Systematic review, meta-analysis and economic modelling of ...
Systematic review, meta-analysis and economic modelling of ... Systematic review, meta-analysis and economic modelling of ...
Assessment of cost-effectiveness evidenceExpected value of perfect informationThe individual patient EVPI for the prognostic model is illustrated in Figure 43. At low and high thresholdsfor cost-effectiveness, additional information is unlikely to change that decision. The EVPI reachesmaximum when there is most uncertainty about whether to adopt or reject the technology based onexisting evidence, i.e. at a threshold of £19,000/QALY.The EVPI for the whole population can be estimated as ‘EVPI per patient multiplied by the number ofpatients affected by the decision over the lifetime of the technology’. Assuming an incidence of 1000patients of the disease per year and a lifetime of 10 years for the technology, the undiscounted populationEVPI at the threshold of £19,000/QALY is £1.09M.Expected value of partial perfect informationThe expected value of partial perfect information (EVPPI) details associated with the parameters areillustrated in Figures 44 and 45. At the threshold of £20,000/QALY, EVPPIs associated with baseline risk ofMI and relative reduction in risk of adverse events after treatment are higher than the EVPPIs associatedwith the rest of the parameters. However, at the threshold of £30,000/QALY, only the EVPPI associatedwith relative reduction in risk of adverse events is significant.Around the NICE threshold, assumed to be between £20,000 and £30,000/QALY, the EVPPIs associatedwith both these parameters are relatively high suggesting that further experimental research will potentiallybe cost-effective.120100EVPI per patient8060402000 50 100Threshold (£000)150 200 250FIGURE 43 Individual patient EVPI.104NIHR Journals Library
DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 160Partial EVPI per patient (£)50403020100Riskof MIRisk ofdeathRelativeriskICA testcostCTCA testcostETT testcostH-FABPtest costCTCAsensitivityFIGURE 44 Individual patient EVPPI at £20,000/QALY.1816Partial EVPI per patient (£)14121086420Riskof MIRisk ofdeathRelativeriskICA testcostCTCA testcostETT testcostH-FABPtest costCTCAsensitivityFIGURE 45 Individual patient EVPPI at £30,000/QALY.© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.105
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DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 160Partial EVPI per patient (£)50403020100Risk<strong>of</strong> MIRisk <strong>of</strong>deathRelativeriskICA testcostCTCA testcostETT testcostH-FABPtest costCTCAsensitivityFIGURE 44 Individual patient EVPPI at £20,000/QALY.1816Partial EVPI per patient (£)14121086420Risk<strong>of</strong> MIRisk <strong>of</strong>deathRelativeriskICA testcostCTCA testcostETT testcostH-FABPtest costCTCAsensitivityFIGURE 45 Individual patient EVPPI at £30,000/QALY.© Queen’s Printer <strong>and</strong> Controller <strong>of</strong> HMSO 2013. This work was produced by Goodacre et al. under the terms <strong>of</strong> a commissioning contract issued by the Secretary <strong>of</strong> Statefor Health. This issue may be freely reproduced for the purposes <strong>of</strong> private research <strong>and</strong> study <strong>and</strong> extracts (or indeed, the full report) may be included in pr<strong>of</strong>essional journalsprovided that suitable acknowledgement is made <strong>and</strong> the reproduction is not associated with any form <strong>of</strong> advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials <strong>and</strong> Studies Coordinating Centre, Alpha House, University <strong>of</strong> Southampton SciencePark, Southampton SO16 7NS, UK.105
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