Hostname: page-component-7d8f8d645b-2q4x6 Total loading time: 0 Render date: 2023-05-27T02:11:39.823Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false

Priority setting for research in health care: An application of value of information analysis to glycoprotein IIb/IIIa antagonists in non-ST elevation acute coronary syndrome

Published online by Cambridge University Press:  09 August 2006

Zoë Philips
University of Nottingham
Karl Philip Claxton
University of York
Stephen Palmer
University of York
Laura Bojke
University of York
Mark John Sculpher
University of York


Abstract: The purpose of this study is to explain the rationale for the value of information approach to priority setting for research and to describe the methods intuitively for those familiar with basic decision analytical modeling. A policy-relevant case study is used to show the feasibility of the method and to illustrate the type of output that is generated and how these might be used to frame research recommendations. The case study relates to the use of glycoprotein IIb/IIIa antagonists for the treatment of patients with non-ST elevation acute coronary syndrome. This is an area that recently has been appraised by the National Institute for Health and Clinical Excellence.

© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Ades A, Lu G, Claxton K. 2004 Expected value of sample information calculations in medical decision modeling. Med Decis Making. 24: 207227.Google Scholar
Boersma E, Harrington RA, Moliterno DJ, et al. 2002 Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: A meta analysis of all major randomised controlled trials. Lancet. 359: 189198.Google Scholar
Briggs A, Goeree R, Blackhouse G, O'Brien BJ. 2002 Probabilistic analysis of cost-effectiveness models: Choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making. 22: 290308.Google Scholar
Brown N, Young T, Gray D, Skene AM, Hampton JR. 1997 Inpatient deaths from acute myocardial infarction, 1982-92: Analysis of data in the Nottingham heart attach register. BMJ. 315: 159164.Google Scholar
Buxton MHS. 1997. Assessing payback from Department of Health Research and Development: Second report. Research Report 24. Uxbridge: Brunel University. London Health Economics Research Group;
Centers for Medicare and Medicaid Services. 2005. Health care financing review. Medicare and Medicaid statistical supplement. Baltimore: Centers for Medicare and Medicaid Services;
Chilcott J, Brennan A, Booth A, Karnon J, Tappenden P. 2003 The role of modelling in prioritising and planning clinical trials. Health Technol Assess. 7: 1125.Google Scholar
Claxton K. 1999 The irrelevance of inference: A decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 18: 341364.Google Scholar
Claxton K, Neumann P, Araki SS, Weinstein MC. 1999 The efficient design of clinical trials: An application to the evaluation of treatment strategies for Alzheimers disease (abstract). Med Decis Making. 19: 521.Google Scholar
Claxton K, Posnett J. 1996 An economic approach to clinical trial design and research priority setting. Health Econ. 5: 513524.Google Scholar
Claxton K, Sculpher M, Drummond M. 2002 A rational framework for decision making by the National Institute for Clinical Excellence (NICE). Lancet. 360: 711715.Google Scholar
Claxton K, Fenwick E, Sculpher M, et al. Decision making with uncertainty. In: Jones A, ed. 2006. Companion to health economics. Northampton, MA: Edward Elgar;
Claxton K, Thompson K. 2001 Dynamic programming approach to efficient clinical trial design. J Health Econ. 20: 432448.Google Scholar
CURE, The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. 22001 Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 345: 494502.
Davies LDM, Papanikolaou P. 2000 Prioritizing investments in health technology assessment. Int J Technol Assess Health Care. 16: 7391.Google Scholar
Department of Health. 1995. Policy appraisal and health. London: Department of Health;
Felli J, Hazen G. 1998 Sensitivity analysis and the expected value of perfect information. Med Decis Making. 18: 95109.Google Scholar
Fenwick E, Claxton K, Sculpher M. 2004. The value of implementation and the value of information: Combined and uneven development. Atlanta: Society for Medical Decision Making;
Fenwick E, Claxton K, Sculpher M. 2005. The value of implementation and the value of information: Combined and uneven development. Oxford: Health Economists' Study Group;
