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:
OBJECTIVES: To determine whether differential item functioning (DIF) was present in the EuroQol five-dimensional questionnaire (EQ-5D) used in cancer (non-small cell lung cancer and prostate cancer).
METHODS: The Partial Credit Model was applied to the three-level version of the EQ-5D with data obtained from four randomized controlled trials in prostate cancer and non-small cell lung cancer completed at baseline before treatment (N = 2213). DIF was assessed across cancer type (two levels), sex (two levels), and age group (three levels) using Mantel-Haenszel chi-square statistics and evaluated against the Educational Testing Service classification rules.
RESULTS: The presence of DIF was determined in 14 of 25 (56%) potential DIF contrasts in all the EQ-5D domains. Although mostly the DIF was categorized as either negligible (3 of 25 [12%]) or medium (7 of 25 [28%]), large DIF was observed in 4 of the 25 contrasts (16%). The mobility domain, in particular, showed consistently large DIF across cancer type, sex, and age.
CONCLUSIONS: Given the use of the instrument in health status assessments across conditions and interventions, these results may have significant implications for the EQ-5D in health economic evaluations. Further research is warranted to determine whether these results hold for other cancers.
BACKGROUND: In the UK, diabetes accounts for approximately 10% of the total UK National Health Service (NHS) resource expenditure, a figure that has been predicted to increase to 17% by 2035/2036. Meta-analysis of association studies indicate that yogurt consumption is potentially protective against type 2 diabetes (T2D). The purpose of this study was to explore the potential economic benefit to the UK NHS of a population increase in yoghurt consumption as a preventative measure against development of T2D.
METHODS: A patient simulation model was constructed for adults in the UK over the age of 25 years old using incidence rates for developing T2D with both current and increased yoghurt consumption. The reduction in risk in developing T2D associated with higher yoghurt consumption was taken from a meta-analysis of studies of dairy consumption on T2D risk. In each annual cycle of the model a patient could develop complications and comorbidities that are known to be more common in patients with T2D. Incidence rates for these conditions for diabetics and non-diabetics were taken from published studies. The model had a 25 year time horizon.
RESULTS: The model predicts that increasing average yoghurt consumption by adults over 25 years of age in the UK by 100g daily could result in 388,000 fewer people developing T2D over 25 years. This could save the UK NHS £2.3bn in direct T2D treatment costs and the costs of treating T2D associated complications. In addition, 267,000 QALYs would be generated. If the NHS values a QALY valued at £20,000, this would mean that the NHS should be prepared to pay £5.5bn for an intervention that generated the same number of QALYs.
CONCLUSIONS: Increasing yoghurt consumption in the adult population of the UK by 100g per day could generate substantial cost savings to the NHS as well as significant patient benefit through reductions in the incidence of T2D.
BACKGROUND: An evaluation was conducted to estimate the cost-effectiveness of insufflation of warmed humidified CO2 during open and laparoscopic colorectal surgery compared with usual care from a UK NHS perspective.
METHODS: Decision analytic models were developed for open and laparoscopic surgery. Incremental costs per quality-adjusted life year (QALY) were estimated. The open surgery model used data on the incidence of intra-operative hypothermia and applied risks of complications for hypothermia and normothermia. The laparoscopic surgery model utilised data describing complications directly. Sensitivity analyses were conducted.
RESULTS: Compared with usual care, insufflation of warmed humidified CO2 dominated. For open surgery, savings of £20 and incremental QALYs of 0.013 were estimated per patient. For laparoscopic surgery, savings of £345 and incremental QALYs of 0.001 per patient were estimated. Results were robust to most sensitivity analyses.
CONCLUSIONS: Considering the current evidence base, the intervention is likely to be cost-effective compared with usual care in patients undergoing colorectal surgery.
OBJECTIVES: To estimate the cost savings and health benefits in the UK NHS that could be achieved if human milk usage in the NICU was increased.
METHODS: A systematic review established the disease areas with the strong sources of evidence of the short, medium and long-term benefits of human milk for preterm infants as opposed to the use of formula milk. The analysis assessed the economic impact of reducing rates of necrotising enterocolitis, sepsis, sudden infant death syndrome, leukaemia, otitis media, obesity and neurodevelopmental impairment.
RESULTS: Based on the number of preterm babies born in 2013, if 100% of premature infants being fed mother's milk could be achieved in the NICU, the total lifetime cost savings to the NHS due to improved health outcomes is estimated to be £46.7 million (£30.1 million in the first year) with a total lifetime QALY gain of 10,594, There would be 238 fewer deaths due to neonatal infections and SIDS, resulting in a reduction of approximately £153.4 million in lifetime productivity. Sensitivity analyses indicated that results were robust to a wide range of inputs.
