2024-03-29T10:49:23Z
https://eprints.whiterose.ac.uk/cgi/oai2
oai:eprints.whiterose.ac.uk:22
2014-06-09T05:44:27Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/22/
Sample size and power estimation for studies with health related quality of life outcomes: a comparison of four methods using the SF-36
Walters, Stephen J.
RA Public aspects of medicine
We describe and compare four different methods for estimating sample size and power, when the primary outcome of the study is a Health Related Quality of Life (HRQoL) measure. These methods are: 1. assuming a Normal distribution and comparing two means; 2. using a non-parametric method; 3. Whitehead's method based on the proportional odds model; 4. the bootstrap. We illustrate the various methods, using data from the SF-36. For simplicity this paper deals with studies designed to compare the effectiveness (or superiority) of a new treatment compared to a standard treatment at a single point in time. The results show that if the HRQoL outcome has a limited number of discrete values (< 7) and/or the expected proportion of cases at the boundaries is high (scoring 0 or 100), then we would recommend using Whitehead's method (Method 3). Alternatively, if the HRQoL outcome has a large number of distinct values and the proportion at the boundaries is low, then we would recommend using Method 1. If a pilot or historical dataset is readily available (to estimate the shape of the distribution) then bootstrap simulation (Method 4) based on this data will provide a more accurate and reliable sample size estimate than conventional methods (Methods 1, 2, or 3). In the absence of a reliable pilot set, bootstrapping is not appropriate and conventional methods of sample size estimation or simulation will need to be used. Fortunately, with the increasing use of HRQoL outcomes in research, historical datasets are becoming more readily available. Strictly speaking, our results and conclusions only apply to the SF-36 outcome measure. Further empirical work is required to see whether these results hold true for other HRQoL outcomes. However, the SF-36 has many features in common with other HRQoL outcomes: multi-dimensional, ordinal or discrete response categories with upper and lower bounds, and skewed distributions, so therefore, we believe these results and conclusions using the SF-36 will be appropriate for other HRQoL measures.
2004-05-25
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/22/1/1477-7525-2-26.pdf
Walters, Stephen J. (2004) Sample size and power estimation for studies with health related quality of life outcomes: a comparison of four methods using the SF-36. Health and Quality of Life Outcomes, 2 (26). ISSN 1477-7525
http://www.hqlo.com/content/2/1/26
10.1186/1477-7525-2-26
oai:eprints.whiterose.ac.uk:25
2014-06-07T01:16:08Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/25/
What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D
Walters, S.J.
Brazier, J.E.
BACKGROUND:
The SF-6D is a new single summary preference-based measure of health derived from the SF-36. Empirical work is required to determine what is the smallest change in SF-6D scores that can be regarded as important and meaningful for health professionals, patients and other stakeholders.
OBJECTIVES:
To use anchor-based methods to determine the minimally important difference (MID) for the SF-6D for various datasets.
METHODS:
All responders to the original SF-36 questionnaire can be assigned an SF-6D score provided the 11 items used in the SF-6D have been completed. The SF-6D can be regarded as a continuous outcome scored on a 0.29 to 1.00 scale, with 1.00 indicating "full health".
Anchor-based methods examine the relationship between an health-related quality of life (HRQoL) measure and an independent measure (or anchor) to elucidate the meaning of a particular degree of change. One anchor-based approach uses an estimate of the MID, the difference in the QoL scale corresponding to a self-reported small but important change on a global scale. Patients were followed for a period of time, then asked, using question 2 of the SF-36 as our global rating scale, (which is not part of the SF-6D), if there general health is much better (5), somewhat better (4), stayed the same (3), somewhat worse (2) or much worse (1) compared to the last time they were assessed. We considered patients whose global rating score was 4 or 2 as having experienced some change equivalent to the MID. In patients who reported a worsening of health (global change of 1 or 2) the sign of the change in the SF-6D score was reversed (i.e. multiplied by minus one). The MID was then taken as the mean change on the SF-6D scale of the patients who scored (2 or 4).
RESULTS:
This paper describes the MID for the SF-6D from seven longitudinal studies that had previously used the SF-36.
CONCLUSIONS:
From the seven reviewed studies (with nine patient groups) the MID for the SF-6D ranged from 0.010 to 0.048, with a weighted mean estimate of 0.033 (95% CI: 0.029 to 0.037). The corresponding Standardised Response Means (SRMs) ranged from 0.11 to 0.48, with a mean of 0.30 and were mainly in the "small to moderate" range using Cohen's criteria, supporting the MID results. Using the half-standard deviation (of change) approach the mean effect size was 0.051 (range 0.033 to 0.066). Further empirical work is required to see whether or not this holds true for other patient groups and populations.
2003-04-11
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/25/1/1477-7525-1-4.pdf
Walters, S.J. and Brazier, J.E. (2003) What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes, 1 (4). ISSN 1477-7525
http://www.hqlo.com/content/1/1/4
10.1186/1477-7525-1-4
oai:eprints.whiterose.ac.uk:263
2015-11-17T15:48:59Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E464350:536865666669656C642E4D4153
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E50484D
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/263/
The SF36 as an outcome measure of services for end stage renal failure
Wight, J.P.
Edwards, L.
Brazier, J.E.
Walters, S.
Payne, J.N.
Brown, C.B.
OBJECTIVE: —To evaluate the use of the short
form 36 (SF36) as a measure of health
related quality of life of patients with end
stage renal failure, document the results,
and investigate factors, including mode of
treatment, which may influence it.
DESIGN: Cross sectional survey of patients
with end stage renal failure, with the
standard United Kingdom version of the
SF36 supplemented by specific questions
for end stage renal failure.
SETTING: A teaching hospital renal unit.
Subjects and methods—660 patients
treated at the Sheffield Kidney Institute by
haemodialysis, peritoneal dialysis, and
transplantation. Internal consistency, percentage
of maximal or minimal responses,
SF36 scores, effect sizes, correlations
between independent predictor variables
and individual dimension scores of the
SF36. Multiple regression analysis of the
SF36 scores for the physical functioning,
vitality, and mental health dimensions
against treatment, age, risk (comorbidity)
score, and other independent variables.
RESULTS: A high response rate was
achieved. Internal consistency was good.
There were no floor or ceiling effects other
than for the two “role” dimensions. Overall
health related quality of life was poor
compared with the general population.
Having a functioning transplant was a significant
predictor of higher score in the
three dimensions (physical functioning,
vitality, and mental health) for which
multiple regression models were constructed.
Age, sex, comorbidity, duration
of treatment, level of social and emotional
support, household numbers, and hospital
dialysis were also (variably) significant
predictors.
CONCLUSIONS: The SF36 is a practical and
consistent questionnaire in this context,
and there is evidence to support its
construct validity. Overall the health related
quality of life of these patients is
poor, although transplantation is associated
with higher scores independently of
the effect of age and comorbidity. Age,
comorbidity, and sex are also predictive of
the scores attained in the three dimensions
studied. Further studies are required
to ascertain whether altering those
predictor variables which are under the
influence of professional carers is associated
with changes in health related quality
of life, and thus confirm the value of this
outcome as a measure of quality of care.
1998-12
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/263/1/brazierje1.pdf
Wight, J.P., Edwards, L., Brazier, J.E. et al. (3 more authors) (1998) The SF36 as an outcome measure of services for end stage renal failure. Quality in Health Care, 7 (4). pp. 209-221. ISSN 0963-8172
http://qhc.bmjjournals.com/
oai:eprints.whiterose.ac.uk:269
2014-06-07T01:17:11Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E4D4352
756E69743D536865666669656C64:536865666669656C642E5F5243:536865666669656C642E4D4352
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/269/
Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial
Munro, J.F.
Nicholl, J.P.
Brazier, J.E.
Davey, R.
Cochrane, T.
OBJECTIVE: To assess the cost effectiveness of a community based exercise programme as a population
wide public health intervention for older adults.
DESIGN: Pragmatic, cluster randomised community intervention trial.
Setting: 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as
control populations.
PARTICIPANTS: All those aged 65 and over in the least active four fifths of the population responding to a
baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control
practices.
INTERVENTION: Eligible subjects were invited to free locally held exercise classes, made available for two
years.
MAIN OUTCOME MEASURES: All cause and exercise related cause specific mortality and hospital service use
at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility
analysis was also undertaken.
RESULTS: Twenty six per cent of the eligible intervention practice population attended one or more exercise
sessions. There were no significant differences in mortality rates, survival times, or admissions. After
adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status,
although this reached significance only for the energy dimension and two composite scores (p,0.05). The
incremental average QALY gain of 0.011 per person in the intervention population resulted in an
incremental cost per QALY ratio of J17 174 (95% CI =J8300 to J87 120).
CONCLUSIONS: Despite a low level of adherence to the exercise programme, there were significant gains in
health related quality of life. The programme was more cost effective than many existing medical
interventions, and would be practical for primary care commissioning agencies to implement.
2004-12
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/269/1/brazierje4.pdf
Munro, J.F., Nicholl, J.P., Brazier, J.E. et al. (2 more authors) (2004) Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial. Journal of Epidemiology and Community Health, 58 (12). pp. 1004-1010. ISSN 1470-2738
http://www.jech.com/
doi:10.1136/jech.2003.014225
oai:eprints.whiterose.ac.uk:278
2014-06-06T06:13:49Z
7374617475733D707562
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/278/
A view from the Bridge: agreement between the SF-6D utility algorithm and the Health utilities Index
O'Brien, B.J.
Spath, M.
Blackhouse, G.
Severens, J.L.
Brazier, J.E.
BACKGROUND: The SF-6D is a new health state classification and utility scoring system based on 6 dimensions (‘6D’)
of the Short Form 36, and permits a ‘‘bridging’’ transformation between SF-36 responses and utilities. The Health
Utilities Index, mark 3 (HUI3) is a valid and reliable multi-attribute health utility scale that is widely used. We
assessed within-subject agreement between SF-6D utilities and those from HUI3.
METHODS: Patients at increased risk of sudden cardiac death and participating in a randomized trial of implantable
defibrillator therapy completed both instruments at baseline. Score distributions were inspected by scatterplot and
histogram and mean score differences compared by paired t-test. Pearson correlation was computed between
instrument scores and also between dimension scores within instruments. Between-instrument agreement was by
intra-class correlation coefficient (ICC).
RESULTS: SF-6D and HUI3 forms were available from 246 patients. Mean scores for HUI3 and SF-6D were 0.61
(95% CI 0.60–0.63) and 0.58 (95% CI 0.54–0.62) respectively; a difference of 0.03 (p50.03). Score intervals for
HUI3 and SF-6D were (-0.21 to 1.0) and (0.30–0.95). Correlation between the instrument scores was 0.58 (95% CI
0.48–0.68) and agreement by ICC was 0.42 (95% CI 0.31–0.52). Correlations between dimensions of SF-6D were
higher than for HUI3.
CONCLUSIONS: Our study casts doubt on the whether utilities and QALYs estimated via SF-6D are comparable with
those from HUI3. Utility differences may be due to differences in underlying concepts of health being measured, or
different measurement approaches, or both. No gold standard exists for utility measurement and the SF-6D is a
valuable addition that permits SF-36 data to be transformed into utilities to estimate QALYs. The challenge is
developing a better understanding as to why these classification-based utility instruments differ so markedly in their
distributions and point estimates of derived utilities.
2003
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/278/1/brazierje6.pdf
O'Brien, B.J., Spath, M., Blackhouse, G. et al. (2 more authors) (2003) A view from the Bridge: agreement between the SF-6D utility algorithm and the Health utilities Index. Health Economics, 12 (11). pp. 975-982. ISSN 1057-9230
http://www.interscience.wiley.com/
doi:10.1002/hec.789
oai:eprints.whiterose.ac.uk:279
2014-06-05T15:35:24Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/279/
A comparison of the EQ-5D and the SF-6D across seven patient groups
Brazier, J.E.
Tsuchiya, A.
Roberts, J.
Busschbach, J.
As the number of preference-based instruments grows, it becomes increasingly important to compare different
preference-based measures of health in order to inform an important debate on the choice of instrument. This paper
presents a comparison of two of them, the EQ-5D and the SF-6D (recently developed from the SF-36) across seven
patient/population groups (chronic obstructive airways disease, osteoarthritis, irritable bowel syndrome, lower back
pain, leg ulcers, post menopausal women and elderly). The mean SF-6D index value was found to exceed the EQ-5D
by 0.045 and the intraclass correlation coefficient between them was 0.51. Whilst this convergence lends some
support for the validity of these measures, the modest difference at the aggregate level masks more significant
differences in agreement across the patient groups and over severity of illness, with the SF-6D having a smaller range
and lower variance in values. There is evidence for floor effects in the SF-6D and ceiling effects in the EQ-5D. These
discrepancies arise from differences in their health state classifications and the methods used to value them. Further
research is required to fully understand the respective roles of the descriptive systems and the valuation methods and
to examine the implications for estimates of the impact of health care interventions.
2004
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/279/1/brazierje7.pdf
Brazier, J.E., Tsuchiya, A., Roberts, J. et al. (1 more author) (2004) A comparison of the EQ-5D and the SF-6D across seven patient groups. Health Economics, 13 (9). pp. 873-884. ISSN 1057-9230
http://www.interscience.wiley.com/
doi:10.1002/hec.866
oai:eprints.whiterose.ac.uk:474
2014-06-04T14:04:33Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/474/
The estimation of a preference-based measure of health from the SF-36
Brazier, J.E.
Roberts, J.
Deverill, M.
This paper reports on the findings of a study to derive a preference-based measure of health from the SF-36 for use in economic evaluation. The SF-36 was revised into a six-dimensional health state classification called the SF-6D. A sample of 249 states defined by the SF-6D have been valued by a representative sample of 611 members of the UK general population, using standard gamble. Models are estimated for predicting health state valuations for all 18,000 states defined by the SF-6D. The econometric modelling had to cope with the hierarchical nature of the data and its skewed distribution. The recommended models have produced significant coefficients for levels of the SF-6D, which are robust across model specification. However, there are concerns with some inconsistent estimates and over prediction of the value of the poorest health states. These problems must be weighed against the rich descriptive ability of the SF-6D, and the potential application of these models to existing and future SF-36 data set.
2002-03
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/474/1/brazierje10.pdf
Brazier, J.E., Roberts, J. and Deverill, M. (2002) The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21 (2). pp. 271-292. ISSN 0167-6296
http://www.sciencedirect.com/science/journal/01676296
doi:10.1016/S0167-6296(01)00130-8
oai:eprints.whiterose.ac.uk:1557
2014-06-06T17:46:50Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/1557/
Clinical-effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: a systematic review
Pandor, A.
Eastham, J.
Beverley, C.
Chilcott, J.
Paisley, S.
Objectives: The clinical- and cost-effectiveness of tandem mass spectrometry (MS)-based neonatal screening for inborn errors of metabolism (IEM) were evaluated.
Cambridge University Press
2005-01
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/1557/1/pandor.a1.pdf
Pandor, A., Eastham, J., Beverley, C. et al. (2 more authors) (2005) Clinical-effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: a systematic review. International Journal of Technology Assessment in Health Care, 21 (1). p. 150. ISSN 0266-4623
http://journals.cambridge.org/action/displayIssue?jid=THC&volumeId=21&issueId=01
oai:eprints.whiterose.ac.uk:1912
2014-06-10T01:08:47Z
7374617475733D707562
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/1912/
A pilot Internet "Value of Health" Panel: recruitment, participation and compliance
Stein, K.
Dyer, M.
Crabb, T.
Milne, R.
Round, A.
Ratcliffe, J.
Brazier, J.
Objectives
To pilot using a panel of members of the public to provide preference data via the Internet
Methods
A stratified random sample of members of the general public was recruited and familiarised with the standard gamble procedure using an Internet based tool. Health states were perdiodically presented in "sets" corresponding to different conditions, during the study. The following were described: Recruitment (proportion of people approached who were trained); Participation (a) the proportion of people trained who provided any preferences and (b) the proportion of panel members who contributed to each "set" of values; and Compliance (the proportion, per participant, of preference tasks which were completed). The influence of covariates on these outcomes was investigated using univariate and multivariate analyses.
Results
A panel of 112 people was recruited. 23% of those approached (n = 5,320) responded to the invitation, and 24% of respondents (n = 1,215) were willing to participate (net = 5.5%). However, eventual recruitment rates, following training, were low (2.1% of those approached). Recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. Eighteen sets of health state descriptions were considered over 14 months. 74% of panel members carried out at least one valuation task. People from areas of higher socioeconomic deprivation and unmarried people were less likely to participate. An average of 41% of panel members expressed preferences on each set of descriptions. Compliance ranged from 3% to 100%.
Conclusion
It is feasible to establish a panel of members of the general public to express preferences on a wide range of health state descriptions using the Internet, although differential recruitment and attrition are important challenges. Particular attention to recruitment and retention in areas of high socioeconomic deprivation and among ethnic minority communities is necessary. Nevertheless, the panel approach to preference measurement using the Internet offers the potential to provide specific utility data in a responsive manner for use in economic evaluations and to address some of the outstanding methodological uncertainties in this field.
BioMed Central
2006-11-27
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/1912/1/ratcliffej1.pdf
Stein, K., Dyer, M., Crabb, T. et al. (4 more authors) (2006) A pilot Internet "Value of Health" Panel: recruitment, participation and compliance. Health and Quality of Life Outcomes, 4 (90). ISSN 1477-7525
http://www.hqlo.com/content/4/1/90
doi:10.1186/1477-7525-4-90
oai:eprints.whiterose.ac.uk:3535
2016-09-16T13:33:50Z
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756E69743D536865666669656C64:536865666669656C642E464350:536865666669656C642E4D4153
756E69743D536865666669656C64:536865666669656C642E5F5243:536865666669656C642E425348
756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
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https://eprints.whiterose.ac.uk/3535/
Using rank data to estimate health state utility models
McCabe, C.
