Our latest research, all in one place. Browse our collection of journal articles, reports and conference proceedings to see how we’re contributing to HEOR research. Remember to:
INTRODUCTION: Health inequalities can be described as avoidable, systematic and unjust differences in health between different groups within society. This research described and evaluated potential methods to measure impacts of health inequalities that could be used in health technology assessment (HTA) in the UK. The research included recommendations for current and future policy objectives relating to incorporating health inequalities.
METHODS: A targeted literature review was conducted to identify methodological approaches used to incorporate health inequalities in HTA. Stakeholder interviews and a workshop were conducted with a range of UK stakeholders. This engagement aimed to discuss any gaps in the literature, and consider if attitudes, methods and policies were evolving at the same rate as the literature. Other aims of the engagement included the reflection of stakeholder views on health inequalities and better understanding the perspectives of decision makers.
RESULTS: Five potential methods were identified to account for health inequalities, with equity-based weighting and distributional cost-effectiveness analysis considered the most feasible of the methods for quantification. Stakeholders reiterated that a deliberative process should remain the centre of HTA. Stakeholders also raised issues such as the burden on committees, trade-offs between complexity and accessibility, and the importance of measuring the size and direction of inequality impacts. Recommendations were then produced based on these findings to better account for inequalities in HTA, highlighting the importance of combining a range of approaches.
CONCLUSIONS: Both companies and HTA agencies should be more proactive in accounting for health inequalities. Companies should be encouraged to provide quantitative analysis on health inequalities, while decision makers should be trained on new methods. Despite the recent rise in quantitative methods, qualitative methods remain extremely important for a 'layered' approach to considering health inequalities.
INTRODUCTION: Environmental sustainability and its incorporation in health technology assessment (HTA) is becoming increasingly researched globally. However, this has yet to lead to a significant impact on HTA processes. This research presents a novel case study, demonstrating how available methods can deepen the understanding of evidence-based approaches to healthcare decision making and support HTA sustainability policy development.
METHODS: A decision analytic model was developed for a digital health technology used to support primary care in the diagnosis and triage of musculoskeletal conditions. The model mapped the potential impact on the care pathway, capturing differences in resource use, including appointments, medications, diagnostic tests, surgical procedures and other non-pharmacological treatments. The model was populated from a UK perspective and captured both health-economic impact and carbon dioxide equivalents CO2e impact. Additional potential environmental impacts were then considered qualitatively as part of the evaluation.
RESULTS: The health economic modelling approach captures all stages of the patient care pathway and resource use demonstrating its practicality for simultaneously mapping out the carbon impacts. This methodological approach is reproducible, transparent and provides a standardised tool for use in future carbon, cost-comparison modelling. This would present decision makers with more complete information. There are some limitations to this approach, such as ambiguity regarding some carbon data estimates used, but still provides a more useful summary than no estimated quantification.
CONCLUSIONS: Adapting HTA will support wider efforts in health systems to reduce environmental impacts. This model can be practically applied to account for both cost and carbon data, facilitating a holistic and environmentally sustainable approach to decision making. As part of encouraging additional research into the environment, HTA agencies will need to provide 'incentives' for companies to undertake this additional research.
BACKGROUND: One of the most prevalent conditions in Western societies is gastroesophageal reflux disease (GERD). In Switzerland, the standard treatment for GERD is proton pump inhibitor (PPI)-based medical management, but surgical options such as Nissen fundoplication and magnetic sphincter augmentation (MSA) are available. RefluxStop is a novel device that offers an alternative solution. The purpose of this report is to evaluate the cost-effectiveness of RefluxStop compared to PPIs and existing surgical treatments.
METHODS: A model (Markov) was developed using the Swiss healthcare payer perspective with a lifetime horizon, 1-month cycle length, and a 3% annual discount rate for costs and benefits. Adverse events specific to treatment arms were incorporated, and benefits were measured in quality-adjusted life-years (QALYs). Clinical efficacy data for RefluxStop was obtained from its CE mark study, and comparator treatments were based on published literature. Deterministic and probabilistic sensitivity analyses were used to explore uncertainty. Since there are no head-to-head studies between RefluxStop and PPI therapy, Nissen fundoplication, or MSA, a limitation of this study is the use of naïve, indirect comparison of clinical effectiveness between the studied treatment options.
