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Introduction
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Publications
Publications (164)
Testing high-risk populations for non-visible haematuria may enable earlier detection of bladder cancer, potentially decreasing mortality. This research aimed to assess the cost-effectiveness of urine dipstick screening for bladder cancer in high-risk populations in England.
A microsimulation model developed in R software was calibrated to national...
Background:
Considering the sequence of treatments is vital for optimising healthcare resource allocation, especially in cancer care, where sequence changes can affect patients’ overall survival and associated costs. A key challenge in evaluating treatment sequences in health technology assessments (HTA) is the scarce evidence on effectiveness, le...
Introduction
Smoking is harmful, and its cessation is recommended to prevent chronic kidney disease, which often begins with abnormal leakage of albumin in the urine, called albuminuria. Smoking cessation’s effect on albuminuria depends on the pack-years smoked, length of abstinence, body mass index (BMI) and glycosylated haemoglobin (HbA1c). Using...
BACKGROUND:
Comparing the cost-effectiveness of different treatments at a pre-specified line-of-therapy (LOT) has been the standard approach in health technology assessments. However, it has become increasingly crucial for decision makers to also consider the impact of treatment sequences due to rapidly evolving treatment paradigms. Several framewo...
Objectives
In 2016, it was announced that the fecal immunochemical test (FIT) would replace the guaiac fecal occult blood test in the UK Bowel Cancer Screening Programme. England has limited endoscopy capacity. This study informed decision making by determining the most cost-effective FIT screening strategy (age range, frequency, and FIT threshold)...
Glutaric aciduria type 1, homocystinuria, isovaleric acidaemia, long-chain hydroxyacyl CoA dehydrogenase deficiency and maple syrup urine disease are all inborn errors of metabolism that can be detected through newborn bloodspot screening. This evaluation was undertaken in 2013 to provide evidence to the UK National Screening Committee for the cost...
Background:
The University of Sheffield School of Health and Related Research (ScHARR) Bowel Cancer Screening Model has been used previously to make decisions about colorectal cancer screening strategies in England.
Objectives:
The objective of this study was to perform an external validation of the ScHARR model against long-term follow-up data...
Introduction
Uptake of screening for colorectal cancer (CRC) can reduce mortality, and population-based screening is offered in England. To date, there is little evidence on the association between having a long-term condition (LTC) and CRC screening uptake. The objective of this study was to examine the association between having an LTC and uptake...
ScHARR has been commissioned by the UK National Screening Committee (NSC) to consider the costeffectiveness and endoscopy capacity requirements of a variety of different screening options incorporating faecal immunochemical testing (FIT) and bowel scope (BS) within the Bowel Cancer Screening Programme (BCSP). An existing cost-effectiveness model wa...
Data S1. Methods
Data S2. Results
Table S1. Total costs, QALYs and incremental analysis per person in the general population comparing all strategies
Table S2. One‐way sensitivity analyses showing expected Net Benefit per individual in the general population (based on 2 million simulated individuals so baseline results differ slightly from Table...
Background Prevention of sexually transmitted infection (STI) incidence in England is a high priority, particularly among young people, men who have sex with men (MSM) and black ethnic minorities. An economic evaluation of condom distribution programmes (CDPs) to reduce STI transmission is presented. Methods An economic model using a Bernoulli proc...
Aim:
To analyse the cost-effectiveness of different interventions for Type 2 diabetes prevention. within a common framework METHODS: A micro-simulation model was developed to evaluate the cost-effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workpla...
Aims:
To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes targeting different at-risk population subgroups with a lifestyle intervention of varying intensity.
Methods:
An individual patient simulation model was constructed to simulate the development of diabetes in a representative sample of adults without diab...
Background
The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was the biggest ovarian cancer screening trial to date. A non-significant effect of screening on ovarian cancer was reported, but the authors noted a potential delayed effect of screening, and suggested the need for four years further follow-up. There are no UK-...
