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  • 1
    Online Resource
    Online Resource
    Estimating changes in overall survival using progression-free survival in metastatic breast and colorectal cancer
    Cambridge University Press (CUP) ; 2011
    In:  International Journal of Technology Assessment in Health Care Vol. 27, No. 3 ( 2011-07), p. 207-214
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 27, No. 3 ( 2011-07), p. 207-214
    Abstract: Objectives: In clinical trials of new cancer drugs, reliable data for progression-free survival will often become available far sooner than reliable data for overall survival. The aim of this study was to determine how many months it would be expected that any given new drug for metastatic breast or colorectal cancer will add to overall survival times given that the number of months the drug adds to progression-free survival times relative to a standard drug is roughly already known. Methods: A literature search was conducted over Medline for randomized controlled trials (RCTs) published between January 1980 and August 2008 that assessed the effect of a drug treatment in comparison to an alternative drug treatment on patients with either metastatic breast or metastatic colorectal cancer. Results: The literature search found 95 and 74 RCTs for metastatic breast and colorectal cancer, respectively, that satisfied the study's inclusion criteria. The results from these trials are consistent, in the case of each of these two metastatic cancers, with gains in time to disease progression being generally associated with no gains or with very slight gains or losses in post-progression survival (i.e., the time between disease progression and death). Conclusions: It would appear that drugs for metastatic breast or colorectal cancer that extend, by a given amount, the time period between the start of treatment and disease progression (i.e., time to progression) have a strong tendency to extend, by roughly the same amount, the period between the start of treatment and death (i.e., overall survival).
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462311000201
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2011
    detail.hit.zdb_id: 2020486-3
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  • 2
    Online Resource
    Online Resource
    Integrating health economics modeling in the product development cycle of medical devices: A Bayesian approach
    Cambridge University Press (CUP) ; 2008
    In:  International Journal of Technology Assessment in Health Care Vol. 24, No. 04 ( 2008-10), p. 459-464
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 24, No. 04 ( 2008-10), p. 459-464
    Abstract: Objectives: Medical device companies are under growing pressure to provide health-economic evaluations of their products. Cost-effectiveness analyses are commonly undertaken as a one-off exercise at the late stage of development of new technologies; however, the benefits of an iterative use of economic evaluation during the development process of new products have been acknowledged in the literature. Furthermore, the use of Bayesian methods within health technology assessment has been shown to be of particular value in the dynamic framework of technology appraisal when new information becomes available in the life cycle of technologies. Methods: In this study, we set out a methodology to adapt these methods for their application to directly support investment decisions in a commercial setting from early stages of the development of new medical devices. Results and Conclusions: Starting with relatively simple analysis from the very early development phase and proceeding to greater depth of analysis at later stages, a Bayesian approach facilitates the incorporation of all available evidence and would help companies to make better informed choices at each decision point.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462308080604
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2008
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  • 3
    Online Resource
    Online Resource
    CLINICAL TRIALS A Place for Randomization in the Interval Between the End of Recruitment and Availability of Results
    Cambridge University Press (CUP) ; 2000
    In:  International Journal of Technology Assessment in Health Care Vol. 16, No. 04 ( 2000-10), p. 1210-1213
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 16, No. 04 ( 2000-10), p. 1210-1213
    Type of Medium: Online Resource
    ISSN: 0266-4623
    URL: Article
    DOI: 10.1017/S0266462300103241
    Language: Unknown
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2000
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  • 4
    Online Resource
    Online Resource
    Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
    Cambridge University Press (CUP) ; 2007
    In:  International Journal of Technology Assessment in Health Care Vol. 23, No. 2 ( 2007-04), p. 269-277
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 23, No. 2 ( 2007-04), p. 269-277
    Abstract: Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (∼.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462307070365
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2007
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  • 5
    Online Resource
    Online Resource
    HEADROOM BEYOND THE QUALITY- ADJUSTED LIFE-YEAR: THE CASE OF COMPLEX PEDIATRIC NEUROLOGY
    Cambridge University Press (CUP) ; 2017
    In:  International Journal of Technology Assessment in Health Care Vol. 33, No. 1 ( 2017), p. 5-10
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 33, No. 1 ( 2017), p. 5-10
    Abstract: Objectives: The headroom method was introduced for the very early evaluation of the potential value of new technologies. It allows for establishing a ceiling price for technologies to still be cost-effective by combining the maximum effect a technology might yield, the maximum willingness-to-pay (WTP) for this effect, and potential downstream expenses and savings. Although the headroom method is QALY-based, not all innovations are expected to result in QALY gain. Methods: This study explores the feasibility and usefulness of the headroom method in the evaluation of technologies that are unlikely to result in QALY gain. This will be illustrated with the diagnostic trajectory of complex pediatric neurology (CPN). Results: Our headroom analysis showed a large room for improvement in the current diagnostic trajectory of CPN in terms of diagnostic yield. Combining this with a maximum WTP value for an additional diagnosis and the potential downstream expenses and savings, resulted in a total headroom of €15,028. This indicates that a new technology in this particular diagnostic trajectory, might be cost-effective as long as its costs do not exceed €15,028. Conclusions: The headroom method seems a useful tool in the very early evaluation of medical technologies, also in cases when immediate QALY gain is unlikely. It allows for allocating healthcare resources to those technologies that are most promising. It should be kept in mind, however, that the headroom assumes an optimistic scenario, and for that reason cannot guarantee future cost-effectiveness. It might be most useful for ruling out those technologies that are unlikely to be cost-effective.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462317000046
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2017
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  • 6
    Online Resource
    Online Resource
    Evaluating New Treatments and Diagnostic Technologies in Obstetrics: Practical Problems, Ethics, and Solutions
    Cambridge University Press (CUP) ; 1989
    In:  International Journal of Technology Assessment in Health Care Vol. 5, No. 3 ( 1989-07), p. 459-472
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 5, No. 3 ( 1989-07), p. 459-472
    Abstract: This article develops arguments for the use of decision theory, rather than intuition, to determine the size of trials. It is wrong to expect doctors to ignore personal preferences in favor of clinical experiments unless the trial is capable of showing differences in treatment effect that would influence clinical practice substantially. It follows from our analysis that if delta (the treatment effect that the trial is designed to detect) is sufficient to alter clinical practice, then the alpha and beta errors of a trial should be equal. This applies even if a new treatment is to be compared with conventional therapy or if a treatment with high “costs” is compared with a less invasive or more inexpensive method.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462300007510
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1989
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