IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v26y2006i5p480-496.html
   My bibliography  Save this article

An Iterative Bayesian Approach to Health Technology Assessment: Application to a Policy of Preoperative Optimization for Patients Undergoing Major Elective Surgery

Author

Listed:
  • Elisabeth Fenwick

    (Department of Economics and Related Studies, University of York, York, United Kingdom, Centre for Health Economics, University of York, e.fenwick@clinmed.gla.ac.uk)

  • Steve Palmer

    (Centre for Health Economics, University of York)

  • Karl Claxton

    (Department of Economics and Related Studies, University of York, York, United Kingdom, Centre for Health Economics, University of York)

  • Mark Sculpher

    (Centre for Health Economics, University of York)

  • Keith Abrams

    (Department of Health Sciences, University of Leicester, Leicester, United Kingdom)

  • Alex Sutton

    (Department of Health Sciences, University of Leicester, Leicester, United Kingdom)

Abstract

Purpose . This article presents an iterative framework for managing the dynamic process of health technology assessment. The framework uses Bayesian statistical decision theory and value of information (VOI) analysis to inform decision making regarding appropriate patient management and to direct future research effort over the lifetime of a technology. 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. Method . The evidence available prior to the trial is used to determine the appropriate method of patient management and to ascertain whether, at the time of commissioning, the trial was potentially worthwhile. The prior information is then updated with the trial data via a Bayesian analysis using informative priors. This post trial information set is then used to reassess the appropriate method for patient management and to determine whether there is a requirement for any further research. Results . Prior to the trial, preoperative optimization with dopexamine is identified as the appropriate method of patient management. The results of the VOI analysis suggest that a short-term trial was potentially worthwhile (population expected value of perfect information [EVPI] = £48 million). Following the trial, the uncertainty surrounding the choice of appropriate patient management and the potential worth of further research had increased (population EVPI = £67 million). Conclusions . The article demonstrates the value and practicality of applying the iterative framework to the dynamic process of health technology assessment. It is only by formally incorporating all of the information available to decision makers, through informed priors, that the appropriate decisions can be made.

Suggested Citation

  • Elisabeth Fenwick & Steve Palmer & Karl Claxton & Mark Sculpher & Keith Abrams & Alex Sutton, 2006. "An Iterative Bayesian Approach to Health Technology Assessment: Application to a Policy of Preoperative Optimization for Patients Undergoing Major Elective Surgery," Medical Decision Making, , vol. 26(5), pages 480-496, September.
  • Handle: RePEc:sae:medema:v:26:y:2006:i:5:p:480-496
    DOI: 10.1177/0272989X06290493
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X06290493
    Download Restriction: no

    File URL: https://libkey.io/10.1177/0272989X06290493?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Maarten Ijzerman & Lotte Steuten, 2011. "Early assessment of medical technologies to inform product development and market access," Applied Health Economics and Health Policy, Springer, vol. 9(5), pages 331-347, September.
    2. Wang, Yi & Rattanavipapong, Waranya & Teerawattananon, Yot, 2021. "Using health technology assessment to set priority, inform target product profiles, and design clinical study for health innovation," Technological Forecasting and Social Change, Elsevier, vol. 172(C).
    3. Stefano Conti & Karl Claxton, 2008. "Dimensions of design space: a decision-theoretic approach to optimal research design," Working Papers 038cherp, Centre for Health Economics, University of York.
    4. Laura McCullagh & Cathal Walsh & Michael Barry, 2012. "Value-of-Information Analysis to Reduce Decision Uncertainty Associated with the Choice of Thromboprophylaxis after Total Hip Replacement in the Irish Healthcare Setting," PharmacoEconomics, Springer, vol. 30(10), pages 941-959, October.
    5. Fasterholdt, Iben & Krahn, Murray & Kidholm, Kristian & Yderstræde, Knud Bonnet & Pedersen, Kjeld Møller, 2017. "Review of early assessment models of innovative medical technologies," Health Policy, Elsevier, vol. 121(8), pages 870-879.
    6. Arthur E. Attema & Anna K. Lugnér & Talitha L. Feenstra, 2010. "Investment in antiviral drugs: a real options approach," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1240-1254, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:26:y:2006:i:5:p:480-496. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.