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Economic approaches to research priority setting Ed Wilson Health - PowerPoint PPT Presentation

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Health Economics Group Health Economics Group Economic approaches to research priority setting Ed Wilson Health Economics Group Introduction Lecturer in Health Economics, University of East Anglia Decision analytic modelling

  1. Health Economics Group Health Economics Group Economic approaches to research priority setting Ed Wilson

  2. Health Economics Group Introduction • Lecturer in Health Economics, University of East Anglia • Decision analytic modelling • Economic evaluation alongside clinical trials • Efficient research design

  3. Health Economics Group Plan • The cycle of evidence (economics?) based medicine • A quantitative approach to research priority setting – Value of information analysis • Methodological research questions – How can we adapt the principles to prioritise Cochrane reviews?

  4. Health Economics Group Cycle of ‘economics based medicine’ Define the decision problem Systematic review & Economic Evaluation Decision: Primary studies (RCT, • Adopt or epidemiological etc) reject new technology? Decision: • More research Value of information analysis worthwhile? End research into current decision problem Wilson & Abrams 2010

  5. Health Economics Group The adoption decision: economic evaluation • The comparison of two or more courses of − C C 2 1 ≤ λ action in terms of their − E E costs and 2 1 consequences 1 £ QALYs ICER New £1,084 1.621 Old £872 1.605 Increment £213 0.015 £14,200 1. Drummond et al. 2005

  6. Health Economics Group From ICERs to Net Benefit − C C 2 1 ≤ λ − E E 2 1 λ − − − ≥ ( E E ) ( C C ) 0 2 1 2 1 λ ∆ − ∆ ≥ E C 0 ≥ INB 0 ≥ b 0

  7. Health Economics Group Approach to economic evaluation • Decision modelling & Monte Carlo Simulation Effectiveness (probabilities) Health state Utilities Costs Decision model (Decision tree, Markov chain etc) Incremental Net Benefit E.g. Briggs, Sculpher & Claxton 2006

  8. Health Economics Group Incremental Net Benefit The research decision: Value of Information Analysis

  9. Health Economics Group The research decision: Value of Information Analysis

  10. Health Economics Group

  11. Health Economics Group Ranking alternative research projects Project Expected Net Benefit of Sampling RCT A £250,000,000 RCT B £100,000,000 RCT C £10,800,000 RCT D £7,350,000 RCT E £1,500,000

  12. Health Economics Group Prioritising Cochrane Reviews – initial thoughts • ENBS of updating a Cochrane review? Decision uncertainty Expected loss Recommendation for new trials

  13. Health Economics Group Prioritising Cochrane Reviews – initial thoughts Define the decision problem Systematic review & Economic Evaluation Decision: Primary studies (RCT, • Adopt or epidemiological etc) reject new technology? Decision: • More research Value of information analysis worthwhile? End research into current decision problem

  14. Health Economics Group Prioritising Cochrane Reviews – initial thoughts • Factors affecting the value of updating a review – Current decision uncertainty – Number of new trials • Specifically number of observations – Cost of the review • Discussion points – International transferability of results – VoI implications • What is the correct scope for a Cochrane review? (Global?) • Possible to generalise for purposes of prioritising? – How much analysis is too much?! • Technical solution vs ‘gut feeling’

  15. Health Economics Group References • Briggs, Sculpher & Claxton 2006. Ch 6, Decision making, uncertaitny and the value of information. In Decision modelling for Health Economic Evaluation . Oxford Handbooks in Health Economic Evaluation 2006. • Briggs, Sculpher & Claxton 2006. Ch 7, Efficient Research Design In Decision modelling for Health Economic Evaluation . Oxford Handbooks in Health Economic Evaluation 2006. Buxton et al. Modelling in economic evaluation: an unavoidable fact of life. Health • Economics 1997;6:217-27 • Sackett, Rosenberg et al. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2 Willan & Briggs. Ch6.5 The Value of Information Approach in Statistical Analysis of Cost- • effectiveness Data. Statistics in Practice, Wiley, 2006. • Willan & Pinto The value of information and optimal clinical trial design. Stat Med 2005;24(12):1791-806. • Wilson & Abrams. From evidence based economics to economics based evidence: using systematic review to inform the design of future research. In Shemilt et al. (eds) Evidence- based decisions and economics. 2 nd Edition. Wiley-Blackwell, 2010. Chichester, UK.

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