Background:
A conceptual modeling framework is a methodology that assists modelers through the process of developing a model structure. Public health interventions tend to operate in dynamically complex systems. Modeling public health interventions requires broader considerations than clinical ones. Inappropriately simple models may lead to poor v...
Background:
The primary colorectal cancer screening test in England is a guaiac faecal occult blood test (gFOBt). The NHS Bowel Cancer Screening Programme (BCSP) interprets tests on six samples on up to three test kits to determine a definitive positive or negative result. However, the test algorithm fails to achieve a definitive result for a sign...
Objectives:
To identify the key methodological challenges for public health economic modelling and set an agenda for future research.
Methods:
An iterative literature search identified papers describing methodological challenges for developing the structure of public health economic models. Additional multidisciplinary literature searches helped...
Background:
Novel epidemiology models are required to link correlated variables over time, especially haemoglobin A1c (HbA1c) and body mass index (BMI) for diabetes prevention policy analysis. This article develops an epidemiology model to correlate metabolic risk factor trajectories.
Method:
BMI, fasting plasma glucose, 2-h glucose, HbA1c, syst...
Aim:
To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes that target different at-risk population subgroups through lifestyle interventions of varying intensity.
Methods:
An individual patient simulation model simulated the development of diabetes in a representative sample of adults without diabetes from the U...
Type-2 diabetes is a complex disease with multiple risk factors and health consequences whose prevention is a major public health priority. We have developed a microsimulation model written in the R programming language that can evaluate the effectiveness and cost-effectiveness of a comprehensive range of different diabetes prevention interventions...
Background:
In many countries, screening for colorectal cancer (CRC) relies on repeat testing using the guaiac faecal occult blood test (gFOBT). This study aimed to compare gFOBT performance measures between initial and repeat screens.
Methods:
Data on screening uptake and outcomes from the English Bowel Cancer Screening Programme (BCSP) for the...
Objectives
The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future ex...
Health economic models have become the primary vehicle for undertaking economic evaluation and are used in various healthcare jurisdictions across the world to inform decisions about the use of new and existing health technologies. Models are required because a single source of evidence, such as a randomised controlled trial, is rarely sufficient t...
Our objective was to review modelling methods for type 2 diabetes mellitus prevention cost-effectiveness studies. The review was conducted to inform the design of a policy analysis model capable of assisting resource allocation decisions across a spectrum of prevention strategies. We identified recent systematic reviews of economic evaluations in d...
Patient and Public Involvement (PPI) helps to ensure that study findings are useful to end users but is under-developed in Health Technology Assessment (HTA). "INTEGRATE-HTA, (a co-funded European Union project -grant agreement 30614) is developing new methods to assess complex health technologies and applying these in a palliative care case study....
To assess the feasibility and value of simulating whole disease and treatment pathways within a single model to provide a common economic basis for informing resource allocation decisions.
A patient-level simulation model was developed with the intention of being capable of evaluating multiple topics within National Institute for Health and Clinica...
Background
Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the ta...
- Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target popu...
Objective:
Low socioeconomic status (SES) is a risk factor for type 2 diabetes and changes in diet and physical activity can prevent diabetes. We assessed the effectiveness and acceptability of community-based dietary and physical activity interventions among low-SES groups in the UK.
Method:
We searched relevant databases and web resources from...
The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the best new treatments reach patients in the clinic as quickly as possible. The journal reflects these aims. It was founded more than fifty years ago and, from the start, its far-sighted mission was to...
This article presents a methodological framework for developing health economic models of whole systems of disease and treatment pathways to inform decisions concerning resource allocation-an approach referred to as "Whole Disease Modeling." This system-level approach can provide a consistent mathematical infrastructure for the economic evaluation...
Objective:
To evaluate the financial consequences of using laparoscopic adjustable gastric banding (LAGB) in place of standard medical management (SMM) in obese patients with type 2 diabetes from a UK healthcare payer perspective.
Design and methods:
A budget impact model was constructed to evaluate the budgetary implications of LAGB in obese pa...
