SLIDE 1
Health Economics Group
Health Economics Group
- Lecturer in Health
Economics, University
- f East Anglia
- Decision analytic
modelling
- Economic evaluation
alongside clinical trials
- Efficient research
Economic approaches to research priority setting Ed Wilson Health - - PowerPoint PPT Presentation
Economic approaches to research priority setting Ed Wilson Health - - PowerPoint PPT Presentation
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
SLIDE 2
SLIDE 3
Health Economics Group
- 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?
Plan
SLIDE 4
Health Economics Group
Define the decision problem Systematic review & Economic Evaluation Decision:
- Adopt or
reject new technology? Value of information analysis Decision:
- More
research worthwhile? End research into current decision problem Primary studies (RCT, epidemiological etc) Wilson & Abrams 2010
Cycle of ‘economics based medicine’
SLIDE 5
Health Economics Group
- The comparison of two
- r more courses of
action in terms of their costs and consequences1
£ QALYs ICER New £1,084 1.621 Old £872 1.605 Increment £213 0.015 £14,200
- 1. Drummond et al. 2005
λ ≤ − −
1 2 1 2
E E C C
The adoption decision: economic evaluation
SLIDE 6
Health Economics Group
λ ≤ − −
1 2 1 2
E E C C
) ( ) (
1 2 1 2
≥ ≥ ≥ ∆ − ∆ ≥ − − − b INB C E C C E E λ λ
From ICERs to Net Benefit
SLIDE 7
Health Economics Group
- Decision modelling & Monte Carlo Simulation
Decision model (Decision tree, Markov chain etc) Costs Effectiveness (probabilities) Health state Utilities Incremental Net Benefit
E.g. Briggs, Sculpher & Claxton 2006
Approach to economic evaluation
SLIDE 8
Health Economics Group
Incremental Net Benefit The research decision: Value of Information Analysis
SLIDE 9
Health Economics Group
The research decision: Value of Information Analysis
SLIDE 10
Health Economics Group
SLIDE 11
Health Economics Group
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
Ranking alternative research projects
SLIDE 12
Health Economics Group
- ENBS of updating a Cochrane review?
Prioritising Cochrane Reviews – initial thoughts
Decision uncertainty Expected loss Recommendation for new trials
SLIDE 13
Health Economics Group
Define the decision problem Systematic review & Economic Evaluation Decision:
- Adopt or
reject new technology? Value of information analysis Decision:
- More
research worthwhile? End research into current decision problem Primary studies (RCT, epidemiological etc)
Prioritising Cochrane Reviews – initial thoughts
SLIDE 14
Health Economics Group
- 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’
Prioritising Cochrane Reviews – initial thoughts
SLIDE 15
Health Economics Group
- 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. 2nd Edition. Wiley-Blackwell, 2010. Chichester, UK.