Value of Information Analysis Applications in Healthcare Interventions

Abstract

Background Decisions on adopting new healthcare interventions should be supported by the best available evidence on their safety, effectiveness and cost-effectiveness. Evidence is never certain and so is any decision based on that evidence. This uncertainty may lead to suboptimal decisions with costly consequences. Collecting more information may reduce uncertainty; however, there is a cost for additional research. Value of information (VOI) analysis is a systematic approach to quantify the value of research in reducing decision uncertainty. It compares the marginal research benefits and marginal costs to inform whether additional research is worthwhile. Furthermore, research studies can be designed and prioritised to optimise the net benefits from additional research. Despite its value, the use of VOI analysis in practice is limited. Objectives To apply VOI analysis in a group of real-world healthcare interventions to guide implementation decisions, and optimise research design and research priorities. Methods All analyses were conducted from the perspective of Queensland Health, the public provider of healthcare in Queensland, Australia. Four interventions were evaluated: clinicallyindicated peripheral intravenous catheter replacement, tissue adhesive for securing arterial catheters, negative pressure wound therapy (NPWT) in caesarean sections, and nutritional support in preventing pressure ulcers in high-risk patients. For each intervention, an economic evaluation was performed, decision uncertainty characterised, and VOI measures calculated using Monte Carlo simulations. The benefits and costs of additional research were considered together with the costs and consequences of implementing the intervention now versus ii waiting for more information. The optimal trial design is the one that maximises the expected net research benefit. Finally, the future research studies were ranked according to their expected net monetary benefits. Results All interventions were cost-effective, but with various levels of decision uncertainty. Negligible uncertainty in the clinically-indicated catheter replacement intervention suggested that current evidence is sufficient for implementation. For the tissue adhesive intervention, an additional research study before implementation is worthwhile with a four-arm trial of 220 patients in each arm, collecting data on its cost and efficacy compared to other securement devices. Additional research on NPWT before implementation is also worthwhile with a twoarm trial of 200 patients per arm, investigating the relative effectiveness of NPWT for preventing surgical site infections in caesarean section patients compared with standard dressings. Nutritional support should be implemented concurrently with a two-arm trial of 1,200 patients in each arm, evaluating the relative effectiveness of nutritional support in preventing pressure ulcers compared with standard hospital diet. Based on their expected net monetary benefits, the future studies would be ranked as: 1) NPWT (AUD 1.2 million), 2) tissue adhesive (AUD 0.3 million), and 3) nutritional support (AUD 0.1 million). Conclusion VOI analysis is a useful and practical tool to inform decisions, optimise trial design and prioritise research studies. Efforts should be focused on promoting the use of this approach and facilitating its integration into decision making frameworks.