Karl P Claxton

..measures of uncertainty should be used to present the results to decision makers; and (v) should formal methods be recommended to inform the assessment of the need for evidence and the consequences of an uncertain decision for the UK NHS?..

..Bayesian decision theory can provide a general methodological framework that can ensure consistency in decision making between service provision, research and development, and the design, conduct and interpretation clinical research...

..This case study also illustrates the need to account for any structural uncertainties appropriately...

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..Additionally, the analysis can be used to aid the efficient design of research. We discuss the implications of adoption of this new framework for regulatory and reimbursement decisions...

..Such comparisons do indeed have to be made, but this is not a consequence of the choice of any particular outcome measure, be it the QALY or anything else...

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..The case study presented considers whether long-term, low-dose antibacterial treatment of recurrent urinary tract infections (UTIs) in children is effective and cost effective compared with short-term antibacterial therapy...

..To evaluate alternative approaches taken to estimate the population that could benefit from research and to demonstrate that explicitly modeling future change leads to more appropriate estimates of the expected value of information (EVI)...

..To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients...

..The paper concludes by describing ongoing methodological work designed to meet the challenges of undertaking decision analysis for resource allocation in health care...

..These have been classified in a number of different ways but can be referred to collectively as structural uncertainties...

..Despite its achievements, there are concerns that the QOF may offer poor value for money...

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..To investigate the expected value of partial perfect information (EVPPI) and the research decisions it can address...

..Elicitation can be used to characterize structural uncertainty within a decision analytic model. This allows the value of acquiring further evidence to resolve these uncertainties to be established...

..In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them...

..Whatever view is taken, the OFT report will inevitably shape the scope of future policy debates about value, guidance, price and innovation...

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..Nor does it reflect the debate that underpinned the guidance. We therefore welcome the opportunity to explain more completely the rationale in the minds of the principal authors of the current guidance...

..It follows that, if health technology assessments are to be based on a correct analysis of all available data, then probabilistic methods must be used both for sensitivity analysis and for estimation of expected costs and benefits...

..It is argued that RCT evidence, with or without economic content, should be viewed as simply one of the sources of evidence, which must be placed in a broader framework of evidence synthesis and decision analysis...

..To conduct a Bayesian value-of-information analysis of the cost effectiveness of pentoxifylline (vs placebo) as an adjunct to compression for venous leg ulcers...

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..Within the article, the framework is applied to a policy decision regarding preoperative patient management before major elective surgery, for which trial data are available...

..Finally, some of the methodological challenges posed by the need fully to characterise decision uncertainty and to inform the research agenda will be identified and discussed...

..They apply this framework of analysis to a realistic and policy-relevant problem...

..However, decisions based solely on expected net benefit provide no such incentives, may undermine the evidence base for future clinical practice and reduce expected net health benefits for the patient population...

..The computational challenges are addressed by implementing optimization algorithms to search the ENBS surface more efficiently over such large dimensions...

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..Value-of-information analysis, a related methodology, helps to determine whether it is worthwhile to collect additional information as well as the type of research that would be most helpful...