Instructions: This course work is in two sections:
Section A)
A critical of a paper: Maximum word count is 1,250 words
Section B) Development of a Modelling plan + outline model structure: Maximum word count is 1,250 words + copy of an outline model structure.
BOTH sections must be completed. The total maximum word count for this course work is 2,500 words + copy of an outline model structure.
You have been provided with a suggested template which you can use to complete Section A and B.
A short scenario has been given to enable you to complete the course work (i will uploed it)
Section A:
Produce a maximum 1,250 word report detailing a critical health economics appraisal of the Nguyen and Bernstein paper (i will be uploaded) using an appropriate critical appraisal tool/framework.
This should include:
• A succinct critical appraisal of the paper including strengths and limitations.
• The gaps in this analysis which could be addressed by adapting or undertaking a new health economic analysis using a decision analytical model.
Section B:
Produce a maximum 1,250 word modelling plan for your proposed health economic analysis to fill the gaps in the analysis and address the decision problem. Provide a fully labelled outline of your proposed model structure Consider the following, along with other relevant features, in your modelling plan The aim of the analysis
• Patient population and any sub-groups to be considered in the analysis.
• Intervention(s) and comparator
• Outcomes Model structure
• The structure of the proposed model (include an outline model structure in your report) with a short description of the treatment pathways to be modelled and health states.
• Report the computer package you will use to undertake your analysis.
• State the proposed setting ( country and health service sector) time horizon and perspective for your model with justification Model assumption Briefly describe the main assumptions you will make in your model. Collection of data inputs
• Resource use and costs—the data and methods you will use to cost up each of your treatment and pathways describing how you will assign values e.g. unit costs and potential sources of information.
• Clinical data required and which sources of data you would consider and why (including any ranking) e.g. meta-analysis, single RCT, observational, registry data etc. The types of data needed to populate the model e.g. transition probabilities, morbidity, mortality should be outlined
• Health utilities- the data and methods you will use to populate your model e.g. baseline utility scores, utility decrements as a result of VTE. Describe the preferred method of capturing utilities to be used.
• Any discounting to be applied Analysis Reporting of base case results How will the cost-effectiveness be presented, what would be done in the case of dominance? Sensitivity analysis Outline the sensitivity analyses to be undertaken to address uncertainty in your model. Feasibility Outline what could be the potential challenges e.g. obtaining high quality clinical evidence
Health Economic Evaluation
Scenario
You are the health economist for a health authority Health Technology Assessment (HTA)panel responsible for making a decision whether new health technologies should be adopted for use. You are responsible for reviewing the health economic evidence, and where identified as a high priority, undertake health economic analysis to provide evidence to the HTA panel.
A summary of the decision problem
The decision problem you have been asked to consider is the effectiveness and cost effectiveness of use of long-term (6-12 months) anticoagulation treatment in the management of venous thromboembolism (VTE) in patients aged 18 years and over with a diagnosis of Inflammatory Bowel Disease (IBD).
IBD is a long-term gastro-intestinal health condition which is associated with an increased risk of VTE during a flare- up episode of IBD with estimates that IBD patient at increased risk compared to the general population [Grainge et al 20101], with this risk increasing during hospitalisation. A number of risk factors have been proposed including hereditary, life style and IBD specific factors such as active disease, surgery and use of corticosteroids [Alkim et al 20162]. The use of anticoagulation, particularly for patients with a first episode of VTE is unclear, with evidence that there is substantial variation in practice by health professionals responsible for the care of IBD patients within your health authority.
You have been given the following question to address which has been identified as a high priority for health economic analysis:
What is the cost-effectiveness of long-term anticoagulation treatment in the management of VTE in patients aged 18 years and over with IBD?
1 Grainge, M.L., West J., Card, T.R. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet 2010; 375:657-63.
2 Alkim, H., Koksal, A.R., Boga, S., Sen, I., Alkim, C. Etiopathogenesis, prevention and treatment of thromboembolism in inflammatory bowel disease. Clinical and Applied Thrombosis/Hemostatis. 2016; 1-10.
Appraisal of the economic evidence and formulation of an economic modelling plan
As the health economist, you have undertaken a systematic search of the evidence and found one study that meets your PICO (see table 1).
Table 1: PICO for the decision problem
Population Adult patients with IBD at high risk of VTE.
Intervention Long-term (6-12 months) oral anticoagulant therapy
Comparator Short-term (< 6months) therapy
Outcome Incremental cost per QALY
The paper is:
Nguyen, G.C., Bernstein, C.N. Duration of anticoagulation for the management of venous thromboembolism in inflammatory bowel disease: A decision analysis. Am J Gastroenterol 2013; 108:1486-95
The paper reports a decision analytical model which compares the cost –effectiveness (measured as cost per QALY) of the use of extended anti-coagulation therapy vs. time limited anticoagulation therapy among IBD patients with first unprovoked VTE.
The HTA panel have asked you to prepare a maximum 2,500 word report and outline model structure summarising the health economic evidence and the proposed plan for a formal health economic analysis of the cost-effectiveness of long-term anticoagulation treatment in the management of VTE in patients aged 18 years and over with IBD.
This report is expected to be submitted to the HTA panel which comprises of clinical experts, pharmacists, nurses, policy makers and other health economists. This will be used as one of the key evidence submissions to make a decision on whether long-term anticoagulation therapy should be used in patients with IBD within the secondary care (hospital) setting.
Course work :
Section A:Produce a maximum 1,250 word report detailing a critical health economics appraisal of the Nguyen and Bernstein paper using an appