Haitham W. Tuffaha

Value of information analysis in healthcare: a review of principles and applications

Abstract Background: Economic evaluations are increasingly utilized to inform decisions in healthcare; however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies. Scope: The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented. Findings: Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges. Conclusion: There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.

Clinical pharmacy services in the outpatient pediatric oncology clinics at a comprehensive cancer center

Background There is a need to expand clinical pharmacy services to cover the ambulatory pediatric cancer patients. There is a paucity of published literature describing pharmacy services in this setting. Objective To describe the development, implementation and the reported interventions of a clinical pharmacy service in the outpatient pediatric hematology–oncology clinics at a comprehensive cancer center in Jordan. Methods A stepwise approach was followed to develop and implement the described service. Four goals were set for the service comprising (1) ensure safe medication use (2) improve patient and caregiver education (3) enhance efficiency in medication distribution (4) facilitate the continuity of care across the inpatient and outpatient settings. The interventions collected were categorized into four major classes: clarification, safety, therapeutic and education. Results A total of 939 interventions were reported. Safety interventions were the highest with 500 (53%), followed by education 247 (26%), clarification 113 (12%) and therapeutic 79 (9%). The most common single interventions were patient counseling 247 (26%) and chemotherapy evaluation 229 (24%). Less frequent interventions were drug interactions and adverse drug reactions with 10 (1%) each. Conclusion Developing pediatric hematology–oncology clinical pharmacy services to cover the outpatient setting is essential to ensure continuity of care and to optimize therapeutics.

Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds

BACKGROUND Obese women undergoing cesarean section are at increased risk of postoperative infection. There is growing interest in negative pressure wound therapy (NPWT) to prevent closed surgical incision complications including surgical site infection; however, the evidence on the effectiveness and cost-effectiveness of this technology is limited. The objective of this study was to evaluate the cost-effectiveness of NPWT compared with that of standard dressing in preventing surgical site infection in obese women undergoing elective cesarean section based on current evidence and to estimate the value and optimal design of additional research to study this technology. METHODS The analysis was from the perspective of Queensland Health, Australia, using a decision model. Parameters were obtained from the published literature, a pilot clinical trial, and expert opinion. Monte Carlo simulation was performed to calculate the net monetary benefit, characterize decision uncertainty, and estimate the value of additional research. Comparing the expected monetary benefits and costs of alternative trial sample sizes informed the optimal future study design. RESULTS The incremental net monetary benefit of NPWT was Australian dollars 70, indicating that NPWT is cost-effective compared with that of standard dressing. The probability of NPWT being cost-effective was 65%. The estimated value of additional research to resolve decision uncertainty would be Australian dollars 2.7 million. The optimal sample size of a future trial investigating the relative effectiveness of NPWT would be 200 patients per arm. CONCLUSIONS Based on the current evidence, NPWT is cost-effective; however, there is high uncertainty surrounding the decision to adopt this technology. Additional research is worthwhile before implementation.

Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia

To evaluate the cost‐effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low‐risk patients into active surveillance (AS).

Quetiapine safety in older adults: a systematic literature review.

Quetiapine is a second‐generation antipsychotic that is commonly prescribed for a range of approved and off‐label indications in older adults. However, little is known about its safety in this population. The available evidence on quetiapine safety is based on studies on second‐generation antipsychotics as a group, often in the general population and for approved indications. There are no systematic reviews on the safety of quetiapine in older adults, and therefore, there is a need for systematically assessing quetiapine safety in this group of patients to establish an appropriate safety profile for this vulnerable population. The aim of this paper was to review and describe adverse drug events associated with quetiapine use in older adults.

Novel technologies can provide effective dressing and securement for peripheral arterial catheters: A pilot randomised controlled trial in the operating theatre and the intensive care unit

BACKGROUND Peripheral arterial catheters are widely used in the care of intensive care patients for continuous blood pressure monitoring and blood sampling, yet failure - from dislodgement, accidental removal, and complications of phlebitis, pain, occlusion and infection - is common. While appropriate methods of dressing and securement are required to reduce these complications that cause failure, few studies have been conducted in this area. OBJECTIVES To determine initial effectiveness of one dressing and two securement methods versus usual care, in minimising failure in peripheral arterial catheters. Feasibility objectives were considered successful if 90/120 patients (75%) received the study intervention and protocol correctly, and had ease and satisfaction scores for the study dressing and securement devices of ≥ 7 on Numerical Rating Scale scores 1-10. METHODS In this single-site, four-arm, parallel, pilot randomised controlled trial, patients with arterial catheters, inserted in the operating theatre and admitted to the intensive care unit postoperatively, were randomly assigned to either one of the three treatment groups (bordered polyurethane dressing (n=30); a sutureless securement device (n=31); tissue adhesive (n=32)), or a control group (usual practice polyurethane dressing (not bordered) (n=30)). RESULTS One hundred and twenty-three patients completed the trial. The primary outcome of catheter failure was 2/32 (6.3%) for tissue adhesive, 4/30 (13.3%) for bordered polyurethane, 5/31 (16.1%) for the sutureless securement device, and 6/30 (20%) for the control usual care polyurethane. Feasibility criteria were fulfilled. Cost analysis suggested that tissue adhesive was the most cost effective. CONCLUSIONS The pilot trial showed that the novel technologies were at least as effective as the present method of a polyurethane dressing for dressing and securement of arterial catheters, and may be cost effective. The trial also provided evidence that a larger, multicentre trial would be feasible.

Value of information analysis in oncology: the value of evidence and evidence of value.

PURPOSE Value of information (VOI) analysis is a novel systematic approach for assessing whether there is sufficient evidence to support regulatory approval of new technologies, estimating the value of additional research, informing trial design, and setting research priorities. This article reviews the use of VOI methods in oncology and identifies the potential applications of VOI in this field. METHODS A systematic literature search was undertaken to identify studies explicitly reporting VOI analyses for interventions directed at cancer management. Articles published from 2000 onward addressing prevention, screening, diagnosis, treatment, or symptom management in oncology were selected. RESULTS A total of 35 articles were included in the review; most were published after 2006. The main cancers addressed were breast (n = 10; 29%), prostate (n = 5; 14%), lung (n = 5; 14%), and colorectal (n = 3; 9%). The VOI analyses were of an applied nature in 31 studies (89%). In the applied studies, VOI was used to characterize decision uncertainty in all studies and to inform future research focus in 16 (52%). Additionally, one article (3%) addressed the value of optimal trial design, and one article (3%) reported the use of VOI methods to prioritize research. CONCLUSION The application of VOI analysis in oncology is growing but remains limited. Benefits in oncology research and practice will potentially be optimized with an increase in the application of VOI methods to inform decision making, optimal trial design, and research prioritization in this field.

Value of Information Analysis Informing Adoption and Research Decisions in a Portfolio of Health Care Interventions

Background: Value of information (VOI) analysis quantifies the value of additional research in reducing decision uncertainty. It addresses adoption and research decisions simultaneously by comparing the expected benefits and costs of research studies. Nevertheless, the application of this approach in practice remains limited. Objectives: To apply VOI analysis in health care interventions to guide adoption decisions, optimize trial design, and prioritize research. Methods: The analysis was from the perspective of Queensland Health, Australia. It included four interventions: clinically indicated catheter replacement, tissue adhesive for securing catheters, negative pressure wound therapy (NPWT) in caesarean sections, and nutritional support for preventing pressure ulcers. For each intervention, cost-effectiveness analysis was performed, decision uncertainty characterized, and VOI calculated using Monte Carlo simulations. The benefits and costs of additional research were considered together with the costs and consequences of acting now versus waiting for more information. All values are reported in 2014 Australian dollars (AU

Value of information analysis optimizing future trial design from a pilot study on catheter securement devices.

). Results: All interventions were cost-effective, but with various levels of decision uncertainty. The current evidence is sufficient to support the adoption of clinically indicated catheter replacement. For the tissue adhesive, an additional study before adoption is worthwhile with a four-arm trial of 220 patients per arm. Additional research on NPWT before adoption is worthwhile with a two-arm trial of 200 patients per arm. Nutritional support should be adopted with a two-arm trial of 1200 patients per arm. Based on the expected net monetary benefits, the studies were ranked as follows: 1) NPWT (AU

Glucarpidase rescue in a patient with high-dose methotrexate-induced nephrotoxicity

1.2 million), 2) tissue adhesive (AU