Brazier, J.
Gilks, P.
Tsuchiya, A.
Roberts, J.
O'Hagan, A.
Stevens, K.
In this paper we report the estimation of conditional logistic regression models for the Health Utilities Index Mark 2 and the SF-6D, using ordinal preference data. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations. For both the HUI2 and the SF-6D, the models estimated using ordinal data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that ordinal data have the potential to provide useful insights into community health state preferences. However, important questions remain.
Elsevier
2006-05
Article
PeerReviewed
text
en
attached
https://eprints.whiterose.ac.uk/3535/1/McCabeetalJHE2006final.pdf
McCabe, C., Brazier, J., Gilks, P. et al. (4 more authors) (2006) Using rank data to estimate health state utility models. Journal of Health Economics, 25 (3). pp. 418-431. ISSN 0167-6296
http://dx.doi.org/10.1016/j.jhealeco.2005.07.008
doi:10.1016/j.jhealeco.2005.07.008
oai:eprints.whiterose.ac.uk:3539
2016-10-24T22:42:17Z
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756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
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https://eprints.whiterose.ac.uk/3539/
NICE clinical guidelines - Health economics must engage with complexity of issues - Reply
Wailoo, A.
Roberts, J.
Brazier, J.
McCabe, C.
BMJ Publishing
2004-09-04
Article
PeerReviewed
text
en
attached
https://eprints.whiterose.ac.uk/3539/1/WailooBMJ_2004.pdf
Wailoo, A., Roberts, J., Brazier, J. et al. (1 more author) (2004) NICE clinical guidelines - Health economics must engage with complexity of issues - Reply. BMJ, 329 (7465). p. 572. ISSN 0959-535X
http://www.bmj.com/cgi/content/full/329/7465/572-a
10.1136/bmj.329.7465.572-a
oai:eprints.whiterose.ac.uk:6705
2009-04-22T17:37:17Z
7374617475733D707562
74797065733D61727469636C65
756E69743D596F726B:596F726B2E52657365617263685F47726F7570:596F726B2E594F523335
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D596F726B
7072696D6F3D6E6F5F646F63756D656E74735F617661696C61626C65
https://eprints.whiterose.ac.uk/6705/
Paediatric home care: a systematic review of randomized trials on costs and effectiveness
Parker, G.
Bhakta, P.
Lovett, C.
Olsen, R.
Paisley, S.
Objective: To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care.
Methods: National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings – on service use, clinical outcomes, costs, and impact on the family – are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible.
Results: About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care – for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model.
Conclusions: Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs.
Royal Society of Medicine
2006-04-01
Article
NonPeerReviewed
Parker, G., Bhakta, P., Lovett, C. et al. (2 more authors) (2006) Paediatric home care: a systematic review of randomized trials on costs and effectiveness. Journal of Health Services Research and Policy, 11 (2). pp. 110-119. ISSN 1355-8196
http://dx.doi.org/10.1258/135581906776318947
10.1258/135581906776318947
oai:eprints.whiterose.ac.uk:8650
2015-11-18T22:19:26Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E464350:536865666669656C642E4D4153
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E4D4352
756E69743D536865666669656C64:536865666669656C642E5F5243:536865666669656C642E4D4352
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/8650/
The multiple sclerosis risk sharing scheme monitoring study - early results and lessons for the future
Pickin, M.
Cooper, C.L.
Chater, T.
O'Hagan, A.
Abrams, K.R.
Cooper, N.J.
Boggild, M.
Palace, J.
Ebers, G.
Chilcott, J.
Tappenden, P.
Nicholl, J.
Background: Risk sharing schemes represent an innovative and important approach to the problems of rationing and achieving cost-effectiveness in high cost or controversial health interventions. This study aimed to assess the feasibility of risk sharing schemes, looking at long term clinical outcomes, to determine the price at which high cost treatments would be acceptable to the NHS.
Methods: This case study of the first NHS risk sharing scheme, a long term prospective cohort study of beta interferon and glatiramer acetate in multiple sclerosis ( MS) patients in 71 specialist MS centres in UK NHS hospitals, recruited adults with relapsing forms of MS, meeting Association of British Neurologists (ABN) criteria for disease modifying therapy. Outcome measures were: success of recruitment and follow up over the first three years, analysis of baseline and initial follow up data and the prospect of estimating the long term cost-effectiveness of these treatments.
Results: Centres consented 5560 patients. Of the 4240 patients who had been in the study for a least one year, annual review data were available for 3730 (88.0%). Of the patients who had been in the study for at least two years and three years, subsequent annual review data were available for 2055 (78.5%) and 265 (71.8%) patients respectively. Baseline characteristics and a small but statistically significant progression of disease were similar to those reported in previous pivotal studies.
Conclusion: Successful recruitment, follow up and early data analysis suggest that risk sharing schemes should be able to deliver their objectives. However, important issues of analysis, and political and commercial conflicts of interest still need to be addressed.
BioMed Central
2009-01-06
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/8650/1/Pickin_1.pdf
Pickin, M., Cooper, C.L., Chater, T. et al. (9 more authors) (2009) The multiple sclerosis risk sharing scheme monitoring study - early results and lessons for the future. BMC Neurology, 9. Art. No.1. ISSN 1471-2377
http://dx.doi.org/10.1186/1471-2377-9-1
10.1186/1471-2377-9-1
oai:eprints.whiterose.ac.uk:9663
2009-10-01T15:23:37Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6E6F5F646F63756D656E74735F617661696C61626C65
https://eprints.whiterose.ac.uk/9663/
Features of asthma management: quantifying the patient perspective
Haughney, J.
Fletcher, M.
Wolfe, S.
Ratcliffe, J.
Brice, R.
Partridge, M.
BACKGROUND:
In the management of asthma, features of care important to patients may not be fully appreciated. This study quantifies the importance of different features of asthma management from the patient perspective. This may assist in the development of personalised management strategies.
METHODS:
We used the technique of discrete choice experiment (DCE). Patients over 18 years of age with asthma, prescribed and taking medicine at step 3 of the UK guidelines were recruited from 15 general (family) practices in three areas of the UK. 147 evaluable questionnaires were returned from a total of 348 sent out. The outcome measures were the relative importance to patients of features of asthma management and the impact of changes in asthma management, as measured by utility shift between the features tested.RESULTS:The largest shift in mean utility values was recorded in "number of inhalers" and "use of inhaled steroid". Use of a personal asthma action plan was ranked next highest.
CONCLUSION:
This study suggests that adults with moderate or severe asthma would trade some improvements in symptom relief in favour of, for example, simpler treatment regimens that use as few inhalers as possible and a lower dose of inhaled steroid.
Biomed Central
2007-12
Article
NonPeerReviewed
Haughney, J., Fletcher, M., Wolfe, S. et al. (3 more authors) (2007) Features of asthma management: quantifying the patient perspective. BMC Pulmonary Medicine, 7 (1). p. 16. ISSN 1471-2466
http://www.biomedcentral.com/1471-2466/7/16
doi:10.1186/1471-2466-7-16
oai:eprints.whiterose.ac.uk:9752
2009-10-08T11:49:52Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6E6F5F646F63756D656E74735F617661696C61626C65
https://eprints.whiterose.ac.uk/9752/
Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)
Thalanany, M.M.
Mugford, M.
Hibbert, C.
Cooper, N.J.
Truesdale, A.
Robinson, S.
Tiruvoipati, R.
Elbourne, D.R.
Peek, G.J.
Clemens, F.
Hardy, P.
Wilson, A.
BACKGROUND:
Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system.
METHODS/DESIGN:
The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated.
DISCUSSION:
In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain.
Biomed Central
2008-04
Article
NonPeerReviewed
Thalanany, M.M., Mugford, M., Hibbert, C. et al. (9 more authors) (2008) Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR). BMC Health Services Research, 8 (1). p. 94. ISSN 1472-6963
http://www.biomedcentral.com/1472-6963/8/94
doi:10.1186/1472-6963-8-94
oai:eprints.whiterose.ac.uk:10793
2014-06-05T12:49:05Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10793/
HEDS Discussion Paper 09-15: Developing preference-based health measures: using Rasch analysis to generate health state values
Young, T.A.
Rowen, D.
Norquist, J.
Brazier, J.E.
Background/aims: Condition specific measures may not always have independent items, and existing techniques of developing health state values from these measures are inappropriate when items are not independent. This study develops methods for deriving and valuing health states for a preference-based measure.
Methods: Three key stages are presented: Rasch analysis is used to develop a health state classification system and identify a set of health states for valuation. A valuation survey of the health states using time-trade-off (TTO) methods is conducted to elicit health state values. Finally, regression models are applied to map the relationship between mean TTO values and Rasch logit values. The model is then used to estimate health state values for all possible health states. Methods are illustrated using the Flushing Symptoms Questionnaire (FSQ).
Results: Rasch models were fitted to 1270 responders to the FSQ and a series of 16 health states identified for the valuation exercise. An ordinary least squares model best described the relationship between mean TTO values and Rasch logit values. (R2 = 0.958; Root mean square error = 0.042).
Conclusions: We have shown how the valuation of health states can be mapped onto the Rasch scale in order to value all states defined by the FSQ. This should significantly enhance work in this field.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10793/2/HEDS_DP_09-15.pdf
Young, T.A., Rowen, D., Norquist, J. et al. (1 more author) (2009) HEDS Discussion Paper 09-15: Developing preference-based health measures: using Rasch analysis to generate health state values. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09-15
oai:eprints.whiterose.ac.uk:10841
2013-02-08T17:00:30Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10841/
Developing a descriptive system for a new preference-based measure of health-related quality of life for children
Stevens, K.
The use of preference-based measures (PBMs) of health-related quality of life (HRQoL) is increasing in health care resource allocation decisions. Whilst there are measures widely used for this purpose in adults, research in the paediatric field is more limited. This paper reports on how the descriptive system for a new paediatric generic PBM of HRQoL was developed from dimensions identified in previous research.
Existing scales from the paediatric literature were reviewed for suitability, and scales were also developed empirically, based on qualitative interview data from children, by taking adverbial phrases and confirming the ordinality by a ranking exercise with children. The resulting scales were applied to the dimensions from the previous research.
No suitable scales were found in the paediatric literature, so the empirically derived scales were used resulting in seven different types. Children were successfully able to rank these to determine the ordinality, and these types were applied to the dimensions.
This work has empirically developed a descriptive system for the dimensions of HRQoL identified in previous research. Further research is needed to test the descriptive system on a paediatric population and reduce the number of dimensions to be amenable to health state valuation.
Springer
2009-10
Article
PeerReviewed
text
en
https://eprints.whiterose.ac.uk/10841/1/Stevens_10941.pdf
Stevens, K. (2009) Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Quality of Life Research, 18 (8). pp. 1105-1113. ISSN 0962-9343
http://dx.doi.org/10.1007/s11136-009-9524-9
10.1007/s11136-009-9524-9
oai:eprints.whiterose.ac.uk:10842
2010-06-07T08:32:33Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6E6F5F646F63756D656E74735F617661696C61626C65
https://eprints.whiterose.ac.uk/10842/
Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure
Stevens, K.
Use of preference-based measures (PBM) of health-related quality of life (HRQoL) is increasing. PBMs allow the calculation of quality-adjusted life years, which can be used in decision making. Research in the field of pediatric PBMs is lacking. This work is the first stage in the development of a new generic, pediatric PBM of HRQoL. Seventy-four qualitative interviews were undertaken with children to find out how health affects their lives. Sampling was purposive, balancing primarily for health within age, with gender and ethnicity as secondary criteria. Interviews covered a wide range of health conditions, and children were successfully able to articulate how their health affected their lives. Eleven dimensions of HRQoL were identified, covering social, emotional, and physical aspects, in common with other generic pediatric HRQoL measures, but differ by including feeling jeal'ous and feeling tired/weak and not including dimensions related to parental, family, or behavioral issues.
SAGE Publications
2010-03
Article
NonPeerReviewed
Stevens, K. (2010) Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure. Qualitative Health Research, 20 (3). pp. 340-351. ISSN 1049-7323
http://dx.doi.org/10.1177/1049732309358328
10.1177/1049732309358328
oai:eprints.whiterose.ac.uk:10872
2014-06-06T09:03:57Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10872/
Deriving a preference-based measure for cancer using the EORTC QLQ-C30
Rowen, D.
Brazier, J.E.
Young, T.A.
Gaugrist, S.
Craig, B.M.
King, M.T.
Velikova, G.
Background: The EORTC QLQ-C30 is one of the most commonly used measures in cancer but in its current form cannot be used in economic evaluation as it does not incorporate preferences.
Methods and results: We address this gap by estimating a preference-based single index for cancer from the EORTC QLQ-C30 for use in economic evaluation. Factor analysis, Rasch analysis and other psychometric analyses were undertaken on a clinical trial dataset of 655 patients with multiple myeloma to derive a health state classification from the QLQ-C30 that is amenable to valuation. The resulting health state classification system has 8 dimensions (physical functioning, role functioning, social functioning, emotional functioning, pain, fatigue and sleep disturbance, nausea, and constipation and diarrhoea) with 4 or 5 levels each. A valuation study was conducted of 350 members of the UK general population using ranking and time trade-off. Mean and individual level additive multivariate regression models including the episodic random utility model were fitted to the valuation data to derive preference weights for the classification system. Mean absolute error ranges from 0.046 to 0.054 and models have few inconsistencies (0 to 2) in estimated preference weights.
Conclusions: We conclude that it is feasible to derive a preference-based measure from the EORTC QLQ-C30 for use in economic evaluation, but this work needs to be extended to other countries and replicated across other patient groups.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10872/1/HEDS_DP_10-01.pdf
Rowen, D., Brazier, J.E., Young, T.A. et al. (4 more authors) (2010) Deriving a preference-based measure for cancer using the EORTC QLQ-C30. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/01
oai:eprints.whiterose.ac.uk:10875
2014-06-06T08:59:47Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10875/
Assessing the performance of a new generic measure of health related quality of life for children and refining it for use in health state valuation
Stevens, K.
Purpose: The aims of this research were to pilot and assess the performance of a new generic paediatric health related quality of life measure and to refine the measure to be amenable to health state valuation to make it suitable for use in economic evaluation.
Methods: A sample of 247 children was recruited from general and clinical paediatric populations. Each child completed the measure and data was collected to allow assessment of practicality, validity, whether the child could self complete and preferences for alternative wordings that could be used. The measure was refined in light of the results and also to make it amenable to health state valuation.
Results: The measure demonstrated good practicality and validity in both the general and clinical paediatric populations with excellent completion rates, a low time to complete and evidence of face, content and construct validity. To make it suitable for health state valuation, the number of dimensions of health related quality of life was reduced from 11 to 9.
Conclusions: The measure performed well and the final measure generates health states which should be feasible for valuation. Further research is needed to value the final descriptive system.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10875/1/HEDS_DP_10-02.pdf
Stevens, K. (2010) Assessing the performance of a new generic measure of health related quality of life for children and refining it for use in health state valuation. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/02
oai:eprints.whiterose.ac.uk:10879
2014-06-13T12:26:14Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10879/
Measuring the value of life: Exploring a new method for deriving the monetary value of a QALY
Tilling, C.
Krol, M.
Tsuchiya, A.
Brazier, J.
van Exel, J.
Brouwer, W.
Economic evaluations of new health technologies now typically produce an incremental cost per Quality Adjusted Life Year (QALY) value. The QALY is a measure of health benefit that combines length of life with quality of life, where quality of life is assessed on a scale where zero represents a health state equivalent to being dead and one represents full health. The challenge for decision makers, such as the Treasury, is to determine the appropriate size of the healthcare budget. Bodies such as the National Institute for Health and Clinical Excellent (NICE) in the U.K. must then determine how much they can afford to pay for a gain of one QALY, while operating under this fixed budget. While there is no fixed cost-effectiveness threshold and each intervention is assessed on a case by case basis, under normal circumstances the threshold will not be below £20,000 and not above £30,000 per QALY.
Recent research has sought to determine the monetary value individuals place on a QALY to inform the size of the healthcare budget and the level of the cost-effectiveness threshold. This research has predominantly used Willingness to Pay (WTP) approaches. However, WTP has a number of known problems, most notably its insensitivity to scope. In this paper we present an alternative approach to estimating the monetary value of a QALY (MVQ), which is based upon a Time Trade Off (TTO) exercise of income with health held constant at perfect health. We present the methods and theory underlying this experimental approach and some results from an online feasibility study in the Netherlands.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10879/1/HEDS_DP_09-14.pdf
Tilling, C., Krol, M., Tsuchiya, A. et al. (3 more authors) (2009) Measuring the value of life: Exploring a new method for deriving the monetary value of a QALY. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/14
oai:eprints.whiterose.ac.uk:10880
2014-06-08T06:14:03Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10880/
Health related quality of life by age, gender and history of cardiovascular disease: results from the Health Survey for England
Ara, R.
Brazier, J.
Introduction: While there is an increasing volume of literature describing the health state utility values (HSUV) individuals with angina, heart attack or stroke, research comparing HSUVs for these conditions within the same study is sparse. This hinders analysts wishing to explore the benefits of interventions in cardiovascular disease (CVD). The objective of this study was to obtain EQ-5D scores to inform health states in CVD economic models using the same source for each health state.