RESULTS: Higher QALYs and lower costs were provided by RefluxStop compared to Nissen fundoplication and the MSA system. The incremental cost-effectiveness ratio (ICER) for RefluxStop was CHF 2,116 in comparison to PPI-based medical management. At a cost-effectiveness threshold of CHF 100,000 per QALY gained, the probability of RefluxStop being cost-effective was high, with probabilities of 100%, 97%, and 100% against PPI-based medical management, Nissen fundoplication, and MSA, respectively. The robustness of the analysis was provided by deterministic and probabilistic sensitivity analyses.
CONCLUSION: This cost-effectiveness analysis demonstrates that there is a high likelihood of RefluxStop being a cost-effective treatment modality in adults with GERD when compared with other treatment options available in Switzerland.
INTRODUCTION: As the most internally rigorous design, randomized controlled trials (RCTs) are the gold standard for assessing the efficacy and safety profile of interventions. Increasingly, health technology assessment (HTA) considers evidence from non-randomized studies. Guidance recommends synthesizing different study designs separately due to their different inherent biases/limitations. But when authors or reviewers misclassify studies, this could affect which studies are included and therefore have an impact on review results.
METHODS: We are conducting a methods project to (i) identify a clear study design classification system, (ii) explore whether its use produces consistent study design categorizations among reviewers, and (iii) iteratively improve the classification system. We performed a pragmatic web-based search for study design categorization tools and used the resulting schemas to develop a clear algorithm for use by reviewers of all levels of experience, specifically in reviews of treatment interventions. Next, we tested tool consistency and user experience by web-based survey in a small internal sample of reviewers, each independently using the system to categorize 18 published studies.
RESULTS: A median of seven reviewers (range four to eight) categorized each study. Rater agreement using the chart varied widely, with 100 percent agreement on the designs of three studies (17%), and at least 75 percent of reviewers agreeing on one design for nine studies (50%). The most common agreement was reached on RCTs and non-randomized controlled trials. The most common sources of disagreement were between different types of cohort studies and between case series and controlled cohort studies, largely due to inconsistent reporting. We also identified several improvements: the wording of prompt questions, the ordering of designs, and the addition of new elements.
CONCLUSIONS: The classification system as initially designed led to too much variation in study design categorization to be useful. Consequently, we present a revised version that we now aim to evaluate in a larger sample of reviewers. Further research will also investigate whether using the tool would change the results of systematic reviews, using a small sample of published reviews.
AIMS: The direct cost of diabetes to the UK health system was estimated at around £10 billion in 2012. This analysis updates that estimate using more recent and accurate data sources.
METHODS: A pragmatic review of relevant data sources for UK nations was conducted, including population-level data sets and published literature, to generate estimates of costs separately for Type 1, Type 2 and gestational diabetes. A comprehensive cost framework, developed in collaboration with experts, was used to create a population-based cost of illness model.
The key driver of the analysis was prevalence of diabetes and its complications. Estimates were made of the excess costs of diagnosis, treatment and diabetes-related complications compared with the general UK population. Estimates of the indirect costs of diabetes focused on productivity losses due to absenteeism and premature mortality.
RESULTS: The direct costs of diabetes in 2021/22 for the UK were estimated at £10.7 billion, of which just over 40% related to diagnosis and treatment, with the rest relating to the excess costs of complications. Indirect costs were estimated at £3.3 billion.
CONCLUSIONS: Diabetes remains a considerable cost burden in the UK, and the majority of those costs are still spent on potentially preventable complications. Although rates of some complications are reducing, prevalence continues to increase and effective approaches to primary and secondary prevention continue to be needed. Improvements in data capture, data quality and reporting, and further research on the human and financial implications of increasing incidence of Type 2 diabetes in younger people are recommended.
