Contact: Claire Rothery
The pressure for health systems to become “early adopters” of promising new technologies has caused increased tension between innovation, access, and efficiency. Early access to new medicines is important to patients, but an evidence base that is premature can carry substantial risk and uncertainty for patient outcomes. A decision made too early could result in a waste of resources on cost-ineffective or even harmful practices, which are often difficult to eliminate once diffused. Rapid approval of new medicines can also result in disincentive effects to invest in further research that would reduce uncertainty and risk to patients. Conversely, if the decision to adopt is delayed until further research is conducted this runs the risk of patients being denied access to a clinically important and cost-effective intervention. Therefore, decision makers must decide how to balance the value of delaying adoption until better information becomes available against the value of providing patients with early access. This requires an assessment of the value of further research to reduce uncertainty.
The value of information (VOI) also plays a key role in research prioritisation and commissioning decisions. Most research funders have limited resources and need to identify high-priority areas for further research. By studying the benefits and costs of each new proposed intervention and the value of information to reduce uncertainty it becomes possible to identify topics where further research offers the greatest value. Research funders can then rank topics in order of value to determine areas of high priority. CHE research in this area covers:
Woods B, Rothery C, Anderson S-J, Eaton JW, Revill P, Hallett TB, Claxton K. Appraising the value of evidence generation activities: An HIV Modelling Study. BMJ Global Health 2018;3(6):e000488.
Rothery C, Claxton K, Palmer S, Epstein D, Tarricone R, Sculpher M. Characterising uncertainty in the assessment of medical devices and determining future research needs. Health Economics 2017;26(S1):109-123.
Claxton K, Palmer S, Longworth L, Bojke L, Griffin S, Soares M, Spackman E, Rothery C. A comprehensive algorithm for approval of health technologies with, without, or only in research: the key principles for informing coverage decisions. Value in Health 2016 http://www.valueinhealthjournal.com/article/S1098-3015(16)30289-3/abstract
McKenna C, Griffin S, Koffijberg H, Claxton K. Methods to place a value on additional evidence are illustrated using a case study of corticosteroids after traumatic brain injury. Journal of Clinical Epidemiology 2016 Feb;70:183-90. https://www.ncbi.nlm.nih.gov/pubmed/26388041
Claxton K, Griffin S, Koffijberg H, McKenna C. How to estimate the health benefits of additional research and changing clinical practice. British Medical Journal 2015; 351 http://www.bmj.com/content/351/bmj.h5987
McKenna C, Soares M, Claxton K, Bojke L, Griffin S, Palmer S, Spackman E. Unifying research and reimbursement decisions: Case studies demonstrating the sequence of assessment and judgments required. Value in Health 2015 18(6):865-75 https://www.ncbi.nlm.nih.gov/pubmed/26409615
Claxton K, Griffin S, Koffijberg H, McKenna C. Expected health benefits of additional evidence: Principles, methods and applications. CHE Research Paper 83. Centre for Health Economics, University of York.
Soares M.O., Dumville J.C., Ashby R.L., Iglesias C.P., Bojke L., Adderley U., McGinnis E., Stubbs N., Torgerson D.J., Claxton K., Cullum N. Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers. Medical Decision Making 2013 33(3):415-36 https://www.ncbi.nlm.nih.gov/pubmed/22927694
Longworth L., Youn J., Bojke L., Palmer S., Griffin S., Spackman E., Claxton K. When does NICE recommend the use of health technologies within a programme of evidence development? : a systematic review of NICE guidance. Pharmacoeconomics 2013 31(2):137-49 https://www.ncbi.nlm.nih.gov/pubmed/23329429
Claxton K, Palmer S, Longworth L, Bojke L, Griffin S, McKenna C, Soares M, Spackman E, Youn J. Informing a decision framework for when NICE should recommend the use of health technologies only in the context of an appropriately designed programme of evidence development. Health Technology Assessment 2012 16(46):1-323 https://www.ncbi.nlm.nih.gov/pubmed/23177626
Walker S, Sculpher M, Claxton K, Palmer S. Coverage with evidence development, only in research, risk sharing, or patient access scheme? A framework for coverage decisions. Value in Health 2012 15(3):570-9 https://www.ncbi.nlm.nih.gov/pubmed/22583469
McKenna C, Claxton K. Addressing adoption and research design decisions simultaneously: the role of value of sample information analysis. Medical Decision Making 2011 31(6):853-65 https://www.ncbi.nlm.nih.gov/pubmed/21393558
Griffin SC, Claxton KP, Palmer SJ, Sculpher MJ. Dangerous omissions: the consequences of ignoring decision uncertainty. Health Economics 2011 20(2):212-24 https://www.ncbi.nlm.nih.gov/pubmed/20091763