Ginnelly Laura, Claxton Karl, Sculpher Mark J, Golder Sue
Centre for Health Economics, University of York, York, UK.
Appl Health Econ Health Policy. 2005;4(1):37-46. doi: 10.2165/00148365-200504010-00006.
The purpose of this article is to demonstrate the application and feasibility of using value of information analysis to help set priorities for research as part of the UK National Health Service (NHS) Health Technology Assessment Programme. Probabilistic decision analysis and value of information methods were applied to a research topic under consideration by the National Coordinating Centre for Health Technology Assessment (NCCHTA), in the UK. The case study presented considers whether long-term, low-dose antibacterial treatment of recurrent urinary tract infections (UTIs) in children is effective and cost effective compared with short-term antibacterial therapy.
A probabilistic decision-analytic model was developed, within which evidence from published sources was synthesised. Eight subgroups were considered and defined in terms of sex and presence of vesico-ureteral reflux (VUR). Costs were assessed from an NHS perspective, and benefits were expressed as quality-adjusted life-years (QALYs). Simulation methods were used to determine the probability that alternative therapies would be cost effective at a range of threshold values that the NHS may attach to an additional QALY. Value of information analysis was used to quantify the cost of uncertainty associated with the decision about which therapy to adopt, which indicates the maximum value of future research. The feasibility and practicality of using value of information methods to help inform research prioritization was evaluated.
At a threshold value for an additional QALY of 30,000 pound , long-term antibacterial treatment may be regarded as cost effective for all eight patient groups. There was, however, substantial uncertainty surrounding the choice of antibacterial.
DISCUSSION/CONCLUSION: The use of value of information methods was feasible and could inform research prioritization for the NHS. In the context of this specific decision faced by the NHS, the results show that long-term low-dose antibacterials for preventing recurrent UTIs may be cost effective, based on current evidence. However, the analysis suggests that further primary research with longer follow-up may be worthwhile, particularly for girls with no VUR.
本文旨在展示信息价值分析在帮助确定研究优先级方面的应用及可行性，这是英国国家医疗服务体系（NHS）卫生技术评估计划的一部分。概率性决策分析和信息价值方法被应用于英国国家卫生技术评估协调中心（NCCHTA）正在考虑的一个研究课题。所呈现的案例研究探讨了与短期抗菌治疗相比，长期、低剂量抗菌治疗儿童复发性尿路感染（UTIs）是否有效且具有成本效益。
开发了一个概率性决策分析模型，综合了已发表文献中的证据。根据性别和膀胱输尿管反流（VUR）的存在情况考虑并定义了八个亚组。从NHS的角度评估成本，效益以质量调整生命年（QALYs）表示。使用模拟方法确定在NHS可能赋予额外一个QALY的一系列阈值下，替代疗法具有成本效益的概率。信息价值分析用于量化与选择采用何种疗法的决策相关的不确定性成本，这表明了未来研究的最大价值。评估了使用信息价值方法来帮助确定研究优先级的可行性和实用性。
在额外一个QALY的阈值为30,000英镑时，长期抗菌治疗可能被视为对所有八个患者组都具有成本效益。然而，在抗菌药物的选择上存在很大的不确定性。
讨论/结论：信息价值方法的使用是可行的，并且可以为NHS的研究优先级提供参考。在NHS面临的这一特定决策背景下，结果表明，根据目前的证据，长期低剂量抗菌药物预防复发性UTIs可能具有成本效益。然而，分析表明，进行更长期随访的进一步基础研究可能是值得的，特别是对于没有VUR的女孩。