Methods: EQ-5D data (N = 26,679) from individuals aged 16 to 98 years taking part in the Health Survey for England (2003, 2006) was used. Regressions were employed to explore the significance of age, gender and history of CVD on HSUVs taking into account the number and type of cardiovascular condition(s) and time since event. The predictive ability of the model was assessed using errors in predicted values on both the individual and the sub-group levels.
Results: Our results show HSUVs differ by age, gender, CV history, time since CV event and the number of concurrent CV conditions. The regression model is reasonably accurate when predicting mean values for sub-groups stratified by age, CV condition and time since event, with 67% of predicted values within the minimal important difference for the EQ-5D index.
Conclusions: The results provide a consistent basis for analysts to populate the most frequently defined health states (no CVD, heart attack, angina and stroke) in CVD models. Further research is required to validate these results in other datasets.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10880/1/HEDS_DP_09-12.pdf
Ara, R. and Brazier, J. (2009) Health related quality of life by age, gender and history of cardiovascular disease: results from the Health Survey for England. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/12
oai:eprints.whiterose.ac.uk:10881
2014-06-05T20:45:50Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10881/
Populating an economic model with health state utility values: moving towards better practice
Ara, R.
Brazier, J.
Background: When estimating health state utility values (HSUV) for multiple health conditions, the alternative models used to combine these data can produce very different values. Results generated using a baseline of perfect health are not comparable with those generated using a baseline adjusted for not having the health condition taking into account age and gender. Despite this, there is no guidance on the preferred techniques that should be used and very little research describing the effect on cost per QALY results.
Methods: Using a cardiovascular disease (CVD) model and cost per QALY thresholds, we assess the consequence of using different baseline health state utility profiles (perfect health, individuals with no history of CVD, general population) in conjunction with three models (minimum, additive, multiplicative) frequently used to estimate proxy scores for multiple health conditions.
Results: Assuming a baseline of perfect health ignores the natural decline in quality of life associated with co-morbidities, over-estimating the benefits of treatment to such an extent it could potentially influence a threshold policy decision. The minimum model biases results in favour of younger aged cohorts while the additive and multiplicative technique produced similar results.
Although further research in additional health conditions is required to support our findings, this pilot study highlights the urgent need for analysts to conform to an agreed reference case and provides initial recommendations for better practice. We demonstrate that in CVD, if data are not available from individuals without the health condition, HSUVs from the general population provide a reasonable approximation.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10881/1/HEDS_DP_09-11.pdf
Ara, R. and Brazier, J. (2009) Populating an economic model with health state utility values: moving towards better practice. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/11
oai:eprints.whiterose.ac.uk:10882
2014-06-15T10:24:26Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10882/
Using rank and discrete choice data to estimate health state utility values on the QALY scale
Brazier, J.
Rowen, D.
Yang, Y.
Tsuchiya, A.
Objective: Recent years has seen increasing interest in the use of ordinal methods to elicit health state utility values as an alternative to conventional methods such as standard gamble and time trade-off. However, in order to use these health state values in cost effectiveness analysis using cost per quality adjusted life year (QALY) analysis, these values must be anchored on the full health-dead scale. This study addresses this challenge and examines how rank and discrete choice experiment data can be used to elicit health state utility values anchored on the full health-dead scale and compares the results to time trade-off (TTO) results.
Methods: Two valuation studies were conducted using identical methods for two health state classification systems: asthma and overactive bladder. Each valuation study involved interviews of 300 members of the general population using ranking and TTO plus a postal survey using discrete choice experiment sent to all consenting interviewees and a "cold" sample of the general population who were not interviewed.
Results: Overall DCE produced different results to ranking and time trade-off, whereas ranking produced similar results to TTO in one study, but not the other.
Conclusions: Ordinal methods offer a promising alternative to conventional cardinal methods of standard gamble and TTO. However, the results do not appear to be robust across different health state classification systems and potentially different medical conditions. There remains a large and important research agenda to address.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10882/1/HEDS_DP_09-10.pdf
Brazier, J., Rowen, D., Yang, Y. et al. (1 more author) (2009) Using rank and discrete choice data to estimate health state utility values on the QALY scale. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/10
oai:eprints.whiterose.ac.uk:10883
2017-11-03T21:51:38Z
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https://eprints.whiterose.ac.uk/10883/
Using Rasch analysis to form plausible health states amenable to valuation: the development of CORE-6D from CORE-OM in order to elicit preferences for common mental health problems
Mavranezouli, I.
Brazier, J.E.
Young, T.A.
Barkham, M.
Purpose: To describe a new approach for deriving a preference-based index from a condition specific measure that uses Rasch analysis to develop health states.
Methods: CORE-OM is a 34-item instrument monitoring clinical outcomes of people with common mental health problems. CORE-OM is characterised by high correlation across its domains. Rasch analysis was used to reduce the number of items and response levels in order to produce a set of unidimensionally-behaving items, and to generate a credible set of health states corresponding to different levels of symptom severity using the Rasch item threshold map.
Results: The proposed methodology resulted in the development of CORE-6D, a 2-dimensional health state description system consisting of a unidimensionally-behaving 5-item emotional component and a physical symptom item. Inspection of the Rasch item threshold map of the emotional component helped identify a set of 11 plausible health states, which, combined with the physical symptom item levels, will be used for the valuation of the instrument, resulting in the development of a preference-based index.
Conclusions: This is a useful new approach to develop preference-based measures where the domains of a measure are characterised by high correlation. The CORE-6D preference-based index will enable calculation of Quality Adjusted Life Years in people with common mental health problems.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10883/2/HEDS_DP_09-09.pdf
Mavranezouli, I., Brazier, J.E., Young, T.A. et al. (1 more author) (2009) Using Rasch analysis to form plausible health states amenable to valuation: the development of CORE-6D from CORE-OM in order to elicit preferences for common mental health problems. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/09
oai:eprints.whiterose.ac.uk:10884
2014-06-05T08:31:52Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10884/
Consistency between direct trial evidence and Bayesian Mixed Treatment Comparison: Is head-to-head evidence always more reliable?
Madan, J.
Cooper, K.L.
Stevenson, M.D.
Whyte, S.
Akehurst, R.
Objectives
This study aims to highlight the benefits of Bayesian mixed treatment comparison (MTC), within a case study of the efficacy of three treatments (pegfilgrastim, filgrastim and lenograstim) for the prevention of febrile neutropenia (FN) following chemotherapy.
Methods
Two published meta-analyses have assessed the relative efficacy of the three treatments based on head-to-head trials. In the present study, all the trials from these meta-analyses were synthesised within a single network in a Bayesian MTC. Following a systematic review, the evidence base was then updated to include further recently-published trials. The metaanalyses and MTC were re-analysed using the updated evidence base.
Results
Using data from the previously-published meta-analyses only, the relative risk of FN for pegfilgrastim vs. no treatment was estimated at 0.08 (95% confidence interval: 0.03, 0.18) from the head-to-head trial and 0.27 (95% credible interval: 0.12, 0.60) from the MTC, reflecting strong inconsistency between the results of the direct and indirect methodologies. When subsequently-published head-to-head trials were included, the meta-analysis estimate increased to 0.29 (95% confidence interval: 0.15, 0.55), while the MTC gave a relative risk of 0.34 (95% credible interval: 0.23, 0.54). The initial MTC results were therefore a better predictor of subsequent study results than was the direct trial. The MTC was also able to estimate the probability that there were clinically significant difference in efficacy between the treatments.
Conclusions
Bayesian MTC provides clinically relevant information, including a measure of the consistency of direct and indirect evidence. Where inconsistency exists, it should not always be assumed that the direct evidence is more appropriate.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10884/1/HEDS_DP_09-08.pdf
Madan, J., Cooper, K.L., Stevenson, M.D. et al. (2 more authors) (2009) Consistency between direct trial evidence and Bayesian Mixed Treatment Comparison: Is head-to-head evidence always more reliable? Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/08
oai:eprints.whiterose.ac.uk:10885
2014-06-21T18:11:12Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10885/
Granulocyte colony-stimulating factors for febrile neutropenia prophylaxis: systematic review and mixed method treatment comparison
Cooper, K.L.
Madan, J.
Whyte, S.
Stevenson, M.D.
Akehurst, R.
Background
This study assesses the efficacy of three granulocyte colony-stimulating factors (G-CSFs; pegfilgrastim, filgrastim and lenograstim) in preventing febrile neutropenia (FN).
Methods
A systematic review was undertaken. Head-to-head studies were combined using direct meta-analyses. In addition, an indirect Bayesian mixed treatment comparison (MTC) was undertaken to facilitate comparison between G-CSFs where there were no direct trials, and to allow data from all trials to be synthesised into a coherent set of results.
Results
The review identified the following studies comparing G-CSF prophylaxis to no primary G-CSF prophylaxis: 5 studies of pegfilgrastim, 9 studies of filgrastim and 5 studies of lenograstim. In addition, 5 studies were identified comparing pegfilgrastim to filgrastim. The two synthesis methods (meta-analysis and MTC) demonstrated that all three G-CSFs significantly reduced FN rate. Pegfilgrastim reduced FN rate to a greater extent than filgrastim (significantly in the head-to-head meta-analysis and in the MTC of all studies, and not quite significantly when the MTC was restricted to RCTs only). In the absence of direct trials, the MTC gave an 80-86% probability that pegfilgrastim is superior to lenograstim in preventing FN, and a 71-72% probability that lenograstim is superior to filgrastim.
Conclusions
Prophylaxis with G-CSFs significantly reduces FN rate. A head-to-head meta-analysis shows pegfilgrastim to be significantly superior to filgrastim in preventing FN events, while an MTC demonstrates that pegfilgrastim is likely to be superior to lenograstim.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10885/1/HEDS_DP_09-07.pdf
Cooper, K.L., Madan, J., Whyte, S. et al. (2 more authors) (2009) Granulocyte colony-stimulating factors for febrile neutropenia prophylaxis: systematic review and mixed method treatment comparison. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/07
oai:eprints.whiterose.ac.uk:10888
2014-06-06T08:32:56Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10888/
The simultaneous valuation of states from multiple instruments using ranking and VAS data: methods and preliminary results
Rowen, D.
Brazier, J.
Tsuchiya, A.
Hernández, M.
Ibbotson, R
Background: Previous methods of empirical mapping involve using regressions on patient or general population self-report data from datasets involving 2 or more instruments. This approach relies on overlap in the descriptive systems of the measures, but key dimensions may not be present in both measures. Furthermore, this assumes it is appropriate to use different instruments on the same population, which may not be the case for all patient groups. The aim of the study described here is to develop a new method of mapping using general population preferences for hypothetical health states defined by the descriptive systems of different measures. This paper presents a description of the methods used in the study and reports on the results of the valuation study including details about the respondents, feasibility and quality (e.g. response rate, completion and consistency) and descriptive results on VAS and ranking data. The use of these results to estimate mapping functions between instruments will be presented in a companion paper.
Methods: The study used interviewer administered versions of ranking and VAS techniques to value 13 health states defined by each of 6 instruments: EQ-5D (generic), SF-6D (generic), HUI2 (generic for children), AQL-5D (asthma specific), OPUS (social care specific), ICECAP (capabilities). Each interview involved 3 ranking and visual analogue scale (VAS) tasks with states from 3 different instruments where each task involves the simultaneous valuation of multiple instruments. The study includes 13 health and well-being states for each instrument (16 for EQ-5D) that reflect a range of health state values according to the published health state values for each instrument and each health state is valued approximately 75-100 times.
Results: The sample consists of 499 members of the UK general population with a reasonable spread of background characteristics (response rate=55%). The study achieved a completion rate of 99% for all states included in the rank and rating tasks and 94.8% of respondents have complete VAS responses and 97.2% have complete rank responses. Interviewers reported that it is doubtful for 4.1% of respondents that they understood the tasks, and 29.3% of respondents stated that they found the tasks difficult. The results suggest important differences in the range of mean VAS and mean rank values per state across instruments; for example, mean VAS values for the worst state vary across instruments from 0.075 to 0.324. Respondents are able to change the ordering of states between the rank and VAS tasks and 12.0% of respondents have one or more differences in their rank and VAS orderings for every task.
Conclusions: This study has demonstrated the feasibility of simultaneously valuing health states from different preference-based instruments. The preliminary analysis of the results presented here provides the basis for a new method of mapping between measures based on general population preferences.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10888/1/HEDS_DP_09-06.pdf
Rowen, D., Brazier, J., Tsuchiya, A. et al. (2 more authors) (2009) The simultaneous valuation of states from multiple instruments using ranking and VAS data: methods and preliminary results. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/06
oai:eprints.whiterose.ac.uk:10889
2014-06-05T00:20:06Z
7374617475733D756E707562
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https://eprints.whiterose.ac.uk/10889/
The psychometric properties of ADCS - activities of daily living inventory and comparison of different ADL scores
Rózsa, S.
Brandtmüller, A.
Nagy, B.
Brennan, A.
Akehurst, R.
Several multi-item activities of daily living (ADL) scales have been developed for assessment of functional status of patients with Alzheimer’s Disease (AD) in the last few decades. A disadvantage of the large number of scales is that scores of different ADL scales cannot be compared directly with each other. ADL scales which are used by McNamee’s (Townsend's disability scale) and Hill’s (Medicare Beneficiary definitions and Katz index of ADL) provide suitable tools for modelling the cost-effectiveness of different treatments in patients with Alzheimer’s disease, since they report empirical results about the relationship between the degree of functional impairment (healthcare costs) and the prevalence of institutionalisation.
The IDEAL trial examines the efficacy of Exelon Patch with the ADCS - Activities of Daily Living Inventory (ADCS-ADL). This ADL instrument is not directly comparable to the ADL scales used by McNamee and Hill. However, the use of the ADL scale from the IDEAL study to predict the prevalence of institutionalisation with scales by Hill and McNamee would be desirable. Because of the generic nature of the ADL construct, and considering the fact that these well validated ADL instruments identify the main physical impairments and functional disabilities in Alzheimer's disease, we should expect high overlap in item content between different ADL instruments. The high overlap in item content between instruments, and the similar wording and scoring criteria, makes it possible to pair each impairment with another. The intention of this study was to establish the link between these ADL scales in order to provide appropriate conditions for further economic analyses on the dataset provided by the IDEAL study.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10889/1/HEDS_DP_09-05.pdf
Rózsa, S., Brandtmüller, A., Nagy, B. et al. (2 more authors) (2009) The psychometric properties of ADCS - activities of daily living inventory and comparison of different ADL scores. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/05
oai:eprints.whiterose.ac.uk:10890
2014-06-04T13:11:09Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10890/
The impact of losses in income due to ill health: Does the EQ-5D reflect lost earnings?
Tilling, C.
Krol, M.
Tsuchiya, A.
Brazier, J.
van Exel, J.
Brouwer, W.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10890/1/HEDS_DP_09-04.pdf
Tilling, C., Krol, M., Tsuchiya, A. et al. (3 more authors) (2009) The impact of losses in income due to ill health: Does the EQ-5D reflect lost earnings? Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/04
oai:eprints.whiterose.ac.uk:10891
2014-06-14T11:25:13Z
7374617475733D756E707562
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https://eprints.whiterose.ac.uk/10891/
A preliminary review of the existing literature investigating ethnic and gender differences in early childhood development
Scope, A.
Hartnell, S.
There exist well documented inequalities in earnings by gender, race and ethnicity. Those disadvantaged groups are usually referred to together as minorities, where the majority is usually "White-male". Empirical research often attributes the lower earnings of minorities to their lower human capital endowments. One view is that minorities choose to invest less in human capital due to expected labour market discrimination. An alternative view is that lower human capital acquisition among the minorities could be determined by pre-labour market factors, such as their adverse socio-economic status. However, the age at which these ability gaps set in is not clear: one could argue that trajectory of these inequalities is established early on in childhood, and just gets accentuated by the adverse socio-economic status.
This paper reports on the findings of a preliminary review of the existing literature investigating ethnic and gender differences in early childhood development.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10891/1/HEDS_DP_09-03.pdf
Scope, A. and Hartnell, S. (2009) A preliminary review of the existing literature investigating ethnic and gender differences in early childhood development. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/03
oai:eprints.whiterose.ac.uk:10892
2014-06-15T11:42:49Z
7374617475733D756E707562
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756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10892/
A qualitative study exploring the general population's
perception of rheumatoid arthritis after being informed
about disease adaptation
McTaggart-Cowan, H.
O'Cathain, A.
Tsuchiya, A.
Brazier, J.
Purpose: This study aimed to gain an understanding of what factors induce individuals to alter their opinions about a health condition after being informed about disease adaptation and being given time to reflect and deliberate on this information. Rheumatoid arthritis (RA) states are used as an illustration.
Methods: Semi-structured interviews were conducted with 12 members of the general population. They completed two time trade-off exercises for three RA states and underwent an adaptation exercise (AE) which consisted of listening to recordings of patients discussing how they adapted to RA. Also included was a structured discussion to encourage the participant to reflect on how the patients have adapted. Participants were shown their own health state values, as well as patient values.
Findings: After being informed about disease adaptation and reflecting on the information, participants were more likely to consider adaptation and alter their opinions of RA if they were able to empathise with the patients in the AE. This enabled individuals to feel that they could cope by reflecting on their experience of RA in family and friends, by drawing on others for support if they had RA, and by having a positive attitude towards life.
Conclusions: The results demonstrate that there is a range of reasons for which people change their perceptions about RA; this requires further exploration.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10892/1/HEDS_DP_09-02.pdf
McTaggart-Cowan, H., O'Cathain, A., Tsuchiya, A. et al. (1 more author) (2009) A qualitative study exploring the general population's perception of rheumatoid arthritis after being informed about disease adaptation. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/02
oai:eprints.whiterose.ac.uk:10893
2014-06-08T04:40:37Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10893/
Towards the genderless society: equitable for female wellbeing and male health?
