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

摘要

>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$). >Results: All interventions were cost-effective, but with various levels of decision uncertainty. The currentevidence is sufficient to support the adoption of clinically indicated catheterreplacement. For the tissue adhesive, an additional study before adoption isworthwhile with a four-arm trial of 220 patients per arm. Additional research onNPWT 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 perarm. Based on the expected net monetary benefits, the studies were ranked asfollows: 1) NPWT (AU$1.2 million), 2) tissue adhesive (AU$0.3 milliion), and 3)nutritional support (AU$0.1 million). >Conclusions: VOI analysis isa useful and practical approach to inform adoption and research decisions.Efforts should be focused on facilitating its integration into decision makingframeworks.