Koffijberg Hendrik, Knies Saskia, Janssen Mart P
Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Medical Technology Assessment, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands.
Value Health. 2018 Feb;21(2):203-209. doi: 10.1016/j.jval.2017.04.011. Epub 2017 May 31.
When proven effective, decision making regarding reimbursement of new health technology typically involves ethical, social, legal, and health economic aspects and constraints. Nevertheless, when applying standard value of information (VOI) analysis, the value of collecting additional evidence is typically estimated assuming that only cost-effectiveness outcomes guide such decisions.
To illustrate how decision makers' constraints can be incorporated into VOI analyses and how these may influence VOI outcomes.
A simulation study was performed to estimate the cost-effectiveness of a new hypothetical technology compared with usual care. Constraints were defined for the new technology on 1) the maximum acceptable rate of complications and 2) the maximum acceptable additional budget. The expected value of perfect information (EVPI) for the new technology was estimated in various scenarios, both with and without incorporating these constraints.
For a willingness-to-pay threshold of €20,000 per quality-adjusted life-year, the probability that the new technology was cost-effective equaled 57%, with an EVPI of €1868 per patient. Applying the complication rate constraint reduced the EVPI to €1137. Similarly, the EVPI reduced to €770 when applying the budget constraint. Applying both constraints simultaneously further reduced the EVPI to €318.
When decision makers explicitly apply additional constraints, beyond a willingness-to-pay threshold, to reimbursement decisions, these constraints can and should be incorporated into VOI analysis as well, because they may influence VOI outcomes. This requires continuous interaction between VOI analysts and decision makers and is expected to improve both the relevance and the acceptance of VOI outcomes.
当新的医疗技术被证明有效时，关于其报销的决策通常涉及伦理、社会、法律和卫生经济等方面及限制因素。然而，在应用标准的信息价值（VOI）分析时，收集额外证据的价值通常是在假设只有成本效益结果指导此类决策的情况下进行估计的。
说明如何将决策者的限制因素纳入VOI分析，以及这些因素如何影响VOI结果。
进行了一项模拟研究，以估计一种新的假设技术与常规治疗相比的成本效益。为新技术定义了以下限制因素：1）并发症的最大可接受发生率；2）最大可接受的额外预算。在有无纳入这些限制因素的各种情况下，估计了新技术的完美信息期望值（EVPI）。
对于每质量调整生命年20,000欧元的支付意愿阈值，新技术具有成本效益的概率为57%，每位患者的EVPI为1868欧元。应用并发症发生率限制将EVPI降至1137欧元。同样，应用预算限制时，EVPI降至770欧元。同时应用这两个限制因素进一步将EVPI降至318欧元。
当决策者在报销决策中明确应用除支付意愿阈值之外的其他限制因素时，这些限制因素也能够且应该纳入VOI分析，因为它们可能会影响VOI结果。这需要VOI分析师与决策者之间持续互动，并有望提高VOI结果的相关性和可接受性。
