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OBJECTIVES: A systematic literature review (SLR) was conducted to identify utilities in acute myeloid leukaemia (AML).
METHODS: SLR methods conformed to National Institute for Health and Care Excellence technology appraisal requirements. Eligible studies were economic evaluations (cost-effectiveness, cost-utility and cost-benefit analyses), utility studies, SLRs and health technology assessments. Nine bibliographic databases and 4 conferences were searched (November 2018) and retrieved 2,278 unique records. Two reviewers independently selected records and one extracted data.
RESULTS: Twenty-six studies (28 documents) met inclusion criteria. Data were derived using: EQ-5D (14 studies, including 2 using EQ-5D-5L), TTO (4), VAS (4), DCE (2), HUI2 (1), QLQ-PBM (1), EORTC-8D (1), standard gamble (1), as well as proxy data (1) and data mapped to utility (1, from QLQ-C30). Studies were conducted in Canada, Japan, the Netherlands, UK, USA, and one study was across Europe. Mean utility data were identified for these health states: induction chemotherapy (-0.15 to 0.706), consolidation chemotherapy (-0.11 to 0.71), maintenance (0.81 to 0.95 [median]), complete remission (0.62 to 0.99) [in transplant: 0.61 to 0.71; prior to transplant: 0.826], no relapse (0.83 to 0.90 [median]), temporary remission (0.66), partial remission (0.6574 to 0.7160), relapse (0.1 to 0.79), refractory (-0.1 to 0.568) and transplant (-0.21 to 0.94) [short-term: 0.4; recovery: 0.75 to 0.826; graft versus host disease (GVHD): 0.37 to 0.691; without GVHD: 0.79 to 0.864; long term: 0.94 to 1 [median]]. Disutilities were reported for chemotherapy (0.42) and transplant (0.57).
CONCLUSIONS: The SLR reported wide variations in utility values across AML health states, with most studies referring to first line treatment with induction/consolidation rather than relapse/refractory. Variations could be due to underlying disease activity within health states, differences utility elicitation methods, and health state definitions. Choice of utility values for decision analytic models should consider these differences to improve validity.
No abstract available.
AIMS: To revisit the data analysis used to inform National Institute of Health and Care Excellence (NICE) NG17 guidance for initiating basal insulin in adults with type 1 diabetes mellitus (diabetes).
METHODS: We replicated the data, methodology and analysis used by NICE diabetes in the NG17 network meta-analysis (NMA). We expanded this data cohort to a more contemporary data set (extended 2017 NMA) and restricted the studies included to improve the robustness of the data set (restricted 2017 NMA) and in a post hoc analysis, changed the index comparator from neutral protamine Hagedorn (NPH) insulin twice daily to insulin detemir twice daily.
RESULTS: The absolute changes in HbA1c were similar to those reported in the NG17. However, all 95% credible intervals for change in HbA1c point estimates crossed the line of null effect, except for detemir twice daily (in the NICE and extended 2017 NMAs) and NPH four times daily. In the detemir twice-daily centred post hoc analysis, the 95% credible intervals for change in HbA1c crossed the line of null effect for all basal therapies, except NPH.
CONCLUSION: In NG17, comparisons of basal insulins were based solely on efficacy of glycaemic control. Many of the trials used in this analysis were treat-to-target, which minimize differences in HbA1c. In the NMAs, statistical significance was severely undermined by the wide credible intervals. Despite these limitations, point estimates of HbA1c were used to rank the insulins and formed the basis of NG17 guidance. This study queries whether such analyses should be used to make specific clinical recommendations.
No abstract available.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the relative effects (benefits and harms) of different designs, articulations, and fixation techniques of arthroplasties for treating hip fractures in adults.
This will include assessment of the relative effects (benefits and harms) of the following:
- THR versus HA
- Cemented versus uncemented arthroplasties
- Alternative articulation designs in THA
- Different designs of HA, e.g. bipolar versus unipolar
AIMS: The Biventricular vs Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF) demonstrated that biventricular (BiV) pacing resulted in better clinical and structural outcomes compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF; =50%). This study investigated the cost-effectiveness of BiV vs RV pacing in the patient population enrolled in the BLOCK-HF trial.
METHODS: All-cause mortality, New York Heart Association (NYHA) Class distribution over time, and NYHA-specific heart failure (HF)-related healthcare utilization rates were predicted using statistical models based on BLOCK-HF patient data. A proportion-in-state model calculated cost-effectiveness from the Medicare payer perspective.
RESULTS: The predicted patient survival was 6.78 years with RV and 7.52 years with BiV pacing, a 10.9% increase over lifetime. BiV pacing resulted in 0.41 more quality-adjusted life years (QALYs) compared to RV pacing, at an additional cost of $12,537. The "base-case" incremental cost-effectiveness ratio (ICER) was $30,860/QALY gained. Within the clinical sub-groups, the highest observed ICER was $43,687 (NYHA Class I). Patients receiving combined BiV pacing and defibrillation (BiV-D) devices were projected to benefit more (0.84 years gained) than BiV pacemaker (BiV-P) recipients (0.49 years gained), compared to dual-chamber pacemakers.
CONCLUSIONS: BiV pacing in AV block patients improves survival and attenuates HF progression compared to RV pacing. ICERs were consistently below the US acceptability threshold ($50,000/QALY). From a US Medicare perspective, the additional up-front cost associated with offering BiV pacing to the BLOCK-HF patient population appears justified.
