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Screening for multiple cancer types in a single test has the potential to offer both cost savings and health gains in comparison to offering several separate type-specific programmes. This study developed an early economic model to evaluate an early generic cancer screening programme and to identify what evidence needs to be generated to allow for robust economic evaluation in the future. There was a substantial degree of uncertainty in the health economic effects of a generic cancer screening programme. Future research is needed into: the lifetime treatment costs for each cancer type by stage at diagnosis; the natural history of multiple cancer types; the follow up pathways for false positive screens; and the QALY gains from earlier detection of cancer.
S Whyte, D Pollard, I Cree
Preference elicitation tasks for health state valuation are generally conducted in one-off interviews that may not give participants enough time to reflect and deliberate on the complex process of valuing health. The aim of this study is to understand if providing members of the public with an opportunity to engage in reflection and deliberation will change their health state preferences. There were large number of changes to health state values at the individual level, but these did not lead to statistically significant changes at the aggregate level. The use of conventional methods with one-off interviews, for purposes that use aggregated valuations, was not invalidated by this study.
M. Karimi, J. Brazier, S. Paisley
This study investigates the thought processes of participants valuing health states using semi-structured interviews and a think-aloud protocol. A range of non-health factors were considered when valuing health, and ultimately participants valued health by judging the non-health consequences of the health states. The importance of non-health factors in valuing health has implications for methods of describing health, for example whether the focus should be health or broader well-being, and for methods of testing and developing informed preferences.
M. Karimi, J. Brazier, S. Paisley
The 2003 Health Economics paper by Dolan, Olsen, Menzel and Richardson on “An inquiry into the different perspectives that can be used when eliciting preferences in health” presents a conceptual framework of six perspectives along two dimensions: preferences (personal, social, and socially inclusive personal) and context (ex ante and ex post). The objective of our paper is to re-think this framework, building on examples using monetary and non-monetary valuations (i.e health state valuation). We propose an extended framework with 20 possible perspectives, and discuss 11 of these.
A Tsuchiya, V Watson
Factors influencing the use of research for policy-making: An umbrella review protocol
In this paper, we present the protocol for an umbrella review (overview of reviews) about factors affecting the use of research by policy-makers. We will focus on barriers and facilitators affecting the use of research outputs and on preferred ways of presenting the results of research to policy-makers. The results of this review will guide the design of a qualitative study with policy-makers.
E E. Atienzo, E Kaltenthaler, S K. Baxter
Copula-based modelling of self-reported health states An application to the use of EQ-5D-3L and EQ-5D-5L in evaluating drug therapies for rheumatic disease
EQ-5D is used in cost-effectiveness studies underlying many important health policy decisions. The original 3-level version of EQ-5D is being replaced with a more sensitive 5-level version but there little is known about the consequences of this change. In this paper, we develop new statistical methods to investigate how well the old and new versions of EQ-5D work, and we find systematic differences in the way they measure mobility problems and pain. We use the findings to re-examine a cost-effectiveness evaluation of alternative drug therapies for rheumatoid arthritis.
M Hernandez-Alava, S Pudney
This paper presents a protocol to summarise the process used to conduct a qualitative evidence synthesis of patient experiences for five key vascular conditions; peripheral arterial disease, carotid artery disease, abdominal aortic aneurysm, varicose veins and venous leg ulcers. The synthesis will form part of a wider project identifying patient outcomes for the included vascular conditions.
R Duncan, A Booth, H B Woods, M Essat, P Phillips, E Poku, E Kaltenthaler, G Jones, J Michaels
Patient reported outcome measures (PROMs) are increasing being used in clinical practice to assess the quality of life of patients. However, PROMs used to assess quality of life of patients with abdominal aortic aneurysm (AAA) in clinical setting are equivocal in terms of their reliability, validity and suitability. The aim of this protocol is to outline the systematic process we intend to use to identify, summarise and assess PROMs that have been administered in patients with AAA.
M Essat, E Poku, R Duncan, P Phillips, H Woods, S Palfreyman, G Jones, E Kaltenthaler and J Michaels
This paper provides details of how the EQ-5D-5L value set was derived, focusing on the methods used to model the stated preference data. Results for different model specifications, and taking different interpretations of the data, are presented and discussed. This paper is intended to accompany HEDS Discussion Paper ‘Valuing health-related quality of life: an EQ-5D-5L value set for England’.
Y Feng, N Devlin, K Shah, B Mulhern, B van Hout
This paper reports the methods and findings from the EQ-5D-5L value set for England study. The value set is derived from the stated preference data of 996 members of the English general public. The study design followed the EuroQol Group’s international protocol for valuing EQ-5D-5L health states. A single value set is reported, and implications for public decisions made using EQ-5D-5L data are discussed. This paper is intended to accompany HEDS Discussion Paper ‘New methods for modelling EQ-5D-5L value sets: an application to English data’.
N Devlin, K Shah, Y Feng, B Mulhern, B van Hout
Peripheral arterial disease (PAD) of the lower limbs is associated with substantial morbidity and functional limitation. In recent times, policy-makers, clinicians and researchers have demonstrated an increased interest in patient-reported outcome measures (PROMs) as relevant clinical indicators of health status and health-related quality of life. To demonstrate the real benefits and risks of treatments, instruments used in clinical settings must provide reliable and valid outcome measures. A clear understanding of the measurement properties of available PROMs in patients with PAD is needed. This is a protocol of a systematic review of PROMs validated in patients with PAD.
E Poku, M Essat, R Duncan, P Phillips, H Woods, S Palfreyman, G Jones, E Kaltenthaler, J Michaels
This paper was provided as preparatory reading to attendees of the meeting on “The Challenge of Early Crossover in Oncology Trials” held in Adelaide, Australia, in October 2014. The paper introduces the concept of treatment switching in randomised controlled trials of oncology treatments, the problems it causes for estimating the treatment effect associated with the new treatment, and the methods available for adjusting for treatment switching. The paper is not exhaustive, and does not cover every issue associated with treatment switching in detail. However it aims to provide an overview of the key issues associated with treatment switching in the context of oncology trials.
This study sought to test whether it is feasible and reliable to obtain children's preferences for paediatric health states from the Child Health Utility 9D (CHU9D) using pair wise discrete choice experiment and best worst scaling techniques.
Interviews with children were carried out and cognitive debriefing techniques were used to determine whether children could understand and respond to the tasks.
This research demonstrated that it is feasible and reliable to obtain children's preferences and there is potential for future valuation studies of child utility measures to obtain child preference weights using these methods.
"This paper investigates the effect of breastfeeding on childhood body mass index (BMI). We use data from the Millennium Cohort Study (MCS), a nationally representative UK cohort survey, containing detailed infant feeding information, which allow us to explore the effects of a range of breastfeeding variables on the mean BMI of children breastfed for different durations and for exclusive and partial breastfeeding."
L Gibson, M Hernandez Alava, M P Kelly, M J Campbell
With low implementation of cost-effective health technologies being a problem, it may be worth considering the potential effect of research on implementation at the time of technology appraisal. We extend an existing framework to assess the values of information and implementation to account for the relationship between information and implementation and to reflect implementation dynamics. We demonstrate in a genuine case study that incorporating implementation dynamics significantly affect the expected value of research. This framework has the potential to complement currently used analyses in health technology appraisals.
S Grimm, S Dixon, J W Stevens