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:
Treatment with imatinib has demonstrated high response rates and improved prognosis in chronic myelogenous leukemia. However, while the short-term response to imatinib is high, there are some concerns that the long-term response is substantially lower. Durable response with imatinib is difficult to achieve in patients with resistant disease. The use of higher doses has also been associated with increased toxicity and intolerance. Dasatinib is a new SRC–ABL-kinase inhibitor that has been developed for treating chronic myelogenous leukemia patients, across all phases of disease, who are resistant or intolerant to imatinib. This article details the existing evidence on the clinical efficacy, safety and value for money of dasatinib in the treatment of imatinib-resistant and -intolerant patients with chronic myelogenous leukemia. Dasatinib is associated with higher levels of response compared with high-dose imatinib. In addition, higher levels of response are associated with improved health outcomes in terms of both quality- and quantity-of-life years.
While economic models are a useful tool to aid decision-making in healthcare, there remain several types of uncertainty associated with this method of analysis. One-way sensitivity analysis allows a reviewer to assess the impact that changes in a certain parameter will have on the model's conclusions. Sensitivity analysis can help the reviewer to determine which parameters are the key drivers of a model's results. By reporting extensive outputs from sensitivity analysis, modellers are able to consider a wide range of scenarios and, as such, can increase the level of confidence that a reviewer will have in the model. Probabilistic sensitivity analysis provides a useful technique to quantify the level of confidence that a decision-maker has in the conclusions of an economic evaluation.
As more countries use HTA to inform decisions on the reimbursement of health technologies, harmonization of evidence requirements between jurisdictions has been proposed, mainly on the grounds of improved efficiency. Harmonization has the potential to avoid duplication of effort for both manufacturers and HTA bodies involved in preparing and reviewing HTA submissions for innovative technologies. However, it also carries risks of loss of local control over decisions, the application of general data standards which are not universally accepted and slowing the rate of development of innovation in the analytical disciplines supporting HTA. This study reviews the issues associated with harmonization taking into account the perspectives of the multiple stakeholders. This study draws on experiences from recent initiatives intended to promote the harmonization of HTA and experience from related fields, particularly regulatory approval of new medical technologies.
OBJECTIVES: The authors developed a tool to assess the quality of search filters designed to retrieve records for studies with specific research designs (e.g., diagnostic studies).
METHODS: The UK InterTASC Information Specialists' Sub-Group (ISSG), a group of experienced health care information specialists, reviewed the literature to evaluate existing search filter appraisal tools and determined that existing tools were inadequate for their needs. The group held consensus meetings to develop a new filter appraisal tool consisting of a search filter appraisal checklist and a structured abstract. ISSG members tested the final checklist using three published search filters.
RESULTS: The detailed ISSG Search Filter Appraisal Checklist captures relevance criteria and methods used to develop and test search filters. The checklist includes categorical and descriptive responses and is accompanied by a structured abstract that provides a summary of key quality features of a filter.
DISCUSSION: The checklist is a comprehensive appraisal tool that can assist health sciences librarians and others in choosing search filters. The checklist reports filter design methods and search performance measures, such as sensitivity and precision. The checklist can also aid filter developers by indicating information on core methods that should be reported to help assess filter suitability. The generalizability of the checklist for non-methods filters remains to be explored.
INTRODUCTION: Two main treatments exist for the repair of abdominal aortic aneurysm (AAA). Open surgical repair has been the standard treatment, but more recently endovascular aneurysm repair (EVAR) has been introduced as a less invasive technique. To compare the long-term outcomes of these, utility outcomes have been suggested to be relevant.
OBJECTIVE: To review studies comparing the utility outcomes of open repair and EVAR treatment for AAA.
DESIGN: Database search with strict inclusion and exclusion criteria.
MATERIALS AND METHODS: The search was performed in PubMed and EMBASE covering terms relating to AAA and utility. Studies were analysed qualitatively.
RESULTS: 10 studies of AAA met the review criteria. The comparative utility scores for the different treatments varied considerably between studies. A Canadian cohort study estimated EVAR as more favorable than open repair, while randomised controlled trials reported lower utilities with EVAR, except for one month post-surgery in the EVAR 1 trial. Furthermore, after screening for AAA, patients testing positive gave similar QoL-5D scores, but worse visual analogue scores than those testing negative.
CONCLUSION: There were few studies calculating utilities in AAA, with inconsistent findings. The limited reporting of data prevents in-depth analysis to explain the differences.
The administration of insulin by a carer or healthcare professional is associated with a risk of needlestick injury. Such injuries create a burden for carers and professionals in terms of anxiety, stress and morbidity as well as the NHS in terms of lost productivity, treatment costs and litigation. This study estimates the economic burden of these injuries to the NHS in the UK based on published estimates of the incidence and cost of needlestick injuries. The findings suggest that such injuries cost the NHS approximately 600,000 pounds sterling per annum. Many of these injuries and their associated costs could be avoided through increased adoption of safety devices. Indeed, evidence suggests that the increased acquisition cost of safety devices could be more than offset by savings resulting from the reduced incidence of needlestick injuries. Trusts are encouraged to implement improved monitoring and surveillance procedures to inform the debate on the appropriate use of safety devices.
OBJECTIVES: Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.
METHODS: Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18-75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the 'top ten' drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.
RESULTS: The minimum annual cost of all drug prescriptions at BMI 20 kg/m(2) was pound 50.71 for men and pound 62.59 for women. Costs were greater by pound 5.27 (men) and pound 4.20 (women) for each unit increase in BMI, to a BMI of 25 (men pound 77.04, women pound 78.91), then by pound 7.78 and pound 5.53, respectively, to BMI 30 (men pound 115.93 women pound 111.23), then by pound 8.27 and pound 4.95 to BMI 40 (men pound 198.66, women pound 160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men pound 8.45, women pound 7.80), substantially greater at BMI 30 (men pound 23.98, women pound 16.72) and highest at BMI 40 (men pound 63.59, women pound 27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately pound 60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by pound 6.35 (men) and pound 3.75 (women) or around 8% of programme costs at one year, and by pound 12.58 and pound 8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.
CONCLUSION: Drug prescriptions rise from a minimum at BMI of 20 kg/m(2) and steeply above BMI 30 kg/m(2). An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.
