding in patients with HNSCC. A total of 60 participants will be randomised to the two arms of the study (1:1 ratio). The primary outcome of feasibility is a composite of recruitment (willingness to randomise and be randomised) and retention. A qualitative process evaluation investigating patient, family and friends and staff experiences of trial participation will also be conducted alongside an economic modelling exercise to synthesise available evidence and provide estimates of cost-effectiveness and value of information. Participants will be assessed at baseline (pre-randomisation), during CRT weekly, 3 months and 6 months. DISCUSSION Clinicians are in equipoise over the enteral feeding options for patients being treated with CRT. Swallowing outcomes have been identified as a top priority for patients following treatment and this trial would inform a future larger scale RCT in this area to inform best practice. TRIAL REGISTRATION ISRCTN48569216.
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Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology–Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- University of Manchester, Manchester, UK
| | | | - Joanne Patterson
- City Hospitals Sunderland NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D. Stocken
- Clinical Trials and Biostatistics, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mike Cole
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Stewart Barclay
- Restorative Dentistry, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Tuffaha HW, Strong M, Gordon LG, Scuffham PA. Efficient Value of Information Calculation Using a Nonparametric Regression Approach: An Applied Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:505-509. [PMID: 27325343 DOI: 10.1016/j.jval.2016.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/18/2016] [Accepted: 01/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Value-of-information (VOI) analysis provides an analytical framework to assess whether obtaining additional evidence is worthwhile to reduce decision uncertainty. The reporting of VOI measures, particularly the expected value of perfect parameter information (EVPPI) and the expected value of sample information (EVSI), is limited because of the computational burden associated with typical two-level Monte-Carlo-based solution. Recently, a nonparametric regression approach was proposed that allows the estimation of multiparameter EVPPI and EVSI directly from a probabilistic sensitivity analysis sample. OBJECTIVES To demonstrate the value of the nonparametric regression approach in calculating VOI measures in real-world cases and to compare its performance with the standard approach of the Monte-Carlo simulation. METHODS We used the regression approach to calculate EVPPI and EVSI in two models, and compared the results with the estimates obtained via the standard Monte-Carlo simulation. RESULTS The VOI values from the two approaches were very close; computation using the regression method, however, was faster. CONCLUSION The nonparametric regression approach provides an efficient and easy-to-implement alternative for EVPPI and EVSI calculation in economic models.
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Affiliation(s)
- Haitham W Tuffaha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia.
| | - Mark Strong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louisa G Gordon
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
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Lee MMY, Petrie MC, Rocchiccioli P, Simpson J, Jackson C, Brown A, Corcoran D, Mangion K, McEntegart M, Shaukat A, Rae A, Hood S, Peat E, Findlay I, Murphy C, Cormack A, Bukov N, Balachandran K, Papworth R, Ford I, Briggs A, Berry C. Non-invasive versus invasive management in patients with prior coronary artery bypass surgery with a non-ST segment elevation acute coronary syndrome: study design of the pilot randomised controlled trial and registry (CABG-ACS). Open Heart 2016; 3:e000371. [PMID: 27110377 PMCID: PMC4838768 DOI: 10.1136/openhrt-2015-000371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/06/2016] [Indexed: 01/10/2023] Open
Abstract
Introduction There is an evidence gap about how to best treat patients with prior coronary artery bypass grafts (CABGs) presenting with non-ST segment elevation acute coronary syndromes (NSTE-ACS) because historically, these patients were excluded from pivotal randomised trials. We aim to undertake a pilot trial of routine non-invasive management versus routine invasive management in patients with NSTE-ACS with prior CABG and optimal medical therapy during routine clinical care. Our trial is a proof-of-concept study for feasibility, safety, potential efficacy and health economic modelling. We hypothesise that a routine invasive approach in patients with NSTE-ACS with prior CABG is not superior to a non-invasive approach with optimal medical therapy. Methods and analysis 60 patients will be enrolled in a randomised clinical trial in 4 hospitals. A screening log will be prospectively completed. Patients not randomised due to lack of eligibility criteria and/or patient or physician preference and who give consent will be included in a registry. We will gather information about screening, enrolment, eligibility, randomisation, patient characteristics and adverse events (including post-discharge). The primary efficacy outcome is the composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction and hospitalisation for heart failure. The primary safety outcome is the composite of bleeding, stroke, procedure-related myocardial infarction and worsening renal function. Health status will be assessed using EuroQol 5 Dimensions (EQ-5D) assessed at baseline and 6 monthly intervals, for at least 18 months. Trial registration number NCT01895751 (ClinicalTrials.gov).
