title: Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers.
abstract: 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.
authors.affiliation: Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
authors.forename: Marta O
authors.initials: MO
authors.lastname: Soares
authors.affiliation: Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
authors.forename: Jo C
authors.initials: JC
authors.lastname: Dumville
authors.affiliation: Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Ashby
authors.affiliation: Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
authors.forename: Cynthia P
authors.initials: CP
authors.lastname: Iglesias
authors.affiliation: Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
authors.forename: Laura
authors.initials: L
authors.lastname: Bojke
authors.affiliation: School of Health and Social Care, Teesside University, Middlesbrough, UK (UA)
authors.forename: Una
authors.initials: U
authors.lastname: Adderley
authors.affiliation: Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds General Infirmary, Leeds, UK (EM)
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGinnis
authors.affiliation: NHS Leeds Community Healthcare, St Mary’s Hospital, Leeds, UK (NS)
authors.forename: Nikki
authors.initials: N
authors.lastname: Stubbs
authors.affiliation: Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
authors.forename: David J
authors.initials: DJ
authors.lastname: Torgerson
authors.affiliation: Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK (NC).
authors.forename: Nicky
authors.initials: N
authors.lastname: Cullum
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D003668:Pressure Ulcer / Q000628:therapy*