Tsuchiya, A.
Månsdotter, A.
Despite the gender system that disadvantages women, in most countries women live longer than men. Women typically have higher morbidity, but this does not cancel out their advantage over a lifetime period, so that women still have a higher level of expected lifetime health than men. At the same time, the gender gap in lifetime health is narrowing. There is evidence to suggest that gender equality may help improve men’s health more than women’s health. The paper discusses the implications of moves towards a genderless, equitable world for women’s wellbeing, and for current notions of high status masculinity.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10893/1/HEDS_DP_09-01.pdf
Tsuchiya, A. and Månsdotter, A. (2009) Towards the genderless society: equitable for female wellbeing and male health? Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/01
oai:eprints.whiterose.ac.uk:10894
2014-06-12T06:34:33Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10894/
Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies
McTaggart-Cowan, H.
Brazier, J.
Tsuchiya, A.
Purpose: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct, comprehensible, and data-driven. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states.
Methods: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort domain from the EuroQol-5D was incorporated at the final stage.
Results: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair.
Conclusions: Overall, the combined use of Rasch and cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10894/1/HEDS_DP_08-15.pdf
McTaggart-Cowan, H., Brazier, J. and Tsuchiya, A. (2008) Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/15
oai:eprints.whiterose.ac.uk:10895
2014-06-06T02:05:15Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10895/
Mapping SF-36 onto the EQ-5D index: how reliable is the relationship?
Rowen, D.
Brazier, J.
Roberts, J.
Mapping from health status measures onto generic preference-based measures is becoming a common solution when health state utility values are not directly available for economic evaluation. However the accuracy and reliability of the models employed is largely untested, and there is little evidence of their suitability in patient datasets. This paper examines whether mapping approaches are reliable and accurate in terms of their predictions for a large and varied UK patient dataset. SF-36 dimension scores are mapped onto the EQ-5D index using a number of different model specifications. The predicted EQ-5D scores for subsets of the sample are compared across inpatient and outpatient settings and medical conditions. This paper compares the results to those obtained from existing mapping functions. Our results suggest that models mapping the SF-36 onto the EQ-5D have similar predictions across inpatient and outpatient setting and medical conditions. However, the models overpredict for more severe EQ-5D states; this problem is also present in the existing mapping functions.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10895/1/HEDS_DP_08-14.pdf
Rowen, D., Brazier, J. and Roberts, J. (2008) Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/14
oai:eprints.whiterose.ac.uk:10900
2014-06-04T14:40:35Z
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https://eprints.whiterose.ac.uk/10900/
Using a discrete choice experiment to estimate societal health state utility values
Bansback, N.
Brazier, J.
Tsuchiya, A.
Anis, A.
In this study we explore a novel application of the Discrete Choice Experiment (DCE) that resembles the Time Trade Off (TTO) task to estimate values on the health utility scale for the EQ-5D. The DCE is tested in a survey alongside the TTO in respondents largely representative of the Canadian general population. The study finds that the DCE is able to derive logical and consistent values for health states valued on the full health – dead scale. The DCE overcame some issues identified in the version of TTO currently used to value EQ-5D, notably whether to exclude respondents who fail to understand the task and incorporating values considered worse than dead without transformation. This has important implications for providing values that represent the preferences of all respondents.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10900/1/HEDS_DP_10-03.pdf
Bansback, N., Brazier, J., Tsuchiya, A. et al. (1 more author) (2010) Using a discrete choice experiment to estimate societal health state utility values. Discussion Paper. HEDS Discussion Paper 10/03 . (Unpublished)
HEDS Discussion Paper 10/03
oai:eprints.whiterose.ac.uk:10901
2014-06-06T18:53:23Z
7374617475733D756E707562
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https://eprints.whiterose.ac.uk/10901/
Resource allocation, health mobility and adaptation to illness
Hauck, K.
Hollingsworth, B.
Tsuchiya, A.
The increased availability of panel data has made it possible to estimate and measure health mobility for population subgroups who may have systematically different levels of mobility. The objective of this paper is to stimulate discussion on what estimated differences across subgroups may mean for resource allocation. We use a straightforward hypothetical example to investigate the implications of different levels of health mobility on health outcomes, considering in addition the effects of adaptation to illness over time. We also discuss some of the ethical and political implications of health mobility.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10901/1/HEDS_DP_08-13.pdf
Hauck, K., Hollingsworth, B. and Tsuchiya, A. (2008) Resource allocation, health mobility and adaptation to illness. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/13
oai:eprints.whiterose.ac.uk:10902
2014-06-04T17:55:15Z
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756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10902/
The relative societal value of health gains to different beneficiaries
Dolan, P.
Edlin, R.
Tsuchiya, A.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10902/1/HEDS_DP_08-12.pdf
Dolan, P., Edlin, R. and Tsuchiya, A. (2008) The relative societal value of health gains to different beneficiaries. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/12
oai:eprints.whiterose.ac.uk:10903
2014-06-06T14:24:30Z
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696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10903/
Health economics of Colonix: A new diagnostic test in colorectal cancer
Whyte, S.
Chilcott, J.
Headey, J.
The Colonix test is used for the early detection/screening of colorectal cancer and other bowel diseases such as inflammatory bowel disease (IBD). An economic model has been constructed to estimate the cost-effectiveness of the use of the Colonix device as a precolonoscopy evaluation test in a primary care setting, i.e. for patients presenting symptomatically to their GP. The aim of using Colonix as a pre-colonoscopy test would be to avoid unnecessary colonoscopies, as colonoscopy is costly, invasive and comes with a risk of perforation.
A cost effectiveness model was built in Treeage. The population consists of patients who have presented to their GP with distal colonic symptoms who were subsequently referred by their GP for endoscopic assessment. Essentially the Colonix test will help determine whether urgent colonoscopy or an extended observation period is preferable. The model calculates costs incurred and QALYs gained over a patient’s lifetime.
A life-time horizon was used as it is possible that a false negative test result could cause a delay in diagnosis which could compromise patient survival, thus affecting QALY gains over a patient's lifetime. The model includes diagnostic test costs and associated costs such as retests and treating bowel perforations due to colonoscopy and it includes colorectal cancer treatment costs. The model is populated with data relating to diagnostic test characteristics, disease prevalence, diagnostic test costs, CRC treatments costs, health state utility values and CRC natural history.
The model output includes the incremental cost effectiveness ratio (ICER), net monetary benefit (NMB) and number of colonoscopies avoided. The model structure allows all parameters such as Colonix test characteristics, cost of Colonix, etc to be easily updated. With the current model assumptions (e.g. patients receiving a true negative Colonix test incur no additional diagnosis costs) the use of Colonix is cost-effective at a willingness to pay of £20K and has a NMB of just over £200 per person. It will also result in around 60% fewer colonoscopies.
In constructing the model, the importance of correctly representing the treatment pathways became evident. Further information relating to the diagnostic pathways for patients receiving a negative Colonix result is required to correctly model the economics. Specifically sensitivity analyses showed that the model results are highly dependent on the variable "cost of additional diagnostics following a negative Colonix test". This cost will be different for patients with different underlying conditions and this should be reflected in the modelling. Three potential courses of action are suggested:
1) Collect further subjective clinical judgement relating to diagnostic pathways following a negative Colonix result.
2) Examine what information of patient pathways is obtainable from existing Colonix trials – i.e. what subsequent diagnostic tests patients received following a negative result.
3) Undertake a randomized control trial (RCT) to directly compare the two fully defined alternative diagnostic pathways (one pathway to represent the existing situation and one to include Colonix).
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10903/1/HEDS_DP_08-11.pdf
Whyte, S., Chilcott, J. and Headey, J. (2008) Health economics of Colonix: A new diagnostic test in colorectal cancer. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/11
oai:eprints.whiterose.ac.uk:10904
2014-06-12T12:01:16Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10904/
Developing a descriptive system for a new preference based measure of health related quality of life for children
Stevens, K.
Aims
The use of preference based measures (PBM) of health related quality of life is increasing in health care resource allocation decisions. Whilst there are measures widely used for this purpose in adults, research in the paediatric field is more limited. This paper reports on how the descriptive system for a new paediatric generic PBM of HRQoL was developed, including how the wording and order of the levels for each dimension was determined. The aim was to develop a descriptive system suitable for health state valuation, based on dimensions identified from previous work.
Methods
The main constraint in designing a descriptive system for a PBM is that the health states defined by the system should be amenable to valuation. Ideally, each dimension needs to contain levels that are ordered within it to fit this criteria well. To develop these levels, the first stage is to determine whether they should be frequency or severity based. To do this, data from the original qualitative work for developing the dimensions was used, reviewing how children described the dimensions. Once this was determined, existing scales from the paediatric literature were reviewed for their suitability and scales were also developed empirically, based on the qualitative interview data from children. The empirical scales were developed by taking the adverbial phrases from the interview work and to confirm the ordinality of these, a ranking exercise was undertaken with children. The resulting scales were applied to the dimensions and a draft descriptive system developed.
Results
For every dimension, severity arose as the predominant characteristic. No suitable scales were found in the paediatric literature for severity and so empirical scales based on the qualitative data were developed and used which resulted in seven different types of scale. Children were successfully able to rank these scales to determine the ordinality and the scales were applied to all the dimensions in order to form a draft descriptive system. The ordering of the statements resulting from the analysis made sense at face value.
Conclusions
This work has empirically developed a descriptive system for the dimensions of HRQoL identified in the original interview work. As the methods were based on using data from children, the content validity of the final measure should be increased and the language and terminology is appropriate. Further research is needed to test the descriptive system on a paediatric population and to test the psychometric performance. In addition, due to the constraints of preference based measures, the number of dimensions will need to be reduced to be amenable to valuation. Further research is required to do this.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10904/1/HEDS_DP_08-10.pdf
Stevens, K. (2008) Developing a descriptive system for a new preference based measure of health related quality of life for children. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/10
oai:eprints.whiterose.ac.uk:10905
2014-06-06T04:04:22Z
7374617475733D756E707562
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696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10905/
Protocols for TTO valuations of health states worse than dead: A literature review and framework for systematic analysis
Tilling, C.
Devlin, N.
Tsuchiya, A.
Buckingham, K.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10905/1/HEDS_DP_08-09.pdf
Tilling, C., Devlin, N., Tsuchiya, A. et al. (1 more author) (2008) Protocols for TTO valuations of health states worse than dead: A literature review and framework for systematic analysis. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/09
oai:eprints.whiterose.ac.uk:10906
2014-06-06T10:31:24Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10906/
From evidence-based to decision-analytic medicine: A mammography case study
Madan, J.
The technology needed to implement mass screening by mammography existed well before the implementation of national screening programmes. This delay arose partly because of the complexities involved in conducting randomised controlled trials (RCTs) of screening programmes. These complexities not only extend the time needed to conduct trials of cancer screening, they reduce the external validity of the results. There is potential to improve the application of evidence-based medicine (EBM) to the evaluation of cancer screening programmes and other complex interventions through adding insights from Operational Research and Decision Theory. This would extend EBM to what might be called Decision-Analytic Medicine (DAM).
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10906/1/HEDS_DP_08-08.pdf
Madan, J. (2008) From evidence-based to decision-analytic medicine: A mammography case study. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/08
oai:eprints.whiterose.ac.uk:10907
2014-06-19T07:40:49Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10907/
Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected
Wailoo, A.
Tsuchiya, A.
McCabe, C.
Current practice in economic evaluation is to assign equal social value to a unit of health improvement (“a QALY is a QALY is a QALY”). Alternative views of equity are typically considered separately to efficiency. One proposal seeks to integrate these two sets of societal concerns by attaching equity weights to QALYs. To date, research in pursuit of this goal has focussed on candidate equity criteria and methods for estimating such weights. It has implicitly been assumed that should legitimate, valid, and reliable equity weights become available, it would be a straightforward task to incorporate them into as a separate simple calculation after estimating cost per unweighted QALY. This paper suggests that in many situations these simple approaches to incorporating equity weights will not appropriately reflect the preferences on which the weights are based and therefore equity weights must be incorporated directly into the cost effectiveness analysis. In addition to these technical issues, there are a number of practical challenges that arise from the movement from implicit to explicit consideration of equity. Equity weights should be incorporated in economic evaluation, but not until these challenges have been appropriately addressed.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10907/1/HEDS_DP_08-07_.pdf
Wailoo, A., Tsuchiya, A. and McCabe, C. (2008) Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/07
oai:eprints.whiterose.ac.uk:10908
2014-06-22T12:57:21Z
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https://eprints.whiterose.ac.uk/10908/
Predicting individual patient outcomes using prognostic models in economic evaluations
Young, T.
Objective
When estimating incremental quality adjusted life years (QALYs) and costs in economic evaluations, prognostic models can be applied to predict survival times. However, these models do not themselves estimate whether the event, e.g. death or survival, would actually occur or not. When this projection is needed it is important to fully incorporate the uncertainty around it.
Study Design and Setting
This paper compares two methods for estimating patient specific outcomes. The average probability method uses the mean estimated proportion of survivors at a particular time point and assumes the patients with the longest survival times are the survivors. The second method uses probabilistic sensitivity analysis (PSA) to simulate individual patient outcomes. The two methods are illustrated using a prognostic model for estimating survival in the absence of liver transplantation.
Results
The mean survival, QALYs, costs and incremental cost-effectiveness ratio (ICER) were similar for the two methods. 95% confidence intervals were slightly wider for survival and QALY estimates and substantially wider for cost and ICER estimates when using PSA to estimate patient outcomes, thus capturing outcome uncertainty at the individual level.
Conclusion
PSA gives more realistic confidence intervals representing uncertainty than an average probability method and is the recommended method when estimating individual patient outcomes from prognostic models.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10908/1/HEDS_DP_08-06.pdf
Young, T. (2008) Predicting individual patient outcomes using prognostic models in economic evaluations. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/06
oai:eprints.whiterose.ac.uk:10909
2014-06-05T00:53:07Z
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756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10909/
Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments
Young, T.
Yang, Y.
Brazier, J.
Tsuchiya, A.
Coyne, K.
Objective: To set out the methodological process for using Rasch analysis alongside traditional psychometric methods in the development of a health state classification that is amenable to valuation.
Methods: The overactive bladder questionnaire is used to illustrate a four step process for deriving a reduced health state classification from an existing nonpreference based health related quality of life instrument. Step I excludes items that do not meet the initial validation process and step II uses criteria based on Rasch analysis and psychometric testing to select the final items for the health state classification. In step III, item levels are examined and Rasch analysis is used to explore the possibility of reducing the number of item levels. Step IV repeats steps I to III on alternative data sets in order to validate the selection of items for the health state classification.
Conclusions: The techniques described enable the construction of a health state classification amenable for valuation exercises that will allow the derivation of preference weights. Thus, the health related quality of life of patients with conditions, like overactive bladder, can be valued and quality adjustment weights such as quality adjusted life years derived.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10909/1/HEDS_DP_08-05.pdf
Young, T., Yang, Y., Brazier, J. et al. (2 more authors) (2008) Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/05
oai:eprints.whiterose.ac.uk:10910
2014-06-19T07:43:25Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10910/
Working with children to develop dimensions for a preference based generic paediatric health related quality of life measure
Stevens, K.
The use of preference based measures (PBM) of health related quality of life (HRQoL) in National Health Service (NHS) decision making is becoming more common. PBMs allow the calculation of quality adjusted life years which can then be used in economic evaluation as part of the decision making process. Research in the field of paediatric PBMs is lacking. This work is the first stage in the development of a generic paediatric PBM of HRQoL for use in economic evaluation.
To identify the dimensions of HRQoL for inclusion in the instrument, 74 qualitative interviews were carried out with children aged 7-11 years, to find out how their health affects their lives. The children were divided into two age groups (7-9 years and 9-11 years). Each age group was sampled and analysed independently to explore whether these age groups have a common HRQoL framework. Sampling was purposive, trying to balance primarily for level of health within age, with gender and ethnicity as secondary criteria. A wide range of health conditions, both acute and chronic were covered in the interviews and children were successfully able to articulate how their health affects their lives.
Thematic content analysis of the data identified ten dimensions of HRQoL relevant to each population, nine of which were the same in each group, giving 11 dimensions in total for the combined group. The dimensions cover social, emotional and physical aspects of HRQoL in common with other frequently used generic paediatric HRQoL measures, but differ in terms of including dimensions on sleep, feeling jealous and feeling tired/weak and not including dimensions related to treatment/procedures and wider family or behavioural issues.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10910/1/HEDS_DP_08-04.pdf
Stevens, K. (2008) Working with children to develop dimensions for a preference based generic paediatric health related quality of life measure. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/04
oai:eprints.whiterose.ac.uk:10911
2014-06-05T09:00:18Z
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74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10911/
Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome
Ward, S.
Ara, R.
Pandor, A.
Hall, A.S.
Introduction: Recent NICE guidance in England and Wales states that statin therapy for secondary CVD should "usually be initiated with a drug with a low acquisition cost (taking into account required daily dose and product price per dose)". Intensive dose statin therapy is more costly than standard dose, but offers additional benefits and may potentially be more cost effective for a sub-group of high risk patients.
Objective: To determine if the strategy of treating ACS patients with intensive dose statin compared with standard dose statin can be considered to be cost effective and to what extent these results are influenced by the age of the patient at start of treatment.
