Karin Groothuis-Oudshoorn

MO4 USING AHP WEIGHTS TO FILL MISSING GAPS IN MARKOV DECISION MODELS

OBJECTIVES: We propose to combine the versatility of the analytic hierarchy process (AHP) with the decision-analytic sophistication of health-economic modeling in a new methodology for early technology assessment. As an illustration, we apply this methodology to a new technology to diagnose breast cancer. METHODS: The AHP is a technique for multicriteria analysis, relatively new in the fi eld of technology assessment. It can integrate both quantitative and qualitative criteria in the assessment of alternative technologies. We applied the AHP to prioritize a more versatile set of outcome measures than most Markov models do. These outcome measures include clinical effectiveness and costs, but also weighted estimates of patient comfort and safety. Furthermore, as no clinical data are available for this technology yet, the AHP is applied to predict the performance of the new technology with regard to all these outcome measures. Results of the AHP are subsequently integrated in a Markov model to make an early assessment of the expected incremental cost-effectiveness of alternative technologies. RESULTS: We systematically estimated priors on the clinical effectiveness and wider impacts of the new technology using AHP. In our illustration, AHP estimates for sensitivity and specifi city of the new diagnostic technology were used as probability parameters in the Markov model. Moreover, the prioritized outcome measures including clinical effectiveness (weight = 0.61), patient comfort (weight = 0.09), and safety (weight = 0.30) were integrated into one outcome measure in the Markov model. CONCLUSIONS: Combining AHP and Markov modelling is particularly valuable in early technology assessment when evidence about the effectiveness of health care technology is still limited or missing. Moreover, combining these methods is valuable when decision makers are interested in other patient relevant outcomes measures besides the technology’s clinical effectiveness, and that may not (adequately or explicitly) be captured in mainstream utility measures.

The Use of Video Clips in Teleconsultation for Preschool Children With Movement Disorders

Purpose: To investigate the reliability and validity of video clips in assessing movement disorders in preschool children. Methods: The study group included 27 children with neuromotor concerns. The explorative validity group included children with motor problems (n = 21) or with typical development (n = 9). Hempel screening was used for live observation of the child, full recording, and short video clips. The explorative study tested the validity of the clinical classifications “typical” or “suspect.” Results: Agreement between live observation and the full recording was almost perfect; Agreement for the clinical classification “typical” or “suspect” was substantial. Agreement between the full recording and short video clips was substantial to moderate. The explorative validity study, based on short video clips and the presence of a neuromotor developmental disorder, showed substantial agreement. Conclusion: Hempel screening enables reliable and valid observation of video clips, but further research is necessary to demonstrate the predictive value.

Measuring public preferences for colorectal cancer screening using new genome-­‐based nanotechnologies

Objectives. Emerging developments in nanomedicine allow the development of genome-based technologies for unobtrusive and individualised screening for diseases such as colorectal cancer. An example is the nanopill that collects gastrointestinal fluid and screens DNA for tumour markers. The main objectives of this study were to measure patient preferences for a new form of screening and measure expected screening uptake compared to standard colorectal cancer screening. Methods. Data was collected through a discrete choice experiment among individuals aged between 50 and 74 years living in the Netherlands and the United Kingdom. A full-profile fractional factorial design with a balanced overlap was implemented. Fourteen random and two fixed choice-tasks with triplets and dual-none response were used. Through an extensive literature search following attributes were included: preparation, technique, sensitivity, specificity, complication rate and testing frequency. Data were analysed using Hierarchical Bayes analysis and a Multinomial Logit model. Results. Thirteen hundred fifty-six respondents completed the questionnaire, from which 884 (65%) passed the consistency test. Most preferred attributes were: technique (pill), sensitivity (100%), preparation (none), specificity (100%), complications (none) and interval (every 5 years). Nanopill was with an expected screening uptake of 46% the most preferred screening modality, followed by iFOBT (40%), colonoscopy (2%) and sigmoidoscopy (1%). Eleven percent would choose not to be screened. Sensitivity analysis showed that the nanopill should be at least 90% sensitive, 100% specific and have an interval of 5 years to be equally attractive as biennial iFOBT. Conclusions. Colorectal cancer (CRC) screening has been introduced in a number of countries using standard screening techniques. In 2013 a population-based CRC screening program with stool sampling will be implemented in the Netherlands. In the United Kingdom a population-based CRC screening program with iFOBT is already implemented. However, current developments in nanomedicine allow the development of new technologies for individualised screening. Expected benefits of genome-based nanotechnologies are improved screening adherence, earlier diagnosis and more accurate test results. Within the framework of early health technology assessment study results suggest the nanopill to be accepted by the public which does support further development. However, consequences of population-based direct-toconsumer genomic testing are unknown and needs to be studied further. Also hypothetical scenarios to describe the nanopill were used in the study and results do not guarantee public acceptance and screening uptake. Cost-benefit analysis and clinical trials remain mandatory.