Med Decis Making - Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers.

Tópicos

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Resumo

Health care resources are scarce, and decisions have to be made about how to allocate funds. Often, these decisions are based on sparse or imperfect evidence. One such example is negative-pressure wound therapy (NPWT), which is a widely used treatment for severe pressure ulcers; however, there is currently no robust evidence that it is effective or cost-effective. This work considers the decision to adopt NPWT given a range of alternative treatments, using a decision analytic modeling approach. Literature searches were conducted to identify existing evidence on model parameters. Given the limited evidence base, a second source of evidence, beliefs elicited from experts, was used. Judgments from experts on relevant (uncertain) quantities were obtained through a formal elicitation exercise. Additionally, data derived from a pilot trial were also used to inform the model. The 3 sources of evidence were collated, and the impact of each on cost-effectiveness was evaluated. An analysis of the value of further information indicated that a randomized controlled trial may be worthwhile in reducing decision uncertainty, where from a set of alternative designs, a 3-arm trial with longer follow-up was estimated to be the most efficient. The analyses presented demonstrate how allocation decisions about medical technologies can be explicitly informed when data are sparse and how this kind of analyses can be used to guide future research prioritization, not only indicating whether further research is worthwhile but what type of research is needed and how it should be designed.

Resumo Limpo

health care resourc scarc decis made alloc fund often decis base spars imperfect evid one exampl negativepressur wound therapi npwt wide use treatment sever pressur ulcer howev current robust evid effect costeffect work consid decis adopt npwt given rang altern treatment use decis analyt model approach literatur search conduct identifi exist evid model paramet given limit evid base second sourc evid belief elicit expert use judgment expert relev uncertain quantiti obtain formal elicit exercis addit data deriv pilot trial also use inform model sourc evid collat impact costeffect evalu analysi valu inform indic random control trial may worthwhil reduc decis uncertainti set altern design arm trial longer followup estim effici analys present demonstr alloc decis medic technolog can explicit inform data spars kind analys can use guid futur research priorit indic whether research worthwhil type research need design

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