This project developed as a result of the activities of the Research Teams at the Centre for Health Economics, University of York, and ScHARR at the University of Sheffield in the methods and application of decision analysis and value of information analysis as a means of informing the research recommendations made by NICE, as part of its Guidance to the NHS in England and Wales, and informing the deliberations of the NICE Research and Development Committee.
Bayesian decision analysis and value of information analysis (DA-VOI) provides a methodological framework which explicitly considers the uncertainty surrounding the decision of a health care system to adopt a health technology. Specifically, using existing evidence, these methods focus on the likelihood of making a wrong decision if the technology is adopted. The value of additional research is based on the extent to which further information will reduce this decision uncertainty. This framework values the additional information, which may be generated by further research, in a way which is consistent with the objectives and the resource constraints of heath care provision (the cost-effectiveness threshold). This allows a comparison of the potential benefits of further research with the costs of further investigation, a comparison and prioritisation of alternative research recommendations, both within and between Technology Assessments, as well as an assessment of the value of investing resources in research or other activities, such as the provision of health service. In this sense it provides a unified and coherent framework for prioritisation of research and the use of heath care technologies.
The specific objectives of the pilot study were to:
Demonstrate the benefits of using appropriate decision analytic methods and value of information analysis to inform research recommendations.
Establish the feasibility and resource implications of applying these methods in a timely way, to inform NICE.
Identify critical issues and methodological challenges to the use of value of information methods for research recommendations (with particular regard to the new reference case as a suitable basis for this type of analysis).
The project consists of a series of case studies based on recent technology assessment reports completed by the York and Sheffield group for NICE. These included:
Screening for age related macular degeneration (AMD)
Glycoprotein IIb/IIIa antagonists for acute coronary syndrome (GPAs)
Clopidogrel and dipyridamole in the secondary prevention of occlusive vascular events (CLO)
Neurominidase inhibitors for the treatment of influenza (NIs)
Liquid based cytology screening for cervical cancer (LBC)
Beta interferon and glatiramer acetate in the management of MS (MS)
The purpose was to establish the feasibility and requirements of value of information analysis once submissions and Technology Assessment Reports (TARs) are conducted within the reference case specified in the recent methods guidance. Therefore case studies were selected on the basis that the existing TAR comes as close to the new reference case analysis as possible.
Keywords: Value of information; need for evidence; uncertainty; only in research; approval with research; evidence development; research prioritisation.
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