Health economic evaluation attempts to provide a rational and coherent framework to help policy makers to decide which health interventions to fund by comparing the differences in costs and outcomes between alternative options. Mathematical models are used to simplify complex realities; as such, there are always uncertainties associated with the mo...
The aim was to use newly available data to estimate the cost effectiveness and endoscopy requirements of screening options for colorectal cancer (CRC) to inform screening policy in England.
A state transition model simulated the life experience of a cohort of individuals in the general population of England with normal colon/rectal epithelium throu...
Compared with children and young people in the general population, looked-after children and young people (LACYP) are more likely to experience behavioural, physical and psychological problems. Consequently, LACYP are likely to have greater need of health and mental health services
to address any specific problems.. However, LACYP do not always hav...
Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55-74, with reflex faecal...
Healthcare resource allocation decisions are commonly informed by computer model predictions of population mean costs and health effects. Model averaging has been proposed as one method for accounting for uncertainty about the 'true' or 'best' model structure. An alternative is to consider uncertainty about the discrep-ancy between the model evalua...
This systematic review aimed to synthesize evidence on the effectiveness of transition support services (TSSs) that are delivered towards the end of care for looked-after young people (LAYP) on their adult outcomes, including education, employment, substance misuse, criminal and offending behaviour, parenthood, housing and homelessness and health....
Background and Objectives As well as guidance on clinical interventions, the National Institute for Health and Clinical Effectiveness (NICE) produces evidence-based public health guidance. The aim of this study was to explore the gap between the requirement for robust research evidence to support guidance development and the actual availability of...
Management options for colorectal cancer have expanded in recent years. We estimated average lifetime cost of care for colorectal cancer in Ireland in 2008, from the health care payer perspective.
A decision tree model was developed in Microsoft EXCEL. Site and stage-specific treatment pathways were constructed from guidelines and validated by expe...
Looked-after children and young people (LACYP) are recognized as a high-risk group for behavioural and emotional problems, and additional specialist training for foster carers may reduce such problems. This systematic review aimed to identify and synthesize evidence on the effectiveness of additional training and support provided to approved carers...
In 2008, the Department of Health made a referral to the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence to develop joint public health guidance on improving the physical and emotional health and well-being of children and young people looked after by the local authority/state. To help inform the d...
Designing cancer screening programmes requires an understanding of epidemiology, disease natural history and screening test characteristics. Many of these aspects of the decision problem are unobservable and data can only tell us about their joint uncertainty. A Metropolis-Hastings algorithm was used to calibrate a patient level simulation model of...
Cancer natural history models are essential when evaluating screening/preventative interventions or changes to diagnostic pathways. Natural history models commonly use a state transition structure, but it is often not possible to observe the state transition probabilities required for parameterization.
. The work aimed to accurately represent the u...
Bowel cancer is the second most common cancer in England and Wales, accounting for approximately 13,000 deaths per year. Economic evaluations and national guidance have been produced for individual treatments for bowel cancer. However, it has been suggested that Primary Care Trusts develop program budgeting or equivalent methodology demonstrating a...
This paper reports on a systematic review of the published literature on the effectiveness of whole-school behavioural interventions, which aim to promote emotional and social well-being among young people in secondary education. The findings are based on 27 studies of varying designs with some limitations. The results suggest that the literature i...
Christopher McCabe and colleagues examine the claims behind the decision not to reduce drug costs in the multiple sclerosis risk sharing scheme
Health policy decisions must be relevant, evidence-based and transparent. Decision-analytic modelling supports this process but its role is reliant on its credibility. Errors in mathematical decision models or simulation exercises are unavoidable but little attention has been paid to processes in model development. Numerous error avoidance/identifi...
Partial expected value of perfect information (EVPI) quantifies the value of removing uncertainty about unknown parameters in a decision model. EVPIs can be computed via Monte Carlo methods. An outer loop samples values of the parameters of interest, and an inner loop samples the remaining parameters from their conditional distribution. This nested...