Fenwick E, Claxton K, Sculpher M, Briggs A. 2000. Improving the efficiency and relevance of health technology assessment: The role of iterative decision analytic modelling. Discussion Paper 179. York: University of York, Centre for Health Economics;
Fischer A, Frankish R, Taylor R. Clinical and cost effectiveness of glycoprotein IIb/IIIa inhibitors in association with Percutaneous Coronary Intervention (PCI). Appraisals Groups, National Institute for Clinical Excellence (NICE), September 2000. A report commissioned by the NHS R&D HTA Programme on behalf of the National Institute for Clinical Excellence (NICE).
Fleurence R, Torgerson D. 2004 Setting priorities for research. Health Policy. 69: 110.Google Scholar
Gray D, Keating N, Murdock J, Skene AM, Hampton JR. 1993 Impact of hospital thrombolysis policy on out-of-hospital response to suspected myocardial infarction. Lancet. 341: 654657.Google Scholar
Hammitt JK, Cave J. Research planning for food safety: A value of information approach. RAND Report 1991.
Hjelmgren J, Berggren F, Andersson F. 2001 Health economic guidelines–similarities, differences and some implications. Value Health. 4: 225250.Google Scholar
Howard R. 1966 Information value theory. IEEE Trans Syst Sci Cybernet. SSC2: 122126.Google Scholar
Johannesson M, Weinstein M. 1993 On the decision rules of cost-effectiveness analysis. J Health Econ. 12: 459467.Google Scholar
Karlsson G, Johannesson M. 1996 The decision rules of cost-effectiveness analysis. Pharmacoeconomics. 9: 113120.Google Scholar
McDonaugh M, Bachmann L, Golder S, et al. 2000 A rapid and systematic review of the clinical effectiveness and cost effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina. Health Technol Assess. 4 (30).Google Scholar
Michaud CM, Murray C, Bloom BR. 2001 Burden of disease–implications for future research. JAMA. 285: 535539.Google Scholar
National Statistics. 2003. Health spending up. London: National Statistics;
National Statistics. National Statistics Office. 2002. Mid 2000 estimates for UK population. Available at:
NICE. 2002. Technology Appraisal Guidance - No 47. Guidance on the use of Glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes. London: National Institute for Clinical Excellence;
Palmer S, Sculpher M, Philips Z, et al. 2005 Management of non-ST-elevation acute coronary syndromes: How cost-effective are glycoprotein IIb/IIIa antagonists in the UK National Health Service? Int J Cardiol. 100: 229240.Google Scholar
Phelps C, Parente S. 1990 Priority setting in medical technology and medical practice assessment. Med Care. 28: 703723.Google Scholar
Pratt J, Raiffa H, Schlaiffer R. 1995. Statistical decision theory. Cambridge MA: MIT Press;
Pritchard C. 1998. Trends in economic evaluation. OHE Briefing no. 36. London: Office of Health Economics;
Raiffa H. 1968. Decision analysis: Introductory lectures on choices under uncertainty. New York: Addison-Wesley;
Raiffa H, Schlaifer R. 1959. Probability and statistics for business decisions. New York: McGraw-Hill;
Robinson M, Ginnelly L, Sculpher M, et al. 2002 A systematic review update of the clinical effectiveness and cost effectiveness of glycoprotein IIb/IIIa antagonists. Health Technol Assess. 6: 1160.Google Scholar
Robinson M, Palmer S, Sculpher M, et al. 2005 A. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: Systematic review and decision-analytical modelling. Health Technol Assess. 9: 1158.Google Scholar
Rosenberg LE. 2002 Exceptional economic returns on investments in medical research. Med J Aust. 177: 368371.Google Scholar
Stinnett A, Mullahy J. 1998 Net health benefits: A new framework for the analysis of uncertainty in cost-effectiveness analyses. Med Decis Making. 18: S68S80.Google Scholar
Thompson KM, Evans J. 1997 The value of improved national exposure information for perchloroethylene (perc): A case study for dry cleaners. Risk Anal. 17: 253271.Google Scholar
Townsend J, Buxton M. 1997 Cost-effectiveness scenario analysis for a proposed trial of hormone replacement therapy. Health Policy. 39: 181194.Google Scholar
Weinstein M. 2004. From cost-effectiveness ratios to resource allocation: Where to draw the line? In: Sloan F, ed. Valuing health care: Costs, benefits and effectiveness of pharmaceuticals and other medical technologies. New York: Cambridge University Press;
Yakota F, Thompson K. 2004 Value of information literature analysis: A review of applications in health risk management. Med Decis Making. 24: 287298.Google Scholar