Methods: A Markov model was used to explore the costs and health outcomes associated with a lifetime of intensive dose (represented by 80mg atorvastatin) versus standard dose (represented by 20mg simvastatin) treatment for patients with acute coronary syndrome. Health states included unstable angina, MI, stroke, fatal CHD, fatal stroke, or non vascular death. The benefits associated with statin treatment were modelled by applying the relative risks from a meta-analysis of 4 large RCTs reporting clinical endpoints. Costs and utilities assigned to health states were derived from a review of published evidence.
Results: Treatment with intensive dose statin therapy offers additional benefits over standard dose therapy. The cost offsets through avoided events are less than the associated treatment costs and result in a cost per QALY of around £24,000 for patients with ACS starting treatment at 60 years of age and falling to around £14,000 for patients starting treatment at 70 years. The key driver of cost effectiveness is the relative risk for mortality.
Conclusions: This analysis suggests that intensive statin regimens (represented by atorvastatin 80mg/day) are cost effective compared with standard statin regimens (represented by simvastatin 20mg/day) for patients with ACS over the age of 60 years. A recent registry study reports a mean age of 70 years for ACS patients admitted to UK hospitals and hence this comparison applies to the great majority of ACS patients.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10911/1/HEDS_DP_08-03.pdf
Ward, S., Ara, R., Pandor, A. et al. (1 more author) (2008) Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/03
oai:eprints.whiterose.ac.uk:10912
2014-06-07T12:44:05Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10912/
A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures
Brazier, J.E.
Yang, Y.
Tsuchiya, A.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10912/1/HEDS_DP_08-02.pdf
Brazier, J.E., Yang, Y. and Tsuchiya, A. (2008) A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/02
oai:eprints.whiterose.ac.uk:10913
2014-06-05T05:41:41Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10913/
Including patient choice in cost-effectiveness decision rules
Dixon, S.
There has been increasing discussion in the economic literature about the appropriateness of using general population values within technology appraisal. This paper proposes an alternative approach to incorporating patient values into the cost-effectiveness decision rule that lies at the heart of funding decisions. Whilst the current decision rule is constructed around a technical question, namely, "which treatment is the most cost-effective?", the key policy question is "which treatments should be offered to the patient?". A two-part decision rule is explored which gives the patient the choice of the most cost-effective treatment plus all cheaper options. Whilst the adoption of this patient-based cost-effectiveness rule may not alter many decisions compared to the current approach, it would represent a profound shift in the way that patient values and patient choice are incorporated into economic evaluation.
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10913/1/HEDS_DP_07-06.pdf
Dixon, S. (2007) Including patient choice in cost-effectiveness decision rules. Discussion Paper. (Unpublished)
HEDS Discussion Paper 07/06
oai:eprints.whiterose.ac.uk:10914
2014-06-17T00:37:47Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10914/
Valuing condition specific health states using simulation contact lenses
Czoski-Murray, C.
Carlton, J.
Brazier, J.
Kang, H.K.
Young, T.A.
Papo, N.L.
OBJECTIVE: This paper reports on a study that used contact lenses to simulate the effects of a visual impairment caused by Age Related Macular Degeneration (ARMD). The aim was to examine the feasibility of using this method of simulation and to compare the results from this experiment with those obtained from ARMD patients (n=209) using generic preference-based measures (HUI3 and EQ-5D) and patient time trade-off TTO.
METHODS: Utility values were elicited from healthy participants (n=108) by TTO for three ARMD states simulated using contact lenses.
RESULTS: A significant relationship was found between visual acuity and TTO values elicited from members of the general population (n=108). It was stronger than that found for HUI3, EQ-5D and own TTO values from patients (n=209). General population values informed by the experience of simulation were found to be significantly different to values from patient TTO and generic preference-based measures for the same level of visual impairment. Socio-demographic characteristics did not significantly affect results, although baseline TTO utility values were positively associated with TTO values for simulated states.
CONCLUSIONS: ARMD has a major impact on general population TTO health state values. Differences across four visual health states appear larger than those found for a generic preference-based measures and patient TTO values. For conditions that are difficult to describe and imagine, simulation methods may offer an important method for obtaining better informed general population preferences.
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10914/1/HEDS_DP_07-05.pdf
Czoski-Murray, C., Carlton, J., Brazier, J. et al. (3 more authors) (2007) Valuing condition specific health states using simulation contact lenses. Discussion Paper. (Unpublished)
HEDS Discussion Paper 07/05
oai:eprints.whiterose.ac.uk:10915
2018-03-20T17:07:58Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D596F726B:596F726B2E46414333:596F726B2E594F523235
756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D596F726B
696E737469747574696F6E3D4C65656473
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10915/
Public health care resource allocation and the rule of rescue
Cookson, R.
McCabe, C.
Tsuchiya, A.
In health care, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the "Rule of Rescue". This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue in public resource allocation decisions. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that, whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, except any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others.
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10915/1/HEDS_DP_07-04.pdf
Cookson, R., McCabe, C. and Tsuchiya, A. (2007) Public health care resource allocation and the rule of rescue. Discussion Paper. (Unpublished)
HEDS Discussion Paper 07/04
oai:eprints.whiterose.ac.uk:10916
2015-12-09T23:01:11Z
oai:eprints.whiterose.ac.uk:10917
2014-06-15T18:18:08Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10917/
Estimating a preference-based single index from the Asthma Quality of Life Questionnaire (AQLQ)
Yang, Y.
Tsuchiya, A.
Brazier, J.E.
Young, T.A.
This paper presents a study to estimate a preference-based single index from the Asthma Quality of Life Questionnaire (AQLQ). Based on the AQL-5D which is a health classification system directly derived from AQLQ, 98 health states were valued by a sample of 307 members of the UK general population. Models were estimated to predict all possible 3125 health states defined by the AQL-5D and compared using a set of criteria. The mean model of main effects was recommended of preferable prediction ability and logically consistent and significant coefficients for levels of dimensions. However, there are concerns over condition-specific valuation issues, such as presenting asthma information to general public and the choice of condition specific full health as the upper anchor for TTO valuation.
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10917/1/HEDS_DP_07-02.pdf
Yang, Y., Tsuchiya, A., Brazier, J.E. et al. (1 more author) (2007) Estimating a preference-based single index from the Asthma Quality of Life Questionnaire (AQLQ). Discussion Paper. (Unpublished)
HEDS Discussion Paper 07/02
oai:eprints.whiterose.ac.uk:10918
2014-06-06T05:40:42Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E5F5243:536865666669656C642E494E43
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E494E43
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10918/
The use of Rasch analysis as a tool in the construction of a preference based measure: the case of AQLQ
Young, T.
Yang, Y.
Brazier, J.
Tsuchiya, A.
The majority of quality of life instruments are not preference-based measures and so cannot be used within cost utility analysis. The Asthma Quality of Life Questionnaire (AQLQ) is one such instrument. The aim of this study was to develop a health state classification that is amenable to valuation from the AQLQ.
Rasch models were applied to samples of responders to the AQLQ with the aim of i) selecting a number of items for a preference based utility measure (AQL-5D), ii) reducing the number of levels for each item to a more manageable number of levels for establishing AQL-5D. Selection of items for the evaluation survey was supported with conventional psychometric criteria for item selection (feasibility, internal consistency, floor and ceiling effects, responsiveness and regression against overall health).
The role of Rasch analysis in reducing the number of item levels to a preconceived target number of levels proved unsuccessful. However, Rasch analysis proved to be a useful tool in assisting in the initial process of selecting items from an existing HRQL instrument in the construction of AQL-5D. The method is recommended for use alongside conventional psychometric testing to aid in the development of preference-based measures.
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10918/1/HEDS_DP_07-01.pdf
Young, T., Yang, Y., Brazier, J. et al. (1 more author) (2007) The use of Rasch analysis as a tool in the construction of a preference based measure: the case of AQLQ. Discussion Paper. (Unpublished)
HEDS Discussion Paper 07/01
oai:eprints.whiterose.ac.uk:10919
2014-06-05T03:31:55Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10919/
Modelling the cost effectiveness of TNF-α inhibitors in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry
Brennan, A.
Bansback, N.
Nixon, R.
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10919/1/HEDS_DP_06-12.pdf
other
en
https://eprints.whiterose.ac.uk/10919/2/HEDS_DP_06-12_supp.xls
Brennan, A., Bansback, N. and Nixon, R. (2006) Modelling the cost effectiveness of TNF-α inhibitors in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/12
oai:eprints.whiterose.ac.uk:10920
2014-06-19T07:37:44Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10920/
Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism
Tsuchiya, A.
Dolan, P.
When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics.
2006-08
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10920/1/HEDS_DP_06-11.pdf
Tsuchiya, A. and Dolan, P. (2006) Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/11
oai:eprints.whiterose.ac.uk:10921
2014-06-05T14:52:56Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10921/
Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment
Tappenden, P.
Brazier, J.
Ratcliffe, J.
Background:
NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. One of NICE’s main roles is to produce national guidance on the use of health technologies within the NHS. Despite the Institute’s recent efforts to clarify the way in which its Appraisal Committees reach their recommendations concerning the use of health technologies, there remains ambiguity about how cost-effectiveness evidence is interpreted alongside other considerations such as the degree of clinical need within the patient population, and the degree of uncertainty surrounding cost-effectiveness estimates.
Objective:
To explore whether the NICE takes account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services.
Methods:
A binary choice experiment was undertaken using NICE’s three Appraisal Committees.
The experiment included five attributes:
(1) Incremental cost-effectiveness
(2) Degree of economic uncertainty
(3) Age of the target population
(4) Baseline health-related quality of life
(5) Availability of other therapies
A choice questionnaire detailing 18 scenarios was administered to NICE’s Appraisal Committees. For each scenario, respondents were asked to indicate whether they would recommend the intervention under consideration or not. The stated preference data obtained from respondents were analysed using a random effects logit regression model.
Results:
A response rate of 46% was obtained from the Appraisal Committees. The regression model suggests that increases in cost-effectiveness, economic uncertainty, and the availability of other therapies are associated with statistically significant reductions in the odds of adoption (p<0.05). The transition from a very low to a comparatively high level of health-related quality of life is also associated with a statistically significant reduction in the odds of a positive recommendation. Smaller changes in health-related quality of life, and the age of the target population are not associated with a statistically significant reduction in the odds of a positive recommendation. Analysis of revealed preference data indicates that the model is capable of distinguishing between those technologies which the Appraisal Committees would be highly likely to recommend, and those technologies which appear to be less attractive, although further external validation is warranted.
Conclusion:
The modelling suggests that cost-effectiveness, uncertainty and certain equity concerns influence the NICE Appraisal Committees’ recommendations on the use of health technologies. The modelling results appear to support Rawlins and Culyer’s notion of a probabilistic cost-effectiveness threshold approach; the "mythical" £30,000 per QALY gained threshold assumed within the literature is not supported by this stated preference modelling analysis.
2006-06
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10921/1/HEDS_DP_06-10.pdf
Tappenden, P., Brazier, J. and Ratcliffe, J. (2006) Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/10
oai:eprints.whiterose.ac.uk:10922
2014-06-17T04:46:45Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10922/
Modelling the impact of referral guideline changes for mild dyskaryosis on colposcopy services in England
Eggington, S.
Hadwin, R.
Brennan, A.
Walker, P.
Objectives: This model examines the effects of changing referral strategies within the established structure of NHS cervical screening driven colposcopy practice. It considers the effects of the new strategy on colposcopy workload, patient waiting times, and associated costs and health benefits.
Methods: By postal survey, the current operational strategies of colposcopy services were established by questionnaire with respect to referral practices and management protocols. After first-cut piloting, and utilising published and original research, a Markovian model was constructed, and the impact of the new strategy was determined on colposcopy workload and patient waiting times for three hypothetical clinic types. Expected costs and benefits of the new policy were assessed through the adaptation of a previous ScHARR cervical screening model.
Results: Clinic workload is expected to increase by between 21% and 35% within three years of the policy change, depending on clinic efficiency in other areas; the majority of this impact would be seen within the first year. It is predicted that particularly inefficient clinics would struggle to meet the existing waiting time requirements for women referred with low-grade disease, owing to the increased level of workload seen throughout the patient pathway as a result of the implementation of the new policy.
The impact of the new policy can, however, be mitigated through improving the efficiency of existing clinics, by altering policies relating to surveillance of low grade disease, post-treatment follow-up, treatment policy (whether or not treatment is performed at the initial colposcopy visit), and through adherence to national guidelines.
A cost-effectiveness analysis using the ScHARR liquid-based cytology model suggests that the policy change is likely to be have a cost per quality-adjusted lifeyear gained of between £1,400 and £5,500 per quality-adjusted life-year gained (excluding the costs of follow-up), which would be deemed acceptable to organisations such as the National Institute for Health and Clinical Excellence.
2006-06
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10922/1/HEDS_DP_06-09.pdf
Eggington, S., Hadwin, R., Brennan, A. et al. (1 more author) (2006) Modelling the impact of referral guideline changes for mild dyskaryosis on colposcopy services in England. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/09
oai:eprints.whiterose.ac.uk:10923
2014-06-19T10:09:01Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10923/
An Internet "Value of Health" panel: recruitment, participation and compliance
Stein, K.
Dyer, M.
Crabb, T.
Milne, R.
Round, A.
Ratcliffe, J.
Brazier, J.
OBJECTIVES
To recruit a panel of members of the public to provide preferences in response to the needs of economic evaluators over the course of a year.
METHODS
A sample of members of the UK general public was recruited in a stratified random sample from the electoral roll and familiarised with the standard gamble method of preference elicitation using an internet based tool. Recruitment (proportion of people approached who were trained), participation (defined as the proportion of people trained who provided any preferences) and compliance (defined as the proportion of preference tasks which were completed) were described. The influence of covariates on these outcomes were investigated using univariate and multivariate analyses.
RESULTS
A panel of 112 people was recruited. The eventual panel reflected national demographics to some extent, but recruitment from areas of high socioeconomic deprivation and among ethnic minority communities was low. 23% of people who were approached (n= 5,320) responded to the invitation to take part in the study, and 24% of respondents (n=1,215) were willing to participate. However, eventual recruitment rates, following training, were low (2.1% of those approached), although significantly higher in Exeter than other cities. 18 sets of health state descriptions were presented to the panel over 14 months. 74% of panel members praticipated in at least one valuation task. Socioeconomic and marital status were significantly associated with participation. Compliance varied from 3% to 100%, with the average per set of health state descriptions being 41%. Compliance was higher in retired people but otherwise no significant predictors were identified.
CONCLUSIONS
It is feasible to recruit and train a panel of members of the general public to express preferences on a wide range of health states using the internet in response to the needs of analysts. In order to provide a sample which reflects the demographics of the general public, and capitalise on the increasing opportunities for the use of the internet in this field, over-sampling in areas of high socioeconomic deprivation and among ethnic minority communities is necessary.
2006-05
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10923/1/HEDS_DP_06-08.pdf
Stein, K., Dyer, M., Crabb, T. et al. (4 more authors) (2006) An Internet "Value of Health" panel: recruitment, participation and compliance. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/08
oai:eprints.whiterose.ac.uk:10924
2014-06-23T04:49:27Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10924/
Estimation of a preference based single index from the sexual quality of life questionnaire (SQOL) using ordinal data
Ratcliffe, J.
Brazier, J.
Tsuchiya, A.
Symonds, T.
Brown, M.
There is increasing interest in using ordinal methods to estimate cardinal values for health states to calculate quality adjusted life years. This paper reports the estimation of models of rank data and discrete choice experiment (DCE) data to derive a preference-based index from a condition specific measure relating to sexual health and to compare the results to values generated from time trade-off valuation (TTO). The DCE data were analysed using a random effects probit model and the DCE predicted values were rescaled according to the highest and lowest predicted TTO values corresponding to the best and worst SQOL health states respectively. The rank data were analysed using a rank ordered logit model and re-scaled using two alternative methods. Firstly, re-scaling the rank predicted values using identical methods to those employed for DCE and secondly, re-scaling the rank model coefficients by dividing each level coefficient by the coefficient relating to death. The study raises some important issues about the use of ordinal data to produce cardinal health state valuations.
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10924/1/HEDS_DP_06-06.pdf
Ratcliffe, J., Brazier, J., Tsuchiya, A. et al. (2 more authors) (2006) Estimation of a preference based single index from the sexual quality of life questionnaire (SQOL) using ordinal data. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/06
oai:eprints.whiterose.ac.uk:10925
2014-06-08T10:58:07Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10925/
Newborn screening using tandem mass spectrometry: A systematic review
Pandor, A.
Eastham, J.
Chilcott, J.
Paisley, S.
Beverley, C.
Objectives: To evaluate the evidence for the clinical effectiveness of neonatal screening for phenylketonuria (PKU) and medium-chain acyl-coA dehydrogenase (MCAD) deficiency using tandem mass spectrometry (tandem MS).
Study design: Systematic review of published research.
Data sources: Studies were identified by searching 12 electronic bibliographic databases; conference proceedings and experts consulted.
Results: Six studies were selected for inclusion in the review. The evidence of neonatal screening for PKU and MCAD deficiency using tandem MS was primarily from observational data of large-scale prospective newborn screening programmes and systematic screening studies from Australia, Germany and the USA. Tandem MS based newborn screening of dried blood spots for PKU and/or MCAD deficiency was shown to be highly sensitive (>93.220%) and highly specific (>99.971%). The false positive rate for PKU screening was less than 0.046% and for MCAD deficiency the false positive rate was less than 0.023%. The positive predictive values ranged from 20 to 32% and 19 to 100%, respectively.
Conclusions: This review suggests that neonatal screening of dried blood spots using a single analytical technique (tandem MS) is highly sensitive and specific for detecting cases of PKU and MCAD deficiency, and provides a basis for modelling of the clinical benefits and potential costeffectiveness.
