Seeking Scientific Health Information for Empowerment: Empowered-Get-More-Empowered Effects

To explore the scientific value of information elements in health news, this article reports on common information elements that are associated with scientific value, according to the findings of surveys conducted in the United States and Taiwan. The design of two further studies in Taiwan reflects an effort to understand whether scientific information elements benefit only health conscious people, through empowered-get-more-empowered effects. A survey-based analysis of perceptions and an experimental test of causal effects of information exposure reveal that health conscious people seek health information, value scientific information elements in it, are persuaded by them, and act on advice.

Individual differences in information-seeking

Vast amounts of personalized information are now available to individuals. A vital research challenge is to establish how people decide what information they wish to obtain. Here, over five studies examining information-seeking in different domains we show that information-seeking is associated with three diverse motives. Specifically, we find that participants assess whether information is useful in directing action, how it will make them feel, and whether it relates to concepts they think of often. We demonstrate that participants integrate these assessments into a calculation of the value of information that explains information seeking or its avoidance. Different individuals assign different weights to these three factors when seeking information. Using a longitudinal approach, we find that the relative weights assigned to these information-seeking motives within an individual show stability over time, and are related to mental health as assessed using a battery of psychopathology questionnaires.

Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

Background Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compared with standard care to detect AKI in hospitalised UK adults. Methods A 90-day decision tree and lifetime Markov cohort model predicted costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from a UK NHS perspective. Test accuracy was informed by a meta-analysis of diagnostic accuracy studies. Clinical trial and observational data informed the link between AKI and health outcomes, health state probabilities, costs and utilities. Value of information (VOI) analysis informed future research priorities. Results Under base case assumptions, the biomarker tests were not cost-effective with ICERs of £105,965 (NephroCheck), £539,041 (NGAL urine BioPorto), £633,846 (NGAL plasma BioPorto) and £725,061 (NGAL urine ARCHITECT) per QALY gained compared to standard care. Results were uncertain, due to limited trial data, with probabilities of cost-effectiveness at £20,000 per QALY ranging from 0 to 99% and 0 to 56% for NephroCheck and NGAL tests respectively. The expected value of perfect information (EVPI) was £66 M, which demonstrated that additional research to resolve decision uncertainty is worthwhile. Conclusions Current evidence is inadequate to support the cost-effectiveness of general use of biomarker tests. Future research evaluating the clinical and cost-effectiveness of test guided implementation of protective care bundles is necessary. Improving the evidence base around the impact of tests on AKI staging, and of AKI staging on clinical outcomes would have the greatest impact on reducing decision uncertainty.

Neurocomputational mechanisms underlying the subjective value of information

Humans have a striking desire to actively seek new information, even when it is devoid of any instrumental utility. However, the mechanisms that drive individuals’ subjective preference for information remain unclear. Here, we used fMRI to examine the processing of subjective information value, by having participants decide how much effort they were willing to trade-off for non-instrumental information. We showed that choices were best described by a model that accounted for: (1) the variability in individuals’ estimates of uncertainty, (2) their desire to reduce that uncertainty, and (3) their subjective preference for positively valenced information. Model-based analyses revealed the anterior cingulate as a key node that encodes the subjective value of information across multiple stages of decision-making – including when information was prospectively valued, and when the outcome was definitively delivered. These findings emphasise the multidimensionality of information value, and reveal the neurocomputational mechanisms underlying the variability in individuals’ desire to physically pursue informative outcomes.

Liothyronine for hypothyroidism: a candidate for disinvestment or in need of further research? A value of information analysis

ObjectiveMedicines with limited evidence of effectiveness are prime candidates for disinvestment. However, investment in further research may be preferable to deimplementation, given that the absence of evidence is not evidence of absence, and research can inform formulary decisions. A case in point is liothyronine, which is sometimes prescribed to levothyroxine-treated patients who continue to experience hypothyroid symptoms. It is a putative low value medicine, associated with uncertainties in both clinical and cost-effectiveness. The aim was to assess the cost-effectiveness of liothyronine in this context, and estimate the value of conducting further research.DesignCost utility and value of information analyses.SettingPrimary care within the National Health Service in the UK.ParticipantsFifty-four levothyroxine-treated patients with persistent symptoms of hypothyroidism.InterventionsLiothyronine plus levothyroxine versus levothyroxine alone.Primary and secondary outcome measuresIncremental cost per quality-adjusted life year (QALY) gained, and the expected monetary value of sample information.Results20/54 (37%) of patients who responded to the survey reported severe problems in carrying out usual activities of everyday living and 12/54 (22%) reported severe anxiety or depression symptoms. Mean (SD) utility was 0.53 (0.23). The differences in expected total, 10-year costs and QALYs between a treatment strategy of liothyronine/levothyroxine combination therapy, and levothyroxine alone, was £12 053 and 1.014, respectively. The incremental cost-effectiveness ratio of £11 881 per QALY gained was sensitive to the price of liothyronine. The probability of liothyronine/levothyroxine combination therapy being cost effective at a threshold of £20 000 per QALY was 0.56. The value of reducing uncertainty in the efficacy of treatment was £3.64 m per year in the UK.ConclusionsA definitive clinical trial to confirm clinical effectiveness may be preferable to immediate disinvestment, and would be justified given the value of the information gained far exceeds the cost.