Thor-Henrik Brodtkorb

The long-term cost-effectiveness of fetal monitoring during labour : a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone

Objective  To assess the cost‐effectiveness of the use of cardiotocography (CTG) complemented with fetal electrocardiography and ST analysis compared with the use of CTG alone in term deliveries when a decision has been made to use fetal monitoring with a scalp electrode.

Value of information: interim analysis of a randomized, controlled trial of goal-directed hemodynamic treatment for aged patients

BackgroundA randomized, controlled trial, intended to include 460 patients, is currently studying peroperative goal-directed hemodynamic treatment (GDHT) of aged hip-fracture patients. Interim efficacy analysis performed on the first 100 patients was statistically uncertain; thus, the trial is continuing in accordance with the trial protocol. This raised the present investigation’s main question: Is it reasonable to continue to fund the trial to decrease uncertainty? To answer this question, a previously developed probabilistic cost-effectiveness model was used. That model depicts (1) a choice between routine fluid treatment and GDHT, given uncertainty of current evidence and (2) the monetary value of further data collection to decrease uncertainty. This monetary value, that is, the expected value of perfect information (EVPI), could be used to compare future research costs. Thus, the primary aim of the present investigation was to analyze EVPI of an ongoing trial with interim efficacy observed.MethodsA previously developed probabilistic decision analytic cost-effectiveness model was employed to compare the routine fluid treatment to GDHT. Results from the interim analysis, published trials, the meta-analysis, and the registry data were used as model inputs. EVPI was predicted using (1) combined uncertainty of model inputs; (2) threshold value of society’s willingness to pay for one, quality-adjusted life-year; and (3) estimated number of future patients exposed to choice between GDHT and routine fluid treatment during the expected lifetime of GDHT.ResultsIf a decision to use GDHT were based on cost-effectiveness, then the decision would have a substantial degree of uncertainty. Assuming a 5-year lifetime of GDHT in clinical practice, the number of patients who would be subject to future decisions was 30,400. EVPI per patient would be €204 at a €20,000 threshold value of society’s willingness to pay for one quality-adjusted life-year. Given a future population of 30,400 individuals, total EVPI would be €6.19 million.ConclusionsIf future trial costs are below EVPI, further data collection is potentially cost-effective. When applying a cost-effectiveness model, statements such as ‘further research is needed’ are replaced with ‘further research is cost-effective and ‘further funding of a trial is justified’.Trial registrationClinicalTrials.gov NCT01141894

Cost-effectiveness of clean air administered to the breathing zone in allergic asthma

Introduction:  Airsonett Airshower (AA) is a novel non‐pharmaceutical treatment for patients with perennial allergic asthma that uses a laminar airflow directed to the breathing zone of patients during sleep. It has been shown that AA treatment in addition to optimized standard therapy significantly increases asthma‐related quality of life among adolescent asthmatics. However, the cost‐effectiveness of AA treatment has not yet been assessed. As reimbursement decisions are increasingly guided by results from the cost‐effectiveness analysis, such information is valuable for health‐care policy‐makers.

Collaboration between academia, manufacturers and healthcare services for development and adoption of medical devices with regard to costs and effects

The market for new medical devices depends on evidence on effectiveness and cost-effectiveness as well as ethical criteria based on patients’ needs and severity of disease. HTA is therefore increasingly used to provide appraisals for decision makers. In comparison to pharmaceuticals, medical devices face difficulties in providing studies with high evidence. There are, however, new promising developments in health economics and in the systems for valuing evidence which may improve the possibility of quicker appraisal of medical devices. This development, comprising Bayesian modeling and revision of systems for grading evidence, may be used in an iterative procedure to anticipate the market potential and to contribute to finding an optimal time when the implementation of a new device is worthwhile. In such a system, researches, developers and manufacturers, and healthcare services should gain from strengthened collaboration.