PMC34 BIBLIOGRAPHIC REVIEW OF DISCRETE EVENTS SIMULATION STUDIES IN HEALTH TECHNOLOGY EVALUATION

AbstractObjectivesIndirect comparisons via a common comparator (anchored comparisons) are commonly used in health technology assessment. However, common comparators may not be available, or the comparison may be biased due to differences in effect modifiers between the included studies. Recently proposed population adjustment methods aim to adjust for differences between study populations in the situation where individual patient data are available from at least one study, but not all studies. They can also be used when there is no common comparator or for single-arm studies (unanchored comparisons). We aim to characterise the use of population adjustment methods in technology appraisals (TAs) submitted to the United Kingdom National Institute for Health and Care Excellence (NICE).MethodsWe reviewed NICE TAs published between 01/01/2010 and 20/04/2018.ResultsPopulation adjustment methods were used in 7 percent (18/268) of TAs. Most applications used unanchored comparisons (89 percent, 16/18), and were in oncology (83 percent, 15/18). Methods used included matching-adjusted indirect comparisons (89 percent, 16/18) and simulated treatment comparisons (17 percent, 3/18). Covariates were included based on: availability, expert opinion, effective sample size, statistical significance, or cross-validation. Larger treatment networks were commonplace (56 percent, 10/18), but current methods cannot account for this. Appraisal committees received results of population-adjusted analyses with caution and typically looked for greater cost effectiveness to minimise decision risk.ConclusionsPopulation adjustment methods are becoming increasingly common in NICE TAs, although their impact on decisions has been limited to date. Further research is needed to improve upon current methods, and to investigate their properties in simulation studies.

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VP57 Using Capital Bids For Hospital-Based Health Technology Assessment

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319003209 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 89-89

Author(s):

Jamie Erskine ◽

Anastasia Chalkidou

Keyword(s):

State Of The Art ◽

Health Technology ◽

Technology Evaluation ◽

Imaging Technology ◽

Total Cost ◽

X Ray ◽

Paediatric Hospital ◽

Horizon Scanning ◽

Made In ◽

New Facilities

IntroductionThe Evelina London Children's Hospital (ELCH) is undergoing a period of growth, including a new building planned to be completed within the next five years. Due to limited space and ambitions to be a state-of-the-art hospital, Horizon Scanning (HS) was considered important to ‘future-proof’ new facilities. As the aim of HS is to identify signals of coming change, ‘scanning’ the previous five years’ trends may be beneficial to an iterative HS methodology. Thus, it was thought that capital bids could provide a range of useful information required to make procurement decisions.MethodsKing's Technology Evaluation Centre (KiTEC) provided hospital-based HTA and HS support for the expansion of a London-based paediatric hospital. KiTEC focused on imaging technology due to its large spatial requirements and high-costs and assessed all capital bids made over the previous five years. A capital bidding system is used within GSTT to allocate funding for medical equipment that costs more than GBP5000 (USD 6540.70). Information was collated for all imaging equipment bid for over the previous five years and assessed for trends in imaging modalities and purchase costs.ResultsA total of 135 bids were made in the period 2013-2018, eight of which were by ECLH. Bids for ultrasound equipment were most common and rose over the period. Bids for CT scanners also rose, while bids for MRI scanners and x-ray technology were consistent and bids for fluoroscopy fell. The total cost of imaging bids over the interval rose steadily from GBP5.4 million to GBP6.9 million.ConclusionsDue to the lifespan of imaging technology, some trends may not emerge within a five year window. While some interesting findings were made, a ten to fifteen year period may require to be scanned for a robust analysis. This methodology is best applied in an iterative fashion along with standard HS techniques.

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