CONCLUSIONS: This analysis established that increasing the use of human milk in NICUs in the UK would lead to cost savings to the NHS. More research is needed on the medium and long term health and economic outcomes associated with breastfeeding preterm infants, and the differences between mother's own and donor breast milk.
The economic evaluation of medical devices is increasingly used to inform decision making on adopting new or novel technologies; however, challenges are inevitable due to the unique characteristics of devices. Costconsequence analyses are recommended and employed by the English National Institute for Health and Care Excellence (NICE) Medical Technologies Evaluation Programme (MTEP) to help address these challenges. The aim of this work was to review the critiques raised for previous MTEP submissions and explore if there were common problems across submissions. We reviewed a sample of 12 economic submissions to MTEP representing 50 % of 24 sets of guidance issued to July 2015. For each submission, we reviewed the External Assessment Centre's (EAC) report and the guidance document produced by NICE. We identified the main problems raised by the EAC's assessments and the committee's considerations for each submission, and explored strategies for improvement. We found that the identification and measurement of costs and consequences are the main shortcomings within economic submissions to MTEP. Together, these shortcomings accounted for 42 % of criticisms by the EACs among the reviewed submissions. In certain circumstances problems with these shortcomings may be unavoidable, for example, if there is a limited evidence base for the device being appraised. Nevertheless, strategies can often be adopted to improve submissions, including the use of more appropriate time horizons, whilst cost and resource use information should be taken, where possible, from nationally representative sources.
AIM: To estimate potential cost avoidance through modest and achievable improvements in glycaemic control in adults with Type 1 or Type 2 diabetes mellitus in the UK healthcare system.
METHODS: The IMS Core Diabetes Model was used to examine the impact of improved glycaemic control (indicated by reduction in HbA1c level), in a representative cohort of adults with Type 1 or Type 2 diabetes. The cumulative incidence of microvascular and macrovascular complications was modelled across 5-year periods to a 25-year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance.
RESULTS: Significant cost avoidance of ~£340 m is apparent in the first 5 years, increasing to ~£5.5bn after 25 years of sustained improvement in control. The overwhelming majority of cost avoidance arises from reductions in microvascular complications. In people with Type 1 diabetes the greatest cost avoidance comes from a reduction in renal disease (74% of cost avoidance), while in people with Type 2 diabetes it is generated by a reduction in foot ulcers, amputations and neuropathy: 57% cost avoidance). Greater cost reduction is accrued more rapidly in people with higher starting HbA1c levels.
CONCLUSION: Modest improvements in glycaemic control generate significant reductions in the incidence and, therefore, cost of microvascular complications in people with Type 1 or Type 2 diabetes. This study provides clear support for the premise that prioritized and sustained investment in early and better intervention can provide concrete financial benefits in both the short and longer term.
BACKGROUND: Previously developed models in ophthalmology have generally used a Markovian structure. There are a number of limitations with this approach, most notably the ability to base patient outcomes on best-corrected visual acuity (BCVA) in both eyes, which may be overcome using a different modelling structure. Simulation modelling allows for this to be modelled more precisely, and therefore may provide more accurate and relevant estimates of the cost effectiveness of ophthalmology interventions.
OBJECTIVES: This study aimed to explore the appropriateness of simulation modelling in ophthalmology, using the disease area of wet age-related macular degeneration (wAMD) as an example.
METHODS: A de novo economic model was built using a patient-level simulation, which compared ranibizumab with aflibercept in wAMD. Disease progression was measured using BCVA. Health-related quality of life (HRQoL) was estimated using a regression analysis linking BCVA in each eye to utility. The analysis was from the perspective of the National Health Service in the UK. Five different regression models were explored and were based on BCVA in either one eye or both eyes.
RESULTS: The model outputs provide some evidence to support the hypothesis that the analyses using the two-eye models for estimating HRQoL generate a more accurate estimation of incremental quality-adjusted life-years (QALYs) associated with the positive treatment effect for ranibizumab versus aflibercept. Second-order analysis broadly supported these findings, and showed that the variation in incremental costs was slightly lower than in incremental QALYs. The second-order analysis estimated similar incremental costs and a greater overall variation in incremental QALYs than the first-order analysis, suggesting important non-linearities within the model.
CONCLUSIONS: This analysis suggests that patient-level simulation models may be well suited to representing the real-world patient pathway in wAMD, particularly when aspects of disease progression cannot be adequately captured using a Markov structure. The benefits of a simulation approach can be demonstrated in the modelling of HRQoL as a function of BCVA in both eyes.
