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  • Jeshika Singh (a1) (a2) and Louise Longworth (a3)


Objectives: Our study addresses the important issue of estimating treatment costs from historical data. It is a problem frequently faced by health technology assessment analysts. We compared four approaches used to estimate current costs when good quality contemporary data are not available using liver transplantation as an example.

Methods: First, the total cost estimates extracted for patients from a cohort study, conducted in the 1990s, were inflated using a published inflation multiplier. Second, resource use estimates from the cohort study were extracted for hepatitis C patients and updated using current unit costs. Third, expert elicitation was carried out to identify changes in clinical practice over time and quantify current resource use. Fourth, routine data on resource use were obtained from National Health Service Blood and Transplant (NHSBT).

Results: The first two methods did not account for changes in clinical practice. Also the first was not specific to hepatitis patients. The use of experts confirmed significant changes in clinical practice. However, the quantification of resource use using experts is challenging as clinical specialists may not have a complete overview of clinical pathway. The NHSBT data are the most accurate reflection of transplantation and posttransplantation phase; however, data were not available for the whole pathway of care. The best estimate of total cost, combining NHSBT data and expert elicitation, is £121,211.

Discussion: Observational data from routine care are potentially the most reliable reflection of current resource use. Efforts should be made to make such data readily available and accessible to researchers. Expert elicitation provided reasonable estimates.



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1. DH. NHS Reference Costs 2012–2013. UK: Department of Health, 2013. (accessed July 21, 2017).
2. Sullivan, W, Payne, K. The appropriate elicitation of expert opinion in economic models. Pharmacoeconomics. 2011;29:455.
3. O'Hagan, A, Buck, EC, Daneshkhah, A. Uncertain judgements: Eliciting experts’ probabilities. New York: John Wiley & Sons; 2006.
4. Soares, MO, Bojke, L, Dumville, J, et al. Methods to elicit experts' beliefs over uncertain quantities: Application to a cost effectiveness transition model of negative pressure wound therapy for severe pressure ulceration. Stat Med. 2011;30:23632380.
5. Grieve, R, Roberts, J, Wright, M, et al. Cost effectiveness of interferon alpha or peginterferon alpha with raibavarin for histologically mild chronic hepatitis C. Gut. 2006;55:13321338.
6. Dakin, H, Bentley, A, Dusheiko, G. Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B. Value Health. 2010;13:922933.
7. Warren, E, Wright, A, Jones, B. Cost-effectiveness of telaprevir in patients with genotype 1 hepatitis C in Australia. Value Health. 2014;17:792800.
8. Crossan, C, Tsochatzis, EA, Longworth, L, et al. Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: Systematic review and economic evaluation. Health Technol Assess. 2015;19:1409.
9. Longworth, L, Young, T, Buxton, MJ, et al. Midterm Cost-effectiveness of the liver transplantation program of England and Wales for three disease groups. Liver Transpl. 2003;9:12951307.
10. BNF. British National Formulary: Number 38, September 1999. London: British Medical Association. Royal Pharmaceutical Society of Great Britain; 1999.
11. BNF. British National Formulary. 2014.
12. Stevenson, M, Lloyd-Jones, M, Morgan, MY, Wong, R. Non-invasive diagnostic assessment tools for the detection of liver fibrosis in patients with suspected alcohol-related liver disease: A systematic review and economic evaluation. Health Technol Assess. 2012;16:1174.
13. PSSRU. Unit costs of health & social care 2013. (accessed July 21, 2017).
14. Leal, J, Wordsworth, S, Legood, R, Blair, E. Eliciting expert opinion for economic models: An applied example. Value Health. 2007;10: 195203.


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