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10. Cost-Effectiveness of HBV and HCV Screening Strategies – A Systematic Review of Existing Modelling Techniques

Author

Geue, Claudia, Wu, Olivia, Xin, Yiqiao, Heggie, Robert, Hutchinson, Sharon, Martin, Natasha K, Fenwick, Elisabeth, and Goldberg, David

Subjects
Economics, Biomedical and Clinical Sciences, Applied Economics, Hepatitis - C, Prevention, Emerging Infectious Diseases, Clinical Research, Health Services, Digestive Diseases, Liver Disease, Cost Effectiveness Research, Infectious Diseases, Chronic Liver Disease and Cirrhosis, Comparative Effectiveness Research, HIV/AIDS, Hepatitis, Hepatitis - B, 4.2 Evaluation of markers and technologies, 8.2 Health and welfare economics, Aetiology, Detection, screening and diagnosis, 2.5 Research design and methodologies (aetiology), Health and social care services research, Infection, Good Health and Well Being, Costs and Cost Analysis, Hepacivirus, Hepatitis B, Hepatitis B virus, Hepatitis C, Humans, Mass Screening, Models, Economic, Consortium, ECDC, General Science & Technology
Abstract

IntroductionStudies evaluating the cost-effectiveness of screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are generally heterogeneous in terms of risk groups, settings, screening intervention, outcomes and the economic modelling framework. It is therefore difficult to compare cost-effectiveness results between studies. This systematic review aims to summarise and critically assess existing economic models for HBV and HCV in order to identify the main methodological differences in modelling approaches.MethodsA structured search strategy was developed and a systematic review carried out. A critical assessment of the decision-analytic models was carried out according to the guidelines and framework developed for assessment of decision-analytic models in Health Technology Assessment of health care interventions.ResultsThe overall approach to analysing the cost-effectiveness of screening strategies was found to be broadly consistent for HBV and HCV. However, modelling parameters and related structure differed between models, producing different results. More recent publications performed better against a performance matrix, evaluating model components and methodology.ConclusionWhen assessing screening strategies for HBV and HCV infection, the focus should be on more recent studies, which applied the latest treatment regimes, test methods and had better and more complete data on which to base their models. In addition to parameter selection and associated assumptions, careful consideration of dynamic versus static modelling is recommended. Future research may want to focus on these methodological issues. In addition, the ability to evaluate screening strategies for multiple infectious diseases, (HCV and HIV at the same time) might prove important for decision makers.

Published
2015

34. The Value of Implementation and the Value of Information: Combined and Uneven Development

Author

Fenwick, Elisabeth, Claxton, Karl, and Sculpher, Mark

Subjects
Medical care, Cost of -- Analysis -- Research -- Technology application, Health care industry -- Technology application -- Research -- Analysis, Health, Health care industry, Technology application, Analysis, Research
Abstract

Byline: Elisabeth Fenwick, PhD (Public Health and Health Policy, University of Glasgow, Glasgow, UK, e.fenwick@clinmed.gla.ac.uk); Karl Claxton, PhD (Department of Economics and Related Studies, Centre for Health Economics University of [...]

Published
2008
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37. An iterative Bayesian approach to health technology assessment: application to a policy of preoperative optimization for patients undergoing major elective surgery

Author

Fenwick, Elisabeth, Palmer, Steve, Claxton, Karl, Sculpher, Mark, Abrams, Keith, and Sutton, Alex

Subjects
Bayesian statistical decision theory -- Usage -- Analysis, Medical informatics -- Management -- Analysis -- Usage, Decision-making -- Analysis -- Usage, Health, Company business management, Management, Analysis, Usage
Abstract

Purpose. This article presents an iterative framework for managing the dynamic process of health technology assessment. The framework uses Bayesian statistical decision theory and value of information (VOI) analysis to [...]

Published
2006

44. The Authorsʼ Reply

Author

OʼHagan, Anthony, McCabe, Christopher, Akehurst, Ron, Brennan, Alan, Briggs, Andrew, Claxton, Karl, Fenwick, Elisabeth, Fryback, Dennis, Sculpher, Mark, Spiegelhalter, David, and Willan, Andrew

Published
2005

48. Impact of metabolic comorbidity on the association between body mass index and health-related quality of life: a Scotland-wide cross-sectional study of 5,608 participants

Author

Ul-Haq Zia, Mackay Daniel F, Fenwick Elisabeth, and Pell Jill P

Subjects
Body mass index, Health-related quality of life, Obesity, Overweight, SF-12, Utility, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The prevalence of obesity is rising in Scotland and globally. Overall, obesity is associated with increased morbidity, mortality and reduced health-related quality of life. Studies suggest that "healthy obesity" (obesity without metabolic comorbidity) may not be associated with morbidity or mortality. Its impact on health-related quality of life is unknown. Methods We extracted data from the Scottish Health Survey on self-reported health-related quality of life, body mass index (BMI), demographic information and comorbidity. SF-12 responses were converted into an overall health utility score. Linear regression analyses were used to explore the association between BMI and health utility, stratified by the presence or absence of metabolic comorbidity (diabetes, hypertension, hypercholesterolemia or cardiovascular disease), and adjusted for potential confounders (age, sex and deprivation quintile). Results Of the 5,608 individuals, 3,744 (66.8%) were either overweight or obese and 921 (16.4%) had metabolic comorbidity. There was an inverted U-shaped relationship whereby health utility was highest among overweight individuals and fell with increasing BMI. There was a significant interaction with metabolic comorbidity (p = 0.007). Individuals with metabolic comorbidty had lower utility scores and a steeper decline in utility with increasing BMI (morbidly obese, adjusted coefficient: -0.064, 95% CI -0.115, -0.012, p = 0.015 for metabolic comorbidity versus -0.042, 95% CI -0.067, -0.018, p = 0.001 for no metabolic comorbidity). Conclusions The adverse impact of obesity on health-related quality of life is greater among individuals with metabolic comorbidity. However, increased BMI is associated with reduced health-related quality of life even in the absence of metabolic comorbidity, casting doubt on the notion of "healthy obesity".

Published
2012
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50. Cost-effectiveness acceptability curves in the dock: case not proven?

Author

Fenwick, Elisabeth and Briggs, Andrew

Subjects
Medical care, Cost of -- Analysis -- Methods, Decision-making -- Methods -- Analysis, Health, Analysis, Methods
Abstract

The article in this issue by Groot Koerkamp and others (1) discusses the limitations of cost-effectiveness acceptability curves (CEACs) for presenting uncertainty in cost-effectiveness analysis to policy makers and urges [...]

Published
2007

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