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10925/1/HEDS_DP_06-03.pdf
Pandor, A., Eastham, J., Chilcott, J. et al. (2 more authors) (2006) Newborn screening using tandem mass spectrometry: A systematic review. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/03
oai:eprints.whiterose.ac.uk:10932
2014-06-10T10:07:51Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D596F726B:596F726B2E46414333:596F726B2E594F523239
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D596F726B
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10932/
Drugs for exceptionally rare diseases: a commentary on Hughes et al
McCabe, C.
Tsuchiya, A.
Claxton, K.
Raftery, J.
Recently in this journal, Hughes and colleagues discussed special funding status to ultra-orphan drugs. They concluded that there should be a uniform policy for the provision of orphan drugs across Europe; that complete restriction was impractical, and that UK policy should aspire to the values of the EU directive on orphan drugs. We critically assess these arguments, demonstrating that they failed to justify special status for treatments for rare diseases.
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10932/1/HEDS_DP_06-02.pdf
McCabe, C., Tsuchiya, A., Claxton, K. et al. (1 more author) (2006) Drugs for exceptionally rare diseases: a commentary on Hughes et al. Discussion Paper. (Unpublished)
HEDS Discussion Paper 06/02
oai:eprints.whiterose.ac.uk:10933
2014-06-08T14:56:51Z
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https://eprints.whiterose.ac.uk/10933/
Modelling health state preference data using a non-parametric Bayesian method
Kharroubi, S.
McCabe, C.
This paper reports on the findings from the application of a recently reported approach to modelling health state valuation data. The approach applies a nonparametric model to estimate the revised version of the Health Utilities Index Mark 2 (HUI 2) health state valuation algorithm using Bayesian methods. The data set is the UK HUI 2 valuation study where a sample of 51 states defined by the HUI 2 was valued by a sample of the UK general population using standard gamble. The paper presents the results from applying the nonparametric model and compares these to the original model estimated using a conventional parametric random effects model. The two models are compared in terms of their predictive performance. The paper discusses the implications of these results for future applications of the HUI 2 and further work in this field.
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10933/1/HEDS_DP_06-01.pdf
Kharroubi, S. and McCabe, C. (2006) Modelling health state preference data using a non-parametric Bayesian method. UNSPECIFIED. (Unpublished)
HEDS Discussion Paper 06/01
oai:eprints.whiterose.ac.uk:10934
2014-06-29T03:29:40Z
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https://eprints.whiterose.ac.uk/10934/
Economic evaluation of the routine use of echocardiography versus natriuretic peptide and ECG-targeted echocardiography in the diagnosis of heart failure
Stevenson, M.
Roberts, J.
Cowie, M.R.
Objectives: To investigate the most efficient use of echocardiography and natriuretic peptide testing in the diagnosis of heart failure.
Design: An economic model comparing two strategies: (A) provide echocardiography and electrocardiogram (ECG) for all individuals who present to a GP with symptoms that may be due to heart failure; (B) carry out B-type natriuretic peptide (BNP) blood test and ECG on all such individuals and provide echocardiography only where an abnormality is detected in one of more of these tests.
Setting: Primary care in the UK NHS.
Subjects: Individuals who present to a GP with new symptoms of heart failure.
Main outcome measures: Cost per life year gained.
Results: Baseline cost per life year gained by strategy A compared with strategy B is £3,987.
Conclusions: Immediate echocardiography is the most cost-effective option. Where echocardiography is a scarce resource, efficient use can be obtained by using BNP and ECG tests to identify patients most likely to have heart failure.
2005
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10934/1/HEDS_DP_05-06.pdf
Stevenson, M., Roberts, J. and Cowie, M.R. (2005) Economic evaluation of the routine use of echocardiography versus natriuretic peptide and ECG-targeted echocardiography in the diagnosis of heart failure. Discussion Paper. (Unpublished)
HEDS Discussion Paper 05/06
oai:eprints.whiterose.ac.uk:10935
2014-06-13T10:27:24Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
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https://eprints.whiterose.ac.uk/10935/
Current state of the art in preference-based measures of health and avenues for further research
Brazier, J.
Preference-based measures of health (PBMH) have been developed primarily for use in economic evaluation. They have two components: a standardised, multidimensional system for classifying health states and a set of preference weights or scores that generate a single index score for each health state defined by the classification, where full health is one and zero is equivalent to death. A health state can have a score of less than zero if regarded as worse than being dead. These PMBH can be distinguished from non-preference-based measures by the way the scoring algorithms have been developed, in that they are estimated from the values people place on different aspects of health rather than a simple summative scoring procedure or weights obtained from techniques based on item response patterns (e.g. factor analysis or Rasch analysis).
The use of PBMH has grown considerably over the last decade with the increasing use of economic evaluation to inform health policy, for example through the establishment of bodies such as the National Institute for Clinical Excellence in England and Wales, the Health Technology Board in Scotland, and similar agencies in Australia and Canada. Preference-based measures have become a common means of generating health state values for calculating quality-adjusted life years (QALY). The status of PBMH was considerably enhanced by the recommendations of the U.S. Public Health Service Panel on Cost-Effectiveness in Health and Medicine to use them in economic evaluation (6). A key requirement for PBHM in economic evaluation is that they allow comparison across programs.
While PBMH have been developed primarily for use in economic evaluation, they have also been used to measure health in populations. PBHM provide a better means than a profile measure of determining whether there has been an overall improvement in self-perceived health. The preference-based nature of their scoring algorithms also offers an advantage over non-preference-based measures since the overall summary score reflects what is important to the general population. A non-preference-based measure does not provide an indication to policy makers of the overall importance of health differences between groups or of changes over time.
The purpose of this paper is to critically review methods of designing preference-based measures. The paper begins by reviewing approaches to deriving preference weights for PBMH, and this is followed by a brief description and comparison of five common PBMH. The main part of the paper then critically reviews the core components of these measures, namely the classifications for describing health states, the source of their values, and the methods for estimating the scoring algorithm. The final section proposes future research priorities for this field.
2005
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10935/1/HEDS_DP_05-05.pdf
Brazier, J. (2005) Current state of the art in preference-based measures of health and avenues for further research. Discussion Paper. (Unpublished)
HEDS Discussion Paper 05/05
oai:eprints.whiterose.ac.uk:10936
2014-06-19T10:46:47Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
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696E737469747574696F6E3D536865666669656C64
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https://eprints.whiterose.ac.uk/10936/
Evidence of preference construction in a comparison of variants of the standard gamble method
Brazier, J.
Dolan, P.
An increasingly important debate has emerged around the extent to which techniques such as the standard gamble, which is used, amongst other things, to value health states, actually serve to construct respondents' preferences rather than simply elicit them. According to standard theory, the variant used should have no bearing on the numbers elicited from respondents, i.e. procedural invariance should hold. This study addresses this debate by comparing two variants of standard gamble in the valuation of health states. It is a mixed methods study that combines a quantitative comparison with the probing of respondents in order to ascertain possible reasons for the differences that emerged. Significant differences were found between variants and, furthermore, there was evidence of an ordering effect. Respondents' responses to probing suggested that they were influenced by the method of elicitation.
2005
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10936/1/HEDS_DP_05-04.pdf
Brazier, J. and Dolan, P. (2005) Evidence of preference construction in a comparison of variants of the standard gamble method. Discussion Paper. (Unpublished)
HEDS Discussion Paper 05/04
oai:eprints.whiterose.ac.uk:10937
2014-06-06T00:49:57Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
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https://eprints.whiterose.ac.uk/10937/
AIDS in Botswana: Evaluating the general equilibrium implications of healthcare interventions
Dixon, S.
McDonald, S.
Roberts, J.
This paper reports an analysis of the effects of health care interventions designed to reduce the impacts of the HIV/AIDS epidemic on the Botswana economy. The analyses were conducted using a recursive dynamic computable general equilibrium model for Botswana within which was embedded a compartmental epidemiological model. The health care interventions examined are reductions in other sexually transmitted diseases (STDs) that reduce the probability of HIV transmission and a mass media health education programme that reduces the number of new sexual partnerships being formed. While the policy scenarios examined are, necessarily, somewhat stylised, the results indicate both the devastating adverse effects of the epidemic and the substantial potential benefits of the interventions. Without interventions disposable household incomes per capita are up to 50 per cent less than they would have been in 2020, but with these interventions the adverse effects of the epidemic are more than halved.
2004
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10937/1/HEDS_DP_04-07.pdf
Dixon, S., McDonald, S. and Roberts, J. (2004) AIDS in Botswana: Evaluating the general equilibrium implications of healthcare interventions. Discussion Paper. (Unpublished)
HEDS Discussion Paper 04/07
oai:eprints.whiterose.ac.uk:10938
2014-06-08T21:02:13Z
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https://eprints.whiterose.ac.uk/10938/
Visual Analogue Scales: do they have a role in the measurement of preferences for health states?
McCabe, C.
Stevens, K.
Health state preference data are increasingly used to inform national health care resource allocation decisions. In such circumstances it is important to be confident that the data we provide to decision makers is fit for purpose. Whilst there are many unresolved issues in health state preference measurement, there are some areas of agreement on procedures that are inappropriate. The past ten years have seen the publication of a number of papers reporting substantive problems with the use of visual analogue scales to value health states. In this journal Torrance and colleagues reviewed this literature and concluded that Visual Analogue Scales have a limited but useful role in health state preference measurement. In this paper we critically review the arguments advanced by Torrance and colleagues and argue that it is increasingly clear that Visual Analogue Scales are not an appropriate method and that the time has come to accept that VAS should not be used for health state preference measurement.
2004
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10938/1/HEDS_DP_04-06.pdf
McCabe, C. and Stevens, K. (2004) Visual Analogue Scales: do they have a role in the measurement of preferences for health states? Discussion Paper. (Unpublished)
HEDS Discussion Paper 04/06
oai:eprints.whiterose.ac.uk:10939
2014-06-21T18:22:47Z
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https://eprints.whiterose.ac.uk/10939/
Public preferences for participation in a large DNA cohort study: a discrete choice experiment
Hapgood, R.
McCabe, C.
Shickle, D.
Objectives. To determine the general public’s preferences over the design and use of UK Biobank; and the design for optimum recruitment.
Design. Discrete choice face-to-face interviews using a fractional factorial design and multinomial logit regression modelling.
Setting. 180 sampling points across 11 regions of the UK.
Participants. Members of the public.
Main outcome measures. Relative risks of people’s preferences for project design and use.
Results: 34.4% of respondents were willing to take part in UK Biobank (n=1283). The most highly preferred scenario was: individual feedback from the study; consent every time new data is requested; DNA and information destruction on withdrawal; and access to the data by the NHS and Universities but not other third parties. The single most important attribute was access to data. If individuals' insurance companies were to be given access to the data, this would be the largest single impediment to recruitment to the study. Extra resources are likely to be needed to counter the reduced recruitment rate if pharmaceutical companies are allowed access to the data.
Conclusions: The general public do have clear preferences regarding the design of biobanks. Whilst designing the study to meet the most preferred scenario may not be practical within available resources, biobanks can use the type of information provided here to compare the costs and benefits of different study designs. The "price" of discounting public preferences in terms of reduced recruitment should be an important part of the "weighing" process. Pilot studies of recruitment under alternative study designs may be justified.
2004
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10939/1/HEDS_DP_04-05.pdf
Hapgood, R., McCabe, C. and Shickle, D. (2004) Public preferences for participation in a large DNA cohort study: a discrete choice experiment. Discussion Paper. (Unpublished)
HEDS Discussion Paper 04/05
oai:eprints.whiterose.ac.uk:10940
2014-06-09T18:47:36Z
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https://eprints.whiterose.ac.uk/10940/
Seeing and doing: Feasibility study towards valuing visual impairment using simulation spectacles
Aballéa, S.
Tsuchiya, A.
Elicitation of utilities from those who do not have the health condition of interest generally uses verbal description of health states. This paper reports on the results of a small-scale investigation on the feasibility of an alternative approach, where health states are simulated and thus directly experienced by respondents. Three visual impairment health states were simulated using plastic spectacles, and were evaluated using the time trade-off. The first group of respondents (n = 19) found it difficult to assess visually impaired health states without referring to their own current health. With a further group of respondents (n = 14), we investigated the use of the respondents’ current health as the upper anchor of the time trade-off. Regression analysis shows that whilst there is a positive effect (p = 0.05) of the respondent’s own health state on the values from the first group, there is a non-significant negative effect (p = 0.36) on the values from the latter group with this revised method. Thus, it is feasible to simulate visual impairment in valuation exercises, but care must be taken to ensure what health state is effectively being valued.
2004
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10940/1/HEDS_DP_04-04.pdf
Aballéa, S. and Tsuchiya, A. (2004) Seeing and doing: Feasibility study towards valuing visual impairment using simulation spectacles. Discussion Paper. (Unpublished)
HEDS Discussion Paper 04/04
oai:eprints.whiterose.ac.uk:10941
2015-11-19T06:25:18Z
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https://eprints.whiterose.ac.uk/10941/
Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data
McCabe, C.
Brazier, J.
Gilks, P.
Tsuchiya, A.
Roberts, J.
O'Hagan, A.
Stevens, K.
Ranking exercises have routinely been used as warm-up exercises within health state valuation surveys. Very little use has been made of the information obtained in this process. Instead, research has focussed upon the analysis of health state valuation data obtained using the visual analogue scale, standard gamble and time trade off methods.
Thurstone’s law of comparative judgement postulates a stable relationship between ordinal and cardinal preferences, based upon the information provided by pairwise choices. McFadden proposed that this relationship could be modelled by estimating conditional logistic regression models where alternatives had been ranked. In this paper we report the estimation of such models for the Health Utilities Index Mark 2 and the SF-6D. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations.
For both the HUI2 and the SF-6D, the models estimated using rank data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that rank data has the potential to provide useful insights into community health state preferences. However, important questions remain.
2004
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10941/1/HEDS_DP_04-02.pdf
McCabe, C., Brazier, J., Gilks, P. et al. (4 more authors) (2004) Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data. Discussion Paper. (Unpublished)
HEDS Discussion Paper 04/02
oai:eprints.whiterose.ac.uk:10943
2014-06-08T02:56:30Z
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https://eprints.whiterose.ac.uk/10943/
Health State Values for the HUI 2 descriptive system: results from a UK survey
McCabe, C.
Stevens, K.
Roberts, J.
Brazier, J.
This paper reports the results of a study to estimate a statistical health state valuation model for a revised version of the Health Utilities Index Mark 2, using Standard Gamble health state preference data. A sample of 51 health states were valued by a sample of the 198 members of the UK general population. Models are estimated for predicting health state valuations for all 8,000 states defined by the revised HUI2. The recommended model produces logical and significant coefficients for all levels of all dimensions in the HUI2. These coefficients appear to be robust across model specifications. This model performs well in predicting the observed health state values within the valuation sample and for a separate validation sample of health states. However, there are concerns over large prediction errors for two health states in the valuation sample. These problems must be balanced against concerns over the validity of using the VAS based health state valuation data of the original HUI2 valuation model.
2003
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10943/1/HEDS_DP_03-03.pdf
McCabe, C., Stevens, K., Roberts, J. et al. (1 more author) (2003) Health State Values for the HUI 2 descriptive system: results from a UK survey. Discussion Paper. (Unpublished)
HEDS Discussion Paper 03/03
oai:eprints.whiterose.ac.uk:10945
2014-06-06T19:05:09Z
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https://eprints.whiterose.ac.uk/10945/
The social welfare function and individual responsibility: Some theoretical issues and empirical evidence from health
Dolan, P.
Tsuchiya, A.
The literature on income distribution has attempted to quantitatively analyse different degrees of inequality using a social welfare function (SWF) approach. However, it has largely ignored the source of such inequalities, and has thus failed to consider different degrees of inequity. The literature on egalitarianism has addressed issues of equity, largely in relation to individual responsibility. This paper brings these two literatures together by introducing the concept of individual responsibility into the SWF approach. The results from an empirical study of people’s preferences in relation to the distribution of health benefits are presented to illustrate how the parameter values in such a SWF might be determined.
2003
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10945/1/HEDS_DP_03-01.pdf
Dolan, P. and Tsuchiya, A. (2003) The social welfare function and individual responsibility: Some theoretical issues and empirical evidence from health. Discussion Paper. (Unpublished)
HEDS Discussion Paper 03/01
oai:eprints.whiterose.ac.uk:10947
2014-06-10T06:39:18Z
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
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https://eprints.whiterose.ac.uk/10947/
Sample sizes for the SF-6D preference based measure of health from the SF-36: a practical guide
Walters, S.J.
Brazier, J.E.
Background
Health Related Quality of Life (HRQoL) measures are becoming more frequently used in clinical trials and health services research, both as primary and secondary endpoints. Investigators are now asking statisticians for advice on how to plan and analyse studies using HRQoL measures, which includes questions on sample size. Sample size requirements are critically dependent on the aims of the study, the outcome measure and its summary measure, the effect size and the method of calculating the test statistic. The SF-6D is a new single summary preference-based measure of health derived from the SF-36 suitable for use clinical trials and in the economic evaluation of health technologies.
Objectives
To describe and compare two methods of calculating sample sizes when using the SF-6D in comparative clinical trials and to give pragmatic guidance to researchers on what method to use.
Methods
We describe two main methods of sample size estimation. The parametric (t-test) method assumes the SF-6D data is continuous and normally distributed and that the effect size is the difference between two means. The non-parametric (Mann-Whitney MW) method assumes the data are continuous and not normally distributed and the effect size is defined in terms of the probability that an observation drawn at random from population Y would exceed an observation drawn at random from population X. We used bootstrap computer simulation to compare the power of the two methods for detecting a shift in location.
