Value of Information: An Innovative Approach to Prioritizing Comparative Effectiveness Research

On September 29, 2010, Ava John-Baptiste made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (750 KB). Free PowerPoint® Viewer (Plugin Software Help).

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Value of Information: An innovative approach to prioritizing comparative effectiveness research

AHRQ Annual Meeting
September 29, 2010

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Organizers & Presenters

• William Lawrence, MD, MS
• Joanna E. Siegel, RN, SM, SD
• Ava John-Baptiste, PhD
• David O. Meltzer, MD, PhD
• Gillian D. Sanders, PhD

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Session Overview

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Session Goals

• Outline the theoretical basis of VOI.
• Describe use of VOI.
• Discuss barriers to applying VOI.
• Consider possible solutions.
• Present AHRQ funded VOI research.

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Research

• Can improve health care decision making
  • ... at a cost

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Prioritizing Research

• Research topics:
  • Span a variety of conditions
  • Pertain to a variety of populations and subgroups
  • Prevention, diagnosis and treatment
  • Drugs, devices, procedures or strategies

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How can research funding organizations systematically target investments in research where the impact of reducing the uncertainties in decisions will have the greatest benefits?

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Topic

• For diabetic patients, what is the effectiveness of between visit patient outreach compared to standard patient care on adherence to therapy?

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Topic

• What is the comparative effectiveness of typical and atypical antipsychotics for schizophrenia, bipolar disorder and other disorders?

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Topic

• What is the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass grafting for coronary artery disease?

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AHRQ Priority Setting Criteria

• Appropriateness
• Importance:
  • Disease burden
  • Cost
  • Stakeholder support
  • Uncertainty/controversy
• Desirability of new research
• Feasibility
• Potential value

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Value of Information

• A measure of the value of acquiring more information to better inform a health care decision
• ... based on an estimate of the foregone benefit of making the wrong decision.

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Value of Information

• Health care decisions are uncertain.
• We choose what we believe is the best option.
• With more information we may choose a different option.

Value of Information = p _{Wrong Decision} x Expected Value _{Wrong Decision}

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VOI Components

1. Decision with two or more options.
2. A model relating the expected value of each option to uncertain parameters.
3. A method of calculation.

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Expected Value

Model
Parameters + Uncertainty leads to: Value of Information = _{Wrong Decision} x Expected Value _{Wrong Decision}
 

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Opportunities

• Encourages structured decision making
• Potential to increase transparency
• Can quantify research benefits relative to:
  • Potential to reduce uncertainty
  • Impact on decision making
  • Cost

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Challenges

• Complex models are resource intensive.
• Simple models may exclude important elements of expected value.
• Estimating uncertainty can be difficult.

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Questions?

Comments?