3 results
Using discrete-choice experiments to elicit preferences for digital wearable health technology for self-management of chronic kidney disease
- Vijay S Gc, Cynthia P Iglesias, Seda Erdem, Lamiece Hassan, Niels Peek, Andrea Manca
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 26 October 2022, e77
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Objectives
Wearable digital health technologies (DHTs) have the potential to improve chronic kidney disease (CKD) management through patient engagement. This study aimed to investigate and elicit preferences of individuals with CKD toward wearable DHTs designed to support self-management of their condition.
MethodsUsing the results of our review of the published literature and after conducting qualitative patient interviews, five-choice attributes were identified and included in a discrete-choice experiment. The design consisted of 10-choice tasks, each comprising two hypothetical technologies and one opt-out scenario. We collected data from 113 adult patients with CKD stages 3–5 not on dialysis and analyzed their responses via a latent class model to explore preference heterogeneity.
ResultsTwo patient segments were identified. In all preference segments, the most important attributes were the device appearance, format, and type of information provided. Patients within the largest preference class (70 percent) favored information provided in any format except the audio, while individuals in the other class preferred information in text format. In terms of the style of engagement with the device, both classes wanted a device that provides options rather than telling them what to do.
ConclusionsOur analysis indicates that user preferences differ between patient subgroups, supporting the case for offering a different design of the device for different patients’ strata, thus moving away from a one-size-fits-all service provision. Furthermore, we showed how to leverage the information from user preferences early in the R&D process to inform and support the provision of nuanced person-centered wearable DHTs.
Systematic reviews and economic evaluations conducted for the National Institute for Health and Clinical Excellence in the United Kingdom: A game of two halves?
- Michael F. Drummond, Cynthia P. Iglesias, Nicola J. Cooper
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 24 / Issue 2 / April 2008
- Published online by Cambridge University Press:
- 09 April 2008, pp. 146-150
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Background: Decision analytic models, as used in economic evaluations, require data on several clinical parameters. The gold standard approach is to conduct a systematic review of the relevant clinical literature, although reviews of economic evaluations indicate that this is rarely done. Technology appraisals for the National Institute for Health and Clinical Excellence (NICE), which are fully funded, represent the best case scenario for the close integration of economic evaluations and systematic reviews. The objective of this study was to assess the extent to which the systematic review of the clinical literature informs the economic evaluation in NICE technology appraisals.
Methods: All NICE technology assessment reports (TARs) published between January 2003 and July 2006 were considered. Data were abstracted on the TAR topics, the primary measure of clinical effectiveness, the approach to pooling in the clinical review, the measure of economic benefit and the use, or non-use, of the systematic review in the economic evaluation.
Results: Forty-one TARs were published in the period studied, all of which contained a systematic review. Most of the economic evaluations (85 percent) were cost-utility analyses, reflecting NICE's guidelines for economic evaluation. In seventeen cases, the clinical data were not pooled in the review, owing to heterogeneity in the clinical data or the limited number of studies. In these cases, the economists used alternative approaches for estimating the key effectiveness parameter in the model. The results of the review (when pooled) were always used when the primary clinical effectiveness measure corresponded with the measure of economic benefit (e.g., survival). However, because preference-based quality of life measures are rarely included in clinical trials, the results of the systematic review were never directly used in the cost-utility analyses. Nevertheless, the outputs of the systematic review were used when the data were useful in estimating components of the quality-adjusted life-year (QALY) (e.g., the life-years gained, or the frequencies of health states to which QALYs could be assigned). Problems occurred mainly when the clinical data were not pooled, or when the measure of clinical benefit could not be converted into health states to which QALYs could be assigned.
Conclusions: Economic evaluations can benefit from systematic reviews of the clinical literature. However, such reviews are not a panacea for conducting a good economic evaluation. Much of the relevant data for estimating QALYs are not contained in such reviews and the chosen method for summarizing the clinical data may inhibit the assessment of economic benefit. Problems would be reduced if those undertaking the technology assessments discussed the data requirements for the economic model at an early stage.
Health-care decision-making processes in Latin America: Problems and prospects for the use of economic evaluation
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Cynthia P. Iglesias, Michael F. Drummond, Joan Rovira, for the NEVALAT Project Group
NEVALAT Project Group: Fernando Antoñanzas, Spain; SOIKOS and Universidad de la Rioja. Gabriel Carrasquilla, Colombia, Fundacion FES. Gerry Crosbie, UK, Office for Health Economics. Michael Drummond, UK. Centre for Health Economics, University of York. Ana María Galvez, Cuba; Escuela Nacional de Salud Pública. Martha González, Nicaragua; Centro de Investigaciones y Estudios de la Salud (CIES). Marino Gonzalez, Venezuela; Universidad Simón Bolívar. Carlos Gouveia Pinto, Portugal; Centro de Investigaciones Sobre Economia Portuguesa. Patricia Hernández, Mexico; World Health Organization. Cynthia Iglesias, UK; Centre for Health Economics/Department of Health Sciences, University of York. Luis Lazarov, Uruguay; Centro de Investigaciones Economicas (CINVE). Kely Rely, Mexico, Secretaria de Salud Pública. Joan Rovira, Spain; SOIKOS and Universidad de Barcelona. Adolfo Rubinstein, Argentina; Hospital Italiano. César Sanabria, Peru; Universidad Nacional Mayor de San Marcos, Adrian Towse, UK, Office for Health Economics. This report was prepared as part of Work Package 5 for the Thematic Network on the Economic Evaluation of Healthcare Programmes and its Applications to Decision Making in Latin American Countries (NEVALAT). Funded by the European Union. We would like to thank Lisa Matter and Sue Golder for conducting the electronic searches. -
- Journal:
- International Journal of Technology Assessment in Health Care / Volume 21 / Issue 1 / January 2005
- Published online by Cambridge University Press:
- 02 March 2005, pp. 1-14
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Objectives: The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA.
Methods: A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward.
Results: There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest.
Conclusions: To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate “evidence-based” approaches such as EE.