Results
This paper describes the SF-6D and retrospectively calculated parametric and nonparametric effect sizes for the SF-6D from a variety of studies that had previously used the SF-36. Computer simulation suggested that if the distribution of the SF-6D is reasonably symmetric then the t-test appears to be more powerful than the MW test at detecting differences in means. Therefore if the distribution of the SF-6D is symmetric or expected to be reasonably symmetric then parametric methods should be used for sample size calculations and analysis. If the distribution of the SF-6D is skewed then the MW test appears to be more powerful at detecting a location shift (difference in means) than the t-test. However the differences in power (between the t and MW tests) are small and decrease as the sample size increases.
Conclusions
We have provided a clear description of the distribution of the SF-6D and believe that the mean is an appropriate summary measure for the SF-6D when it is to be used in clinical trials and the economic evaluation of new health technologies. Therefore pragmatically we would recommend that parametric methods be used for sample size calculation and analysis when using the SF-6D.
2002
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10947/1/HEDS_DP_02-03.pdf
Walters, S.J. and Brazier, J.E. (2002) Sample sizes for the SF-6D preference based measure of health from the SF-36: a practical guide. Discussion Paper. (Unpublished)
HEDS Discussion Paper 02/03
oai:eprints.whiterose.ac.uk:10950
2019-05-23T14:39:26Z
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https://eprints.whiterose.ac.uk/10950/
Determining the parameters in a social welfare function using stated preference data: an application to health
Dolan, P.
Tsuchiya, A.
Smith, P.
Shaw, R.
Williams, A.
One way in which economists might determine how best to balance the competing objectives of efficiency and equity is to specify a social welfare function (SWF). This paper looks at how the stated preferences of a sample of the general public can be used to estimate the shape of the SWF in the domain of health benefits. The results suggest that it is possible to determine the parameters in a social welfare function from stated preference data, but show that people are sensitive to what inequalities exist and to the groups across which those inequalities exist.
School of Health and Related Research
2002-05-01
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10950/1/HEDS_DP_02-02.pdf
Dolan, P., Tsuchiya, A., Smith, P. et al. (2 more authors) (2002) Determining the parameters in a social welfare function using stated preference data: an application to health. Discussion Paper. ScHARR HEDS Discussion Papers . School of Health and Related Research , University of Sheffield.
https://www.sheffield.ac.uk/scharr/sections/heds/dps-2002
oai:eprints.whiterose.ac.uk:10952
2014-06-15T16:53:39Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10952/
Deriving preference-based single indices from non-preference based condition-specific instruments: Converting AQLQ into EQ5D indices
Tsuchiya, A.
Brazier, J.
McColl, E.
Parkin, D.
Suppose that one has a clinical dataset with only non-preference-based QOL data, and that one nevertheless would like to perform a cost/QALY analysis. This study reports on some efforts to establish a "mapping" relationship between AQLQ (a non-preference-based QOL instrument for asthma) and EQ5D (a preference-based generic instrument). Various methods are described in terms of associated assumptions regarding the measurement properties of the instruments. This is followed by empirical mapping, based on regressing EQ5D on AQLQ. Six main regression models and two supplementary models are identified, and the regressions carried out. Performance of each model is explored in terms of goodness of fit between observed and predicted values, and of robustness of predictions on external data. The results show that it is possible to predict mean EQ5D indices given AQLQ data. The general implications for methods of mapping non-preference-based instruments onto preference-based measures are discussed.
2002
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10952/1/HEDS_DP_02-01.pdf
Tsuchiya, A., Brazier, J., McColl, E. et al. (1 more author) (2002) Deriving preference-based single indices from non-preference based condition-specific instruments: Converting AQLQ into EQ5D indices. Discussion Paper. (Unpublished)
HEDS Discussion Paper 02/01
oai:eprints.whiterose.ac.uk:10954
2014-06-17T20:29:53Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/10954/
Quality of life evidence for patients with Alzheimer's disease : Use of existing quality of life evidence from the ADENA trials to estimate the utility impact of Exelon® (Appendix 1 - Utility evidence)
Brazier, J.
2001
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/10954/1/HEDS_DP_01-01.pdf
Brazier, J. (2001) Quality of life evidence for patients with Alzheimer's disease : Use of existing quality of life evidence from the ADENA trials to estimate the utility impact of Exelon® (Appendix 1 - Utility evidence). Discussion Paper. (Unpublished)
HEDS Discussion Paper 01/01
oai:eprints.whiterose.ac.uk:11019
2014-06-05T06:37:16Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11019/
Mapping SF-36 onto the EQ-5D index: how reliable is the relationship?
Rowen, D.
Brazier, J.
Roberts, J.
Mapping from health status measures onto generic preference-based measures is becoming a common solution when health state utility values are not directly available for economic evaluation. However the accuracy and reliability of the models employed is largely untested, and there is little evidence of their suitability in patient datasets. This paper examines whether mapping approaches are reliable and accurate in terms of their predictions for a large and varied UK patient dataset. SF-36 dimension scores are mapped onto the EQ-5D index using a number of different model specifications. The predicted EQ-5D scores for subsets of the sample are compared across inpatient and outpatient settings and medical conditions. This paper compares the results to those obtained from existing mapping functions. Our results suggest that models mapping the SF-36 onto the EQ-5D have similar predictions across inpatient and outpatient setting and medical conditions. However, the models overpredict for more severe EQ-5D states; this problem is also present in the existing mapping functions.
Health and Quality of Life Outcomes
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11019/1/HEDS_DP_08-14.pdf
Rowen, D., Brazier, J. and Roberts, J. (2009) Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Discussion Paper. Health and Quality of Life Outcomes
HEDS Discussion Paper 08/14
oai:eprints.whiterose.ac.uk:11020
2014-06-18T20:57:26Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D4C65656473
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11020/
The relative societal value of health gains to different beneficiaries
Dolan, P.
Edlin, R.
Tsuchiya, A.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11020/1/HEDS_DP_08-12.pdf
Dolan, P., Edlin, R. and Tsuchiya, A. (2008) The relative societal value of health gains to different beneficiaries. Discussion Paper. Birmingham.
http://www.pcpoh.bham.ac.uk/publichealth/methodology/projects/RM03_JH11_PD.shtml
HEDS Discussion Paper 08/12
oai:eprints.whiterose.ac.uk:11021
2014-06-05T15:21:15Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11021/
Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome
Ward, S.
Ara, R.
Pandor, A.
Hall, A.S.
Introduction: Recent NICE guidance in England and Wales states that statin therapy for secondary CVD should "usually be initiated with a drug with a low acquisition cost (taking into account required daily dose and product price per dose)". Intensive dose statin therapy is more costly than standard dose, but offers additional benefits and may potentially be more cost effective for a sub-group of high risk patients.
Objective: To determine if the strategy of treating ACS patients with intensive dose statin compared with standard dose statin can be considered to be cost effective and to what extent these results are influenced by the age of the patient at start of treatment.
Methods: A Markov model was used to explore the costs and health outcomes associated with a lifetime of intensive dose (represented by 80mg atorvastatin) versus standard dose (represented by 20mg simvastatin) treatment for patients with acute coronary syndrome. Health states included unstable angina, MI, stroke, fatal CHD, fatal stroke, or non vascular death. The benefits associated with statin treatment were modelled by applying the relative risks from a meta-analysis of 4 large RCTs reporting clinical endpoints. Costs and utilities assigned to health states were derived from a review of published evidence.
Results: Treatment with intensive dose statin therapy offers additional benefits over standard dose therapy. The cost offsets through avoided events are less than the associated treatment costs and result in a cost per QALY of around £24,000 for patients with ACS starting treatment at 60 years of age and falling to around £14,000 for patients starting treatment at 70 years. The key driver of cost effectiveness is the relative risk for mortality.
Conclusions: This analysis suggests that intensive statin regimens (represented by atorvastatin 80mg/day) are cost effective compared with standard statin regimens (represented by simvastatin 20mg/day) for patients with ACS over the age of 60 years. A recent registry study reports a mean age of 70 years for ACS patients admitted to UK hospitals and hence this comparison applies to the great majority of ACS patients.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11021/1/HEDS_DP_08-03.pdf
Ward, S., Ara, R., Pandor, A. et al. (1 more author) (2008) Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/03
oai:eprints.whiterose.ac.uk:11022
2016-11-05T20:01:02Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D4C65656473:4C656564732E46412D4D444845:4C656564732E52432D4D454453:4C656564732E53522D4C494853:4C656564732E44492D41554845
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D4C65656473
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11022/
Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected
Wailoo, A.
Tsuchiya, A.
McCabe, C.
Current practice in economic evaluation is to assign equal social value to a unit of health improvement (“a QALY is a QALY is a QALY”). Alternative views of equity are typically considered separately to efficiency. One proposal seeks to integrate these two sets of societal concerns by attaching equity weights to QALYs. To date, research in pursuit of this goal has focussed on candidate equity criteria and methods for estimating such weights. It has implicitly been assumed that should legitimate, valid, and reliable equity weights become available, it would be a straightforward task to incorporate them into as a separate simple calculation after estimating cost per unweighted QALY. This paper suggests that in many situations these simple approaches to incorporating equity weights will not appropriately reflect the preferences on which the weights are based and therefore equity weights must be incorporated directly into the cost effectiveness analysis. In addition to these technical issues, there are a number of practical challenges that arise from the movement from implicit to explicit consideration of equity. Equity weights should be incorporated in economic evaluation, but not until these challenges have been appropriately addressed.
2008
Monograph
NonPeerReviewed
text
en
attached
https://eprints.whiterose.ac.uk/11022/1/HEDS_DP_08-07.pdf
Wailoo, A., Tsuchiya, A. and McCabe, C. (2008) Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected. Discussion Paper. (Unpublished)
HEDS Discussion Paper 08/07
oai:eprints.whiterose.ac.uk:11023
2013-02-08T17:00:46Z
oai:eprints.whiterose.ac.uk:11024
2014-06-19T03:09:20Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464353:536865666669656C642E45434E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11024/
Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments
Young, T.
Yang, Y.
Brazier, J.
Tsuchiya, A.
Coyne, K.
Objective: To set out the methodological process for using Rasch analysis alongside traditional psychometric methods in the development of a health state classification that is amenable to valuation.
Methods: The overactive bladder questionnaire is used to illustrate a four step process for deriving a reduced health state classification from an existing nonpreference based health related quality of life instrument. Step I excludes items that do not meet the initial validation process and step II uses criteria based on Rasch analysis and psychometric testing to select the final items for the health state classification. In step III, item levels are examined and Rasch analysis is used to explore the possibility of reducing the number of item levels. Step IV repeats steps I to III on alternative data sets in order to validate the selection of items for the health state classification.
Conclusions: The techniques described enable the construction of a health state classification amenable for valuation exercises that will allow the derivation of preference weights. Thus, the health related quality of life of patients with conditions, like overactive bladder, can be valued and quality adjustment weights such as quality adjusted life years derived.
Quality of Life Research
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11024/1/HEDS_DP_08-05.pdf
Young, T., Yang, Y., Brazier, J. et al. (2 more authors) (2009) Making Rasch decisions: The use of Rasch analysis in the construction of preference based health related quality of life instruments. Discussion Paper. Quality of Life Research
HEDS Discussion Paper 08/05
oai:eprints.whiterose.ac.uk:11027
2014-06-07T03:39:04Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11027/
A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures
Brazier, J.E.
Yang, Y.
Tsuchiya, A.
2008
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11027/1/HEDS_DP_08-02.pdf
Brazier, J.E., Yang, Y. and Tsuchiya, A. (2008) A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures. Discussion Paper. HEDS Discussion Paper (08/02).
oai:eprints.whiterose.ac.uk:11028
2014-06-05T05:51:54Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11028/
Valuing condition specific health states using simulation contact lenses
Czoski-Murray, C.
Carlton, J.
Brazier, J.
Kang, H.K.
Young, T.A.
Papo, N.L.
OBJECTIVE: This paper reports on a study that used contact lenses to simulate the effects of a visual impairment caused by Age Related Macular Degeneration (ARMD). The aim was to examine the feasibility of using this method of simulation and to compare the results from this experiment with those obtained from ARMD patients (n=209) using generic preference-based measures (HUI3 and EQ-5D) and patient time trade-off TTO.
METHODS: Utility values were elicited from healthy participants (n=108) by TTO for three ARMD states simulated using contact lenses.
RESULTS: A significant relationship was found between visual acuity and TTO values elicited from members of the general population (n=108). It was stronger than that found for HUI3, EQ-5D and own TTO values from patients (n=209). General population values informed by the experience of simulation were found to be significantly different to values from patient TTO and generic preference-based measures for the same level of visual impairment. Socio-demographic characteristics did not significantly affect results, although baseline TTO utility values were positively associated with TTO values for simulated states.
CONCLUSIONS: ARMD has a major impact on general population TTO health state values. Differences across four visual health states appear larger than those found for a generic preference-based measures and patient TTO values. For conditions that are difficult to describe and imagine, simulation methods may offer an important method for obtaining better informed general population preferences.
Value in Health
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11028/2/HEDS_DP_07-05.pdf
Czoski-Murray, C., Carlton, J., Brazier, J. et al. (3 more authors) (2009) Valuing condition specific health states using simulation contact lenses. Discussion Paper. Value in Health
HEDS Discussion Paper 07/05
oai:eprints.whiterose.ac.uk:11030
2014-06-07T11:41:01Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11030/
Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism
Tsuchiya, A.
Dolan, P.
When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics.
Health Economics
2009-08
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11030/1/HEDS_DP_06-11.pdf
Tsuchiya, A. and Dolan, P. (2009) Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism. Discussion Paper. Health Economics
HEDS Discussion Paper 06/11
oai:eprints.whiterose.ac.uk:11031
2014-06-05T06:47:18Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11031/
Estimation of a preference based single index from the sexual quality of life questionnaire (SQOL) using ordinal data
Ratcliffe, J.
Brazier, J.
Tsuchiya, A.
Symonds, T.
Brown, M.
There is increasing interest in using ordinal methods to estimate cardinal values for health states to calculate quality adjusted life years. This paper reports the estimation of models of rank data and discrete choice experiment (DCE) data to derive a preference-based index from a condition specific measure relating to sexual health and to compare the results to values generated from time trade-off valuation (TTO). The DCE data were analysed using a random effects probit model and the DCE predicted values were rescaled according to the highest and lowest predicted TTO values corresponding to the best and worst SQOL health states respectively. The rank data were analysed using a rank ordered logit model and re-scaled using two alternative methods. Firstly, re-scaling the rank predicted values using identical methods to those employed for DCE and secondly, re-scaling the rank model coefficients by dividing each level coefficient by the coefficient relating to death. The study raises some important issues about the use of ordinal data to produce cardinal health state valuations.
Health Economics
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11031/1/HEDS_DP_06-06.pdf
Ratcliffe, J., Brazier, J., Tsuchiya, A. et al. (2 more authors) (2006) Estimation of a preference based single index from the sexual quality of life questionnaire (SQOL) using ordinal data. Discussion Paper. HEDS Discussion Paper (06/06). Health Economics
oai:eprints.whiterose.ac.uk:11033
2014-06-22T23:59:48Z
7374617475733D707562
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756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11033/
Seeing and doing: Feasibility study towards valuing visual impairment using simulation spectacles
Aballéa, S.
Tsuchiya, A.
Elicitation of utilities from those who do not have the health condition of interest generally uses verbal description of health states. This paper reports on the results of a small-scale investigation on the feasibility of an alternative approach, where health states are simulated and thus directly experienced by respondents. Three visual impairment health states were simulated using plastic spectacles, and were evaluated using the time trade-off. The first group of respondents (n = 19) found it difficult to assess visually impaired health states without referring to their own current health. With a further group of respondents (n = 14), we investigated the use of the respondents’ current health as the upper anchor of the time trade-off. Regression analysis shows that whilst there is a positive effect (p = 0.05) of the respondent’s own health state on the values from the first group, there is a non-significant negative effect (p = 0.36) on the values from the latter group with this revised method. Thus, it is feasible to simulate visual impairment in valuation exercises, but care must be taken to ensure what health state is effectively being valued.
Health Economics
2007
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11033/1/HEDS_DP_04-04.pdf
Aballéa, S. and Tsuchiya, A. (2007) Seeing and doing: Feasibility study towards valuing visual impairment using simulation spectacles. Discussion Paper. Health Economics
HEDS Discussion Paper 04/04
oai:eprints.whiterose.ac.uk:11034
2015-11-16T11:49:13Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E464350:536865666669656C642E4D4153
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11034/
Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data
McCabe, C.
Brazier, J.
Gilks, P.
Tsuchiya, A.
Roberts, J.
O'Hagan, A.
Stevens, K.
Ranking exercises have routinely been used as warm-up exercises within health state valuation surveys. Very little use has been made of the information obtained in this process. Instead, research has focussed upon the analysis of health state valuation data obtained using the visual analogue scale, standard gamble and time trade off methods.
Thurstone’s law of comparative judgement postulates a stable relationship between ordinal and cardinal preferences, based upon the information provided by pairwise choices. McFadden proposed that this relationship could be modelled by estimating conditional logistic regression models where alternatives had been ranked. In this paper we report the estimation of such models for the Health Utilities Index Mark 2 and the SF-6D. The results are compared to the conventional regression models estimated from standard gamble data, and to the observed mean standard gamble health state valuations.
For both the HUI2 and the SF-6D, the models estimated using rank data are broadly comparable to the models estimated on standard gamble data and the predictive performance of these models is close to that of the standard gamble models. Our research indicates that rank data has the potential to provide useful insights into community health state preferences. However, important questions remain.