The role of models in supporting health policy decisions is reliant on model credibility. Credibility is fundamentally determined by the choices and judgements that people make in the process of developing a model. However, the method of uncovering choices and making judgements in model development is largely unreported and is not addressed by mode...
Colorectal cancer includes cancerous growths in the colon, rectum and appendix and affects around 30 000 people in England each year. Maximizing health benefits for patients with colorectal cancer requires consideration of costs and outcomes across the whole service. In an era of scarce healthcare resources, there is a need to consider not only whe...
The aim of this study was to examine the availability and consistency of economic evidence for the detection, diagnosis, treatment, and follow-up of colorectal cancer.
A systematic review of UK economic evaluations of colorectal cancer interventions was undertaken. Searches were undertaken across ten electronic databases. Studies were critically ap...
The nurse scheduling problem (NSP) consists of generating a work schedule for nursing staff in a hospital. The approach presented in this paper considers a multi-objective NSP involving the nurses’ preferences. These preferences are modelled by fuzzy sets and aggregated to determine an overall preference cost function. The schedules are generated b...
This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of docetaxel for the adjuvant treatment of early node-positive breast cancer based upon the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) pr...
This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of docetaxel for the adjuvant treatment of early node-positive breast cancer based upon the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) pr...
This report addressed the question 'What is the clinical and cost-effectiveness of spinal cord stimulation (SCS) in the management of chronic neuropathic or ischaemic pain?'
Thirteen electronic databases [including MEDLINE (1950-2007), EMBASE (1980-2007) and the Cochrane Library (1991-2007)] were searched from inception; relevant journals were hand...
To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) for the management of multiple sclerosis (MS) compared to best supportive care in the United States.
Cost-effectiveness analysis was undertaken using a state transition model of disease natural history and the impact of DMTs for the representative Medicare beneficiary with MS....
Background: Risk sharing schemes represent an innovative and important approach to the problems of rationing and achieving cost-effectiveness in high cost or controversial health interventions. This study aimed to assess the feasibility of risk sharing schemes, looking at long term clinical outcomes, to determine the price at which high cost treatm...
To study the evidence on the efficacy and safety of ezetimibe monotherapy for the treatment of primary (heterozygous familial and non-familial) hypercholesterolaemia.
Systematic review and meta-analysis of randomized controlled trials (RCTs).
Eleven electronic bibliographic databases covering the biomedical, scientific and grey literature were sear...
To evaluate the cost effectiveness of long-term ezetimibe monotherapy in patients with established cardiovascular disease (CVD) who do not tolerate statins or in whom they are contraindicated.
A Markov model was used to estimate the potential costs and benefits associated with ezetimibe monotherapy compared with no treatment. The benefits associate...
Ezetimibe has been reported to improve lipid control in patients with established cardiovascular disease (CVD).
The aim of this study was to estimate the potential long-term impact on health status of prescribing ezetimibe in combination with statin therapy in patients with established CVD and evaluate its cost-effectiveness in a health economic mo...
A discrete event simulation (DES) model has been used to analyse options with the potential to facilitate a 7-day turn-around of cervical screening results in England, with the aim of reducing the anxiety experienced by the participants. Detailed information regarding the cervical screening process collected from the NHS Cancer Screening Programme,...
To review the clinical and cost-effectiveness of ezetimibe as a combination therapy or monotherapy for the treatment of primary hypercholesterolaemia in the UK.
Twelve electronic databases were searched from inception to June 2006. Searches were supplemented by hand-searching relevant articles, sponsor and other submissions of evidence to the Natio...
The objective of this study was to assess the cost-effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective.
Cost-effectiveness model.
Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05.
Women with two embryos available for transfer in...
A treatment pathway model was developed to examine the costs and benefits of the current bowel cancer service in England and to evaluate potential alternatives in service provision. To use the pathway model, various parameters and probability distributions had to be specified. They could not all be determined from empirical evidence and, instead, e...
