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3. Modifying the Composite Time Trade-Off Method to Improve Its Discriminatory Power

Author

Jakubczyk, M, Lipman, Stefan, Roudijk, Bram, Norman, Richard, Pullenayegum, E, Yang, Yaling, Yan Gu, Ning, Stolk, Elly, Jakubczyk, M, Lipman, Stefan, Roudijk, Bram, Norman, Richard, Pullenayegum, E, Yang, Yaling, Yan Gu, Ning, and Stolk, Elly

Abstract

Objectives: In cost-effectiveness analysis of health technologies, health state utilities are needed. They are often elicited with a composite time trade-off (cTTO) method, particularly for the widely used EQ-5D-5L. Unfortunately, cTTO discriminatory power is hindered by (1) respondents’ nontrading (NT) of time for quality, (2) censoring of utilities at 21, and (3) poor correlation of negative utilities with state severity. We investigated whether modifying cTTO can mitigate these effects. Methods: We interviewed online 478 students (February to April, 2021) who each valued the same 10 EQ-5D-5L health states in 1 of 3 arms. Arm A used a standard cTTO, expanded with 2 questions to explore reasons for NT and censoring. Arms B and C used a time trade-off with modified alternatives offered to overcome loss aversion, to unify the tasks for positive and negative utilities, and to enable eliciting utilities , 21. Results: In arms B and C, we observed less NT than in A (respectively, 4% and 4% vs 10%), more strictly negative utilities (38% and 40% vs 25%), and more utilities # 21 (18% and 30% vs 10%). The average utility of state 55555 dropped to 22.15 and 22.52 from 20.53. Enabling finer trades in arm A reduced NT by 70%. Arms B and C yielded an intuitive association between negative utilities and state severity. These arms were considered more difficult and resulted in more inconsistencies. Conclusions: The discriminatory power of cTTO can be improved, but it may require increasing the difficulty of the task. The standard cTTO may overestimate the utilities, especially of severe states.

Published
2023

10. P503 Early TNF-antagonist maintenance therapy results in better outcomes than immunomodulators in paediatric Crohn’s disease: A multi-centre prospective cohort study

Author

Schneider, R, primary, Jacobson, K, additional, Huynh, H, additional, Mack, D, additional, Deslandres, C, additional, deBruyn, J, additional, El-Matary, W, additional, Otley, A, additional, Lawrence, S, additional, Wine, E, additional, Sherlock, M, additional, Critch, J, additional, Jantchou, P, additional, Rashid, M, additional, Carroll, M, additional, Bax, K, additional, Seidman, E, additional, Benchimol, E, additional, Ricciuto, A, additional, Wu, A, additional, Pullenayegum, E, additional, Walters, T, additional, Nguyen, G, additional, Griffiths, A, additional, and Church, P, additional

Published
2022
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15. Severity of Neonatal Respiratory Distress and Future Lung Function in Children with Primary Ciliary Dyskinesia

Author

Wee, W.B., primary, Sullivan, K.M., additional, Sawras, M.G., additional, Leigh, M.W., additional, Davis, S.D., additional, Pullenayegum, E., additional, Ferkol, T.W., additional, Knowles, M.R., additional, Milla, C.E., additional, Rosenfeld, M., additional, Sagel, S.D., additional, Zariwala, M.A., additional, and Dell, S.D.M., additional

Published
2021
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20. United States Valuation of EQ-5D-5L Health States Using an International Protocol

Author

Pickard, A.S. (Simon), Law, E.H., Jiang, R.X., Pullenayegum, E., Shaw, J.W., Xie, F., Oppe, M., Boye, K.S., Chapman, R.H., Gong, C.L., Balch, A., Busschbach, J.J. (Jan) van, Pickard, A.S. (Simon), Law, E.H., Jiang, R.X., Pullenayegum, E., Shaw, J.W., Xie, F., Oppe, M., Boye, K.S., Chapman, R.H., Gong, C.L., Balch, A., and Busschbach, J.J. (Jan) van

Abstract

Objective To derive a US-based value set for the EQ-5D-5L questionnaire using an international, standardized protocol developed by the EuroQol Group. Methods Respondents from the US adult population were quota-sampled on the basis of age, sex, ethnicity, and race. Trained interviewers guided participants in completing composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks using the EuroQol Valuation Technology software and routine quality control measures. Data were modeled using a Tobit model for cTTO data, a mixed logit model for DCE data, and a hybrid model that combined cTTO and DCE data. Model performance was compared on the basis of logical ordering of coefficients, statistical significance, parsimony, and theoretical considerations. Results Of 1134 respondents, 1062, 1099, and 1102 respondents provided useable cTTO, DCE, and cTTO or DCE responses, respectively, on the basis of quality control criteria and interviewer judgment. Respondent demographic characteristics and health status were similar to the 2015 US Census. The Tobit model was selected as the preferred model to generate the value set. Values ranged from −0.573 (55 555) to 1 (11 111), with 20% of all predicted health states scores less than 0 (ie, worse than dead). Conclusions A societal value set for the EQ-5D-5L was developed that can be used for economic evaluations and decision making in US health systems. The internationally established, standardized protocol used to develop this US-based value set was recommended by the EuroQol Group and can facilitate cross-country comparisons.