Journal of Health Economics
2006
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11034/1/HEDS_DP_04-02.pdf
McCabe, C., Brazier, J., Gilks, P. et al. (4 more authors) (2006) Estimating population cardinal health state valuation models from individual ordinal (rank) health state preference data. Discussion Paper. Journal of Health Economics
HEDS Discussion Paper 04/02
oai:eprints.whiterose.ac.uk:11035
2014-06-09T12:28:53Z
7374617475733D707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11035/
The social welfare function and individual responsibility: Some theoretical issues and empirical evidence from health
Dolan, P.
Tsuchiya, A.
The literature on income distribution has attempted to quantitatively analyse different degrees of inequality using a social welfare function (SWF) approach. However, it has largely ignored the source of such inequalities, and has thus failed to consider different degrees of inequity. The literature on egalitarianism has addressed issues of equity, largely in relation to individual responsibility. This paper brings these two literatures together by introducing the concept of individual responsibility into the SWF approach. The results from an empirical study of people’s preferences in relation to the distribution of health benefits are presented to illustrate how the parameter values in such a SWF might be determined.
Journal of Health Economics
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11035/1/HEDS_DP_03-01.pdf
Dolan, P. and Tsuchiya, A. (2009) The social welfare function and individual responsibility: Some theoretical issues and empirical evidence from health. Discussion Paper. Journal of Health Economics
HEDS Discussion Paper 03/01
oai:eprints.whiterose.ac.uk:11037
2014-06-12T19:40:01Z
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74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11037/
Public attitudes to compulsory health programmes: generating questions from a focus group to support a willingness to pay study
Dixon, S.
Background
The willingness to pay approach to valuing goods has been heavily criticised due to perceived biases in their resultant valuations. Recently, attempts have been made to use data relating to respondent attitudes to produce better informed preferences and remove "warm glow". This paper reports a study that uses rigorous methods by which salient attitudes can be identified and measured for use in a subsequent willingness to pay study. The topic area is that of compulsory health programmes (CHPs).
Methods
Six focus groups were undertaken among members of the public using a questioning route designed to highlight different attitudes between CHPs. Framework analysis was used, including thematic and contrast charting, to identify themes that described the issues raised by participants. The resultant coding framework was translated into a set of scales which were then used in a survey of 831 members of the general population. Factor analysis was applied to identify latent themes.
Results
Analysis of the focus group transcripts highlighted seven themes relating to the effects of policy, alternatives, the role of government, uncertainties, coherence of policy, rights and responsibilities, and other issues. These themes were translated into 48 statements that were used as attitude scales. The factor analysis of the general population survey identified 4 latent factors: "common sense", "government", "warm glow" and "rights and responsibilities".
Conclusions
The focus group work described in this paper shows that across individuals, coherent themes relating to public health and compulsion can be identified. It also demonstrates sophisticated thinking by participants about public health issues. This study shows that the work of Nunes (2002) and Pouta (2004) is potentially generalisable to other topic areas and that their methods can be improved upon. This work has been used in a subsequent analysis of WTP responses by using the attitudinal scales in an attempt to elicit better informed preferences and explain responses in terms of underlying attitudes and "warm glow".
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11037/1/HEDS_DP_10-04.pdf
Dixon, S. (2010) Public attitudes to compulsory health programmes: generating questions from a focus group to support a willingness to pay study. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/04
oai:eprints.whiterose.ac.uk:11040
2014-06-06T16:13:06Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11040/
Amblyopia and quality of life: a systematic review
Carlton, J.
Kaltenthaler, E.
Background/Aims
Amblyopia is a common condition which can affect up to 5% of the general population. The health-related quality of life (HRQoL) implications of amblyopia and/or its treatment have been explored in the literature.
Methods
A systematic literature search was undertaken (16th-30th January 2007) to identify the HRQoL implications of amblyopia and/or its treatment.
Results
A total of 25 papers were included in the literature review. The HRQoL implications of amblyopia related specifically to amblyopia treatment, rather than the condition itself. These included the impact upon family life; social interactions; difficulties undertaking daily activities; and feelings and behaviour. The identified studies adopted a number of methodologies. The study populations included; children with the condition; parents of children with amblyopia; and adults who had undertaken amblyopia treatment as a child. Some studies developed their own measures of HRQoL, and others determined HRQoL through proxy measures.
Conclusions
The reported findings of the HRQoL implications are of importance when considering the management of cases of amblyopia. Further research is required to assess the immediate and long-term effects of amblyopia and/or its treatment upon HRQoL using a more standardised approach.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11040/1/HEDS_DP_10-05.pdf
Carlton, J. and Kaltenthaler, E. (2010) Amblyopia and quality of life: a systematic review. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/05
oai:eprints.whiterose.ac.uk:11048
2014-06-05T12:41:23Z
7374617475733D756E707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11048/
Comparing EQ-5D scores for comorbid health conditions estimated using five different methods
Ara, R.
Brazier, J.
BACKGROUND: While health state utility values (HSUVs) for many single health conditions are now in the public domain, due to the large number of possible combinations of comorbid health conditions (CHC) the HSUVs for these are not readily available. As a consequence, HSUVs for CHCs are frequently estimated using data obtained from cohorts with single health conditions. With researchers presenting conflicting results, there is currently no consensus on the most appropriate method to estimate HSUVs for CHCs.
OBJECTIVE: The objective of the study was to assess the accuracy of five different methods in the same dataset.
METHODS: EQ-5D data (n=41,174) from the Health Survey for England was used to compare HSUVs generated using the following techniques: the additive, multiplicative and minimum methods, the adjusted decrement estimator (ADE), and a linear regression model.
RESULTS: The additive and multiplicative methods under estimated the majority of HSUVs and the magnitude of the errors increased as the actual HSUV increased. Conversely, the minimum and DAE methods over estimated the majority of HSUVs and the magnitude of errors increased as the actual HSUV decreased. Although the simple linear model produced more accurate results than the others, there was a tendency to under predict higher HSUVs and over predict lower HSUVs and 20% of the errors were greater than the MID (|0.074|) for the EQ-5D. We found the magnitude and direction of mean errors in the estimated scores could be driven by the actual scores being estimated in addition to the technique used and in general the HSUVs estimated using an adjusted baseline were more accurate.
We found the additive and minimum methods performed very poorly in our data. While the simple linear model gave the most accurate results, the model requires validating in external data and additional research exploring alternative model specification is warranted. Our comparison of errors in subgroups of actual EQ-5D scores highlights the need to present additional data when reporting results of analyses in this area as conclusions using average errors in truncated ranges could be misleading.
2010-07-06
Article
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11048/2/HSE_combining_data.pdf
Ara, R. and Brazier, J. (2010) Comparing EQ-5D scores for comorbid health conditions estimated using five different methods. (Unpublished)
oai:eprints.whiterose.ac.uk:11049
2014-06-04T17:15:34Z
7374617475733D756E707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11049/
Estimating health state utility values for comorbid health conditions using SF-6D data
Ara, R.
Brazier, J.
BACKGROUND: When health state utility values for comorbid health conditions are not available, analysts frequently use data from cohorts with single health conditions to estimate proxy scores. The methods used can produce very different results and there is currently no consensus on which is the most appropriate approach.
OBJECTIVE: The objective of the current study was to assess the accuracy of five different methods that have been used to estimated HSUVs for comorbid health conditions.
METHOD: Data collected during five Welsh Health Surveys (WHS) were subgrouped by health status. Mean SF-6D scores from cohorts with a particular health condition were used to estimate mean SF-6D scores for cohorts with two comorbid health conditions using:the additive, multiplicative, and minimum methods, and the adjusted decrement estimator. A linear model was obtained by regressing mean HSUV from subgroups with single health conditions onto mean HSUVs from subgroups with combined health conditions.
RESULTS: The pooled WHS data provided 64,437 cases with SF-6D scores. When subgrouped by self reported health condition(s), 32 groups (n>30) were identified with comorbid health conditions. The mean SF-6D for these subgroups ranged from 0.4648 to 0.6068. The linear model produced the most accurate HSUVs for the combined health conditions with 88% of values accurate to within the minimum important difference for the SF-6D. The additive method underestimated the actual SF-6D scores and produced some substantial errors in the estimated values. The minimum method overestimated all mean SF-6D scores but was more accurate when estimating higher values. The multiplicative and ADE methods both underestimated the majority of the actual SF-6D scores. However, both methods both performed better when estimating SF-6D scores smaller than 0.50 with 43% and 86% of estimated HSUVs accurate to within the MID for the multiplicative and ADE respectively.
This study makes an important contribution to the existing evidence as it is the first to compare five different methods on SF-6D data. Although the range in actual HSUVs was relatively small, the data covered the lower end of the index while the majority of previous research has involved actual HSUVs covering the upper end of possible ranges. While the linear model gave the most accurate results in our data, additional research is required to develop and validate the model.
2010-07-07
Article
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11049/2/WHS_combining_data.pdf
Ara, R. and Brazier, J. (2010) Estimating health state utility values for comorbid health conditions using SF-6D data. (Unpublished)
oai:eprints.whiterose.ac.uk:11055
2014-06-05T08:25:49Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11055/
Multilevel modelling of cost data: an application to thrombolysis and primary angioplasty in the UK NHS
Hernández Alava, M.
Wailoo, A.
Cost data are frequently collected from several locations and tend to be non negative and skewed. Generalised linear multilevel models provide a means of dealing with each of these issues. This paper compares several statistical models within this class using data drawn from an observational study of 3,000 patients treated for heart attack in 15 UK NHS hospitals. A number of alternative link functions and covariates were considered. We demonstrate that whilst it is important to take account of clustering in the data, the precise manner in which this is done is equally important. Models which allow for correlation between the random effects components and heteroskedasticity across all hospitals performed best in terms of model fit and made substantial di¤erences to cost estimates.
2010-01
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11055/1/HEDS_DP_10-06.pdf
Hernández Alava, M. and Wailoo, A. (2010) Multilevel modelling of cost data: an application to thrombolysis and primary angioplasty in the UK NHS. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/06
oai:eprints.whiterose.ac.uk:11056
2014-06-05T22:36:19Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11056/
Valuation of the Child Health Utility Index 9D (CHU9D)
Stevens, K.
Objectives:
The aim of this study was to test the feasibility of estimating preference weights for all health states defined by the Child Health Utility 9D (CHU9D), a new generic measure of health related quality of life for children. This will allow the calculation of quality adjusted life years (QALYs) for use in paediatric economic evaluation.
Methods:
Valuation interviews were undertaken with 300 members of the UK adult general population using standard gamble and ranking valuation methods. Regression modelling was undertaken to estimate models that could predict a value for every health state defined by the CHU9D. A range of models were tested and evaluated based on their predictive performance.
Results:
Models estimated on the standard gamble data performed better than the rank model. All models had a few inconsistencies or insignificant levels and so further modelling was done to estimate a parsimonious consistent regression model, by combining inconsistent levels and removing non significant levels. The final preferred model was an OLS model where all coefficients were significant, there were no inconsistencies and the model had the best predictive performance.
Conclusion:
This research has demonstrated it is feasible to value the CHU9D descriptive system and preference weights for each health state can be generated to allow the calculation of QALYs. The CHU9D can now be used in the economic evaluation of paediatric health care interventions. Further research is needed to investigate the impact of children’s preferences for the health states and what methods could be used to obtain these preferences.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11056/1/HEDS_DP_10-07.pdf
Stevens, K. (2010) Valuation of the Child Health Utility Index 9D (CHU9D). Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/07
oai:eprints.whiterose.ac.uk:11074
2014-06-04T11:51:21Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11074/
Tails from the Peak District: adjusted censored mixture models of EQ-5D health state utility values
Hernández Alava, M.
Wailoo, A.J.
Ara, R.
Health state utility data generated using the EQ-5D instrument are typically right bounded at one with a substantial gap to the next set of observations, left bounded by some negative value, and are multi modal. These features present challenges to the estimation of the e¤ect of clinical and socioeconomic characteristics on health utilities. We present an adjusted censored model and then use this in a flexible, mixture modelling framework to address these issues. We demonstrate superior performance of this model compared to linear regression and Tobit censored regression using a dataset from repeated observations of patients with rheumatoid arthritis. We �nd that three latent classes are appropriate in estimating EQ-5D from function, pain and sociodemographic factors. Analysis of utility data should apply methods that recognise the distributional features of the data.
2010
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11074/1/HEDS_DP_10-08.pdf
other
en
https://eprints.whiterose.ac.uk/11074/2/HEDS_DP_10-08_supplement.xlsx
Hernández Alava, M., Wailoo, A.J. and Ara, R. (2010) Tails from the Peak District: adjusted censored mixture models of EQ-5D health state utility values. Discussion Paper. (Unpublished)
HEDS Discussion Paper 10/08
oai:eprints.whiterose.ac.uk:11084
2017-08-19T09:58:41Z
7374617475733D707562
74797065733D626F6F6B5F73656374696F6E
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11084/
The value of screening for amblyopia revisited
Carlton, J.
Czoski-Murray, C.
Springer
2010
Book Section
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11084/2/Carlton_11084.pdf
Carlton, J. and Czoski-Murray, C. (2010) The value of screening for amblyopia revisited. In: Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics: Strabismus - New Concepts in Pathophysiology, Diagnosis, and Treatment. Essentials in Ophthalmology . Springer , Berlin Heidelberg , pp. 95-111. ISBN 978-3-540-85850-8
http://dx.doi.org/10.1007/978-3-540-85851-5
10.1007/978-3-540-85851-5
oai:eprints.whiterose.ac.uk:11088
2014-09-15T01:19:28Z
7374617475733D707562
74797065733D61727469636C65
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6E6F5F646F63756D656E74735F617661696C61626C65
https://eprints.whiterose.ac.uk/11088/
Screening for amblyopia and strabismus in children aged 4-5 years: where do we go from here?
Carlton, J.
Czoski-Murray, C.
Aim: To describe the history of vision screening for amblyopia and strabismus and identify knowledge gaps within the literature.
Method: A review of the literature is presented which includes an examination of screening guidelines.
Results: A recent Health Technology Appraisal reported that screening for amblyopia and amblyogenic factors was not cost-effective, and highlighted a need for further research into the impact of amblyopia and amblyogenic factors in the long-term. Despite recommendations to the contrary vision screening varies in content across the United Kingdom (UK), particularly with respect to personnel undertaking the screening tests.
Conclusion: Uncertainty surrounding the appropriateness of vision screening remains, with areas of the literature still lacking in evidence to support screening programmes. Debate is needed as to the strategic approach of the orthoptic profession in the application of vision screening across the UK.
British and Irish Orthoptic Society
2009
Article
NonPeerReviewed
Carlton, J. and Czoski-Murray, C. (2009) Screening for amblyopia and strabismus in children aged 4-5 years: where do we go from here? British and Irish Orthoptic Journal, 6. pp. 15-21. ISSN 1743-9868
http://www.orthoptics.org.uk/journal/journal
oai:eprints.whiterose.ac.uk:11095
2014-06-23T00:47:40Z
7374617475733D756E707562
74797065733D6D6F6E6F6772617068
756E69743D536865666669656C64:536865666669656C642E46434D:536865666669656C642E485252:536865666669656C642E48434D:536865666669656C642E48434D2E5750
696E737469747574696F6E3D536865666669656C64
7072696D6F3D6861735F7075626C6963
https://eprints.whiterose.ac.uk/11095/
Granulocyte colony-stimulating factors for prevention of febrile neutropenia following chemotherapy: systematic review and meta-analysis
Cooper, K.L.
Madan, J.
Whyte, S.
Stevenson, M.D.
Akehurst, R.
Background: Febrile neutropenia (FN) occurs following myelosuppressive chemotherapy and is associated with morbidity, mortality, costs, and chemotherapy reductions and delays. Granulocyte colony-stimulating factors (G-CSFs) stimulate neutrophil production and may reduce FN incidence when given prophylactically following chemotherapy.
Methods: A systematic review and meta-analysis assessed the effectiveness of G-CSFs (pegfilgrastim, filgrastim or lenograstim) in preventing FN in adults undergoing chemotherapy for solid tumours or lymphoma. G-CSFs were compared with no primary G-CSF prophylaxis and with one another. Nine databases were searched in December 2009. Meta-analysis used a random effects model due to heterogeneity.
Results: Twenty studies compared primary G-CSF prophylaxis with no primary G-CSF prophylaxis: five studies of pegfilgrastim; ten of filgrastim; and five of lenograstim. All three G-CSFs significantly reduced FN incidence, with relative risks of 0.30 (95% CI: 0.14 – 0.65) for pegfilgrastim, 0.57 (95% CI: 0.48 – 0.69) for filgrastim, and 0.62 (95% CI: 0.44 – 0.88) for lenograstim. Five studies compared pegfilgrastim with filgrastim; FN incidence was significantly lower for pegfilgrastim than filgrastim, with relative risk 0.66 (95% CI: 0.44 – 0.98).
Conclusions: Primary prophylaxis with G-CSFs significantly reduces FN incidence in adults undergoing chemotherapy for solid tumours or lymphoma. Pegfilgrastim reduces FN incidence to a significantly greater extent than filgrastim.
2009
Monograph
NonPeerReviewed
text
en
https://eprints.whiterose.ac.uk/11095/1/HEDS_DP_09-07.pdf
Cooper, K.L., Madan, J., Whyte, S. et al. (2 more authors) (2009) Granulocyte colony-stimulating factors for prevention of febrile neutropenia following chemotherapy: systematic review and meta-analysis. Discussion Paper. (Unpublished)
HEDS Discussion Paper 09/07
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