Methods for the analysis of quality-of-life and survival data in health technology assessment.

Abstract

T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Methodology Panel and funded as project number 93/50/04. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Evidence-based medicine as Bayesian decision-making

“…There is a large literature on trading quality of life against survival, especially in diseases such as cancer, with developments such as the quality adjusted life year (QUALY) [12]. In drug regulation the concept of risk-beneÿt is essentially a utility trade-o , although it is rarely formally addressed.…”

An Educational Review of the Statistical Issues in Analysing Utility Data for Cost-Utility Analysis

“…These models are considerably more complex and, although they will report different results to a linear model, will only make a minimal difference to the results over short trial durations or if follow-up timepoints are close. Authors such as Billingham et al [25] have also investigated assumptions regarding changes over time and mortality using survival analysis and provided recommendations for calculating QALYs. The SF-36 was also administered to patients in the example trial at baseline and the last follow-up point (2 years).…”

Theorie der gesundheitlichen Risiken

“…Die Gesundheitsökonomie hat dazu interessante Beiträge geliefert, insbesondere die Entwicklung des Konzepts eines einheitlichen Maßes "QALY" (quality adjusted life years) zur vergleichenden Bewertung verschiedener Gesundheitsprobleme und -maßnahmen [9,10]. Der Ansatz hat sich aber trotz vieler Verbesserungen und Weiterentwicklungen sowie der Anwendung durch wichtige Gesundheitsinstanzen wie das National Institute for Health and Clinical Excellence (NICE, GB) noch nicht allgemein durchgesetzt.…”