Published
2019
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22. Response to Rubanovich et al.

Author

Hayeems, R. Z., primary, Luca, S., additional, Ungar, W. J., additional, Bhatt, A., additional, Chad, L., additional, Pullenayegum, E., additional, and Meyn, M. S., additional

Published
2019
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24. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

Author

Ahmed, RJ, Gafni, A, Hutton, EK, Hu, ZJ, Pullenayegum, E, von Dadelszen, P, Rey, E, Ross, S, Asztalos, E, Murphy, KE, Menzies, J, Sanchez, JJ, Ganzevoort, W, Helewa, M, Lee, SK, Lee, T, Logan, AG, Moutquin, J-M, Singer, J, Thornton, JG, Welch, R, Magee, LA, and CHIPS Trial Collaborative Group

Abstract

The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.

Published
2016

29. Prophylactic antibiotic regimens in tumour surgery (PARITY):a pilot multicentre randomised controlled trial

Author

Ghert, M., Bhandari, M., Deheshi, B., Guyatt, G., Holt, G., O'Shea, T., Randall, R. L., Thabane, L., Wunder, J., Evaniew, N., McKay, P., Schneider, P., Turcotte, R., Madden, K., Scott, T., Sprague, S., Simunovic, N., Swinton, M., Racano, A., Heels-Ansdell, D., Buckingham, L., Rose, P., Brigman, B., Pullenayegum, E., Mckay, P., Sobhi, G., Chan, R., Biljan, M., Ferguson, P., Griffin, A., Mantas, I., Wylie, A., Han, A., Grewal, G., Goulding, K., Dandachli, F., Matte, G., Werier, J., Abdelbary, H., Paquin, K., Cosgrove, H., Dugal, A-M., Jutte, P., Ploegmakers, J. J. W., Stevens, M., Ghert, M., Bhandari, M., Deheshi, B., Guyatt, G., Holt, G., O'Shea, T., Randall, R. L., Thabane, L., Wunder, J., Evaniew, N., McKay, P., Schneider, P., Turcotte, R., Madden, K., Scott, T., Sprague, S., Simunovic, N., Swinton, M., Racano, A., Heels-Ansdell, D., Buckingham, L., Rose, P., Brigman, B., Pullenayegum, E., Mckay, P., Sobhi, G., Chan, R., Biljan, M., Ferguson, P., Griffin, A., Mantas, I., Wylie, A., Han, A., Grewal, G., Goulding, K., Dandachli, F., Matte, G., Werier, J., Abdelbary, H., Paquin, K., Cosgrove, H., Dugal, A-M., Jutte, P., Ploegmakers, J. J. W., and Stevens, M.

Abstract

ObjectiveClinical studies of patients with bone sarcomas have been challenged by insufficient numbers at individual centres to draw valid conclusions. Our objective was to assess the feasibility of conducting a definitive multi-centre randomised controlled trial (RCT) to determine whether a five-day regimen of post-operative antibiotics, in comparison to a 24-hour regimen, decreases surgical site infections in patients undergoing endoprosthetic reconstruction for lower extremity primary bone tumours.MethodsWe performed a pilot international multi-centre RCT. We used central randomisation to conceal treatment allocation and sham antibiotics to blind participants, surgeons, and data collectors. We determined feasibility by measuring patient enrolment, completeness of follow-up, and protocol deviations for the antibiotic regimens.ResultsWe screened 96 patients and enrolled 60 participants (44 men and 16 women) across 21 sites from four countries over 24 months (mean 2.13 participants per site per year, standard deviation 2.14). One participant was lost to follow-up and one withdrew consent. Complete data were obtained for 98% of eligible patients at two weeks, 83% at six months, and 73% at one year (the remainder with partial data or pending queries). In total, 18 participants missed at least one dose of antibiotics or placebo post-operatively, but 93% of all postoperative doses were administered per protocol.ConclusionsIt is feasible to conduct a definitive multi-centre RCT of post-operative antibiotic regimens in patients with bone sarcomas, but further expansion of our collaborative network will be critical. We have demonstrated an ability to coordinate in multiple countries, enrol participants, maintain protocol adherence, and minimise losses to follow-up.

Published
2015

33. ABSTRACT 38

Author

Choong, K., primary, Fraser, D.J., additional, Hutchison, J., additional, Joffe, A., additional, Jouvet, P., additional, Menon, K., additional, Pullenayegum, E., additional, and Ward, R., additional

Published
2014
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43. Estimating the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis

Author

Hopkins, R. B., primary, Tarride, J. E., additional, Leslie, W. D., additional, Metge, C., additional, Lix, L. M., additional, Morin, S., additional, Finlayson, G., additional, Azimaee, M., additional, Pullenayegum, E., additional, Goeree, R., additional, Adachi, J. D., additional, Papaioannou, A., additional, and Thabane, L., additional

Published
2012
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