This presentation is part of: Oral Concurrent Session A - Cost Effective Analysis: Methods
A PILOT STUDY OF VALUE OF INFORAMTION ANALYSIS TO SUPPORT RESEARCH RECOMMENDATIONS FOR THE NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
Karl Claxton, PhD, MSc, BA1, Simon Eggington, BSc2, Laura Ginnelly, MSc, BSc1, Susan Griffin, MSc, BSc1, Chris McCabe, PhD, MSc, BA3, Zoe Philips, MSc, BSc4, Paul Tappenden, BSc2, and Allan Wailoo, Phd, MA, BSc3. (1) University of York, Centre for Health Economics, York, United Kingdom, (2) University of Sheffield, Operational Research, Sheffield, United Kingdom, (3) University of Sheffield, Sheffield Health Economics Group, Sheffield, United Kingdom, (4) University of Nottingham, School of Economics, Nottingham, United Kingdom
Purpose: To demonstrate the benefits and feasibility of value of information analysis to support research recommendations made by the National Institute for Clinical Excellence (NICE). Methods: A series of six case studies was selected from recent technology appraisals conducted by NICE. The case studies included: clopidogrel and dipyridamole in secondary prevention (CD); glycoprotein antagonists (GPAs); screening for age related macular degeneration (AMD); neuroaminidase inhibitors (NIs) for influenza; liquid based cytology (LBC); and beta interferons for multiple sclerosis (BIs). The case studies were broadly consistent with the recent NICE guidance on reference case analysis and included a probabilistic decision analytic model. In each case a re-analysis using value of information analysis was conducted. The Expected Value of Perfect Information (EVPI) surrounding each decision problem for the UK population, and the EVPI associated with particular model inputs was established using appropriate non-parametric methods. Results: The reanalysis of each case study was completed within 4 weeks and the results were used to inform the recommendations of the NICE Research and Development Committee. The value of research differed substantially across the 6 technology appraisals (EVPI ranged from £2.8m to £865m). In some cases the analysis indicated that the original research recommendations should not be regarded as a priority, e.g., the EVPI surrounding LBC was low (£2.8m). In other cases it indicated that additional research should be commissioned, e.g., the EVPI surrounding CD for stroke patients, and GPAs was high (£865m and £175m respectively). The analysis also indicated which comparators should be included, e.g., clinical trials of clopidogrel and ASA-MR-dipyridamole maybe worthwhile (EVPI=£600m) but MR-dipyridamole could be excluded. The analysis also indicated which patient sub-groups should be included, e.g., further trials of treatment for AMD were more valuable for those with lower starting visual acuity. The case studies highlighted a number of general methodological issues including: consideration of all comparators, synthesis of direct and indirect evidence, and considering structural as well as parameter uncertainty. Conclusions: Value of information analysis can be conducted in a timely way, which can inform the research recommendations made by NICE. It can be used to identify circumstances where decisions should be made conditional on additional evidence and indicate the type of research which should be required including: the comparators; patient subgroups; and follow-up.