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Affiliation(s)
- Matthew M Y Lee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Western Infirmary, Glasgow, UK; Royal Alexandra Hospital, Paisley, UK; Glasgow Royal Infirmary, Glasgow, UK
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Glasgow Royal Infirmary, Glasgow, UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Glasgow Royal Infirmary, Glasgow, UK
| | - Joanne Simpson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colette Jackson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ammani Brown
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Western Infirmary, Glasgow, UK
| | - David Corcoran
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Western Infirmary, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Glasgow Royal Infirmary, Glasgow, UK
| | - Alan Rae
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Glasgow Royal Infirmary, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Royal Alexandra Hospital, Paisley, UK
| | - Eileen Peat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Royal Alexandra Hospital, Paisley, UK
| | | | | | | | | | | | - Richard Papworth
- Robertson Centre for Biostatistics, University of Glasgow , Glasgow , UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow , Glasgow , UK
| | - Andrew Briggs
- Department of Health Economics and Health Technology Assessment , University of Glasgow , Glasgow , UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Western Infirmary, Glasgow, UK
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Bayar MA, Le Teuff G, Michiels S, Sargent DJ, Le Deley MC. New insights into the evaluation of randomized controlled trials for rare diseases over a long-term research horizon: a simulation study. Stat Med 2016; 35:3245-58. [DOI: 10.1002/sim.6942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Mohamed Amine Bayar
- Biostatistics and Epidemiology Unit; Gustave Roussy; Villejuif France
- Université Paris-Saclay, Université Paris-Sud; CESP, INSERM; Villejuif France
| | - Gwénaël Le Teuff
- Biostatistics and Epidemiology Unit; Gustave Roussy; Villejuif France
- Université Paris-Saclay, Université Paris-Sud; CESP, INSERM; Villejuif France
| | - Stefan Michiels
- Biostatistics and Epidemiology Unit; Gustave Roussy; Villejuif France
- Université Paris-Saclay, Université Paris-Sud; CESP, INSERM; Villejuif France
| | - Daniel J. Sargent
- Department of Health Science Research, Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester MN U.S.A
| | - Marie-Cécile Le Deley
- Biostatistics and Epidemiology Unit; Gustave Roussy; Villejuif France
- Université Paris-Saclay, Université Paris-Sud; CESP, INSERM; Villejuif France
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Bennette CS, Veenstra DL, Basu A, Baker LH, Ramsey SD, Carlson JJ. Development and Evaluation of an Approach to Using Value of Information Analyses for Real-Time Prioritization Decisions Within SWOG, a Large Cancer Clinical Trials Cooperative Group. Med Decis Making 2016; 36:641-51. [PMID: 27012232 DOI: 10.1177/0272989x16636847] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 12/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Value of information (VOI) analyses can align research with areas with the greatest potential impact on patient outcome, but questions remain concerning the feasibility and acceptability of these approaches to inform prioritization decisions. Our objective was to develop a process for calculating VOI in "real time" to inform trial funding decisions within SWOG, a large cancer clinical trials group. METHODS We developed an efficient and scalable VOI modeling approach using a selected sample of 9 randomized phase II/III trial proposals from the Breast, Gastrointestinal, and Genitourinary Disease Committees reviewed by SWOG's leadership between 2008 and 2013. There was bidirectional communication between SWOG investigators and the research team throughout the modeling development. Partial expected value of sample information for the treatment effect evaluated by the proposed trial's primary endpoint was calculated using Monte Carlo simulation. RESULTS We derived prior uncertainty in the treatment effect estimate from the sample size calculations. Our process was feasible for 8 of 9 trial proposals and efficient: the time required of 1 researcher was <1 week per proposal. We accommodated stakeholder input primarily by deconstructing VOI metrics into expected health benefits and incremental healthcare costs and assuming treatment decisions within our simulations were based on health benefits. Following customization, feedback from over 200 SWOG members was positive regarding the overall VOI framework, specific retrospective results, and potential for VOI analyses to inform future trial proposal evaluations. CONCLUSIONS We developed an efficient and customized process to calculate the expected VOI of cancer clinical trials that is feasible for use in decision making and acceptable to investigators. Prospective use and evaluation of this approach is currently underway within SWOG.
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Affiliation(s)
- Caroline S Bennette
- Departments of Pharmacy, University of Washington, Seattle, Washington (CSB, DLV, JJC)
| | - David L Veenstra
- Departments of Pharmacy, University of Washington, Seattle, Washington (CSB, DLV, JJC)
| | - Anirban Basu
- Washington Health Services, University of Washington, Seattle, Washington (AB)
| | | | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington (SDR)
| | - Josh J Carlson
- Departments of Pharmacy, University of Washington, Seattle, Washington (CSB, DLV, JJC)
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Scannell JW, Bosley J. When Quality Beats Quantity: Decision Theory, Drug Discovery, and the Reproducibility Crisis. PLoS One 2016; 11:e0147215. [PMID: 26863229 PMCID: PMC4749240 DOI: 10.1371/journal.pone.0147215] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022] Open
Abstract
A striking contrast runs through the last 60 years of biopharmaceutical discovery, research, and development. Huge scientific and technological gains should have increased the quality of academic science and raised industrial R&D efficiency. However, academia faces a "reproducibility crisis"; inflation-adjusted industrial R&D costs per novel drug increased nearly 100 fold between 1950 and 2010; and drugs are more likely to fail in clinical development today than in the 1970s. The contrast is explicable only if powerful headwinds reversed the gains and/or if many "gains" have proved illusory. However, discussions of reproducibility and R&D productivity rarely address this point explicitly. The main objectives of the primary research in this paper are: (a) to provide quantitatively and historically plausible explanations of the contrast; and (b) identify factors to which R&D efficiency is sensitive. We present a quantitative decision-theoretic model of the R&D process. The model represents therapeutic candidates (e.g., putative drug targets, molecules in a screening library, etc.) within a "measurement space", with candidates' positions determined by their performance on a variety of assays (e.g., binding affinity, toxicity, in vivo efficacy, etc.) whose results correlate to a greater or lesser degree. We apply decision rules to segment the space, and assess the probability of correct R&D decisions. We find that when searching for rare positives (e.g., candidates that will successfully complete clinical development), changes in the predictive validity of screening and disease models that many people working in drug discovery would regard as small and/or unknowable (i.e., an 0.1 absolute change in correlation coefficient between model output and clinical outcomes in man) can offset large (e.g., 10 fold, even 100 fold) changes in models' brute-force efficiency. We also show how validity and reproducibility correlate across a population of simulated screening and disease models. We hypothesize that screening and disease models with high predictive validity are more likely to yield good answers and good treatments, so tend to render themselves and their diseases academically and commercially redundant. Perhaps there has also been too much enthusiasm for reductionist molecular models which have insufficient predictive validity. Thus we hypothesize that the average predictive validity of the stock of academically and industrially "interesting" screening and disease models has declined over time, with even small falls able to offset large gains in scientific knowledge and brute-force efficiency. The rate of creation of valid screening and disease models may be the major constraint on R&D productivity.
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Affiliation(s)
- Jack W. Scannell
- The Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, United Kingdom
- Innogen Institute, Science, Technology and Innovation Studies, University of Edinburgh, Edinburgh, United Kingdom
- J W Scannell Analytics Ltd., 32 Queen’s Crescent, Edinburgh, United Kingdom
| | - Jim Bosley
- Clerbos LLC, Kennett Square, Pennsylvania, United States of America
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Breeze P, Brennan A. Valuing Trial Designs from a Pharmaceutical Perspective Using Value-Based Pricing. HEALTH ECONOMICS 2015; 24:1468-1482. [PMID: 25204721 DOI: 10.1002/hec.3103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/25/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
Our aim was to adapt the traditional framework for expected net benefit of sampling (ENBS) to be more compatible with drug development trials from the pharmaceutical perspective. We modify the traditional framework for conducting ENBS and assume that the price of the drug is conditional on the trial outcomes. We use a value-based pricing (VBP) criterion to determine price conditional on trial data using Bayesian updating of cost-effectiveness (CE) model parameters. We assume that there is a threshold price below which the company would not market the new intervention. We present a case study in which a phase III trial sample size and trial duration are varied. For each trial design, we sampled 10,000 trial outcomes and estimated VBP using a CE model. The expected commercial net benefit is calculated as the expected profits minus the trial costs. A clinical trial with shorter follow-up, and larger sample size, generated the greatest expected commercial net benefit. Increasing the duration of follow-up had a modest impact on profit forecasts. Expected net benefit of sampling can be adapted to value clinical trials in the pharmaceutical industry to optimise the expected commercial net benefit. However, the analyses can be very time consuming for complex CE models.
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Affiliation(s)
- Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Andronis L. Analytic approaches for research priority-setting: issues, challenges and the way forward. Expert Rev Pharmacoecon Outcomes Res 2015; 15:745-54. [DOI: 10.1586/14737167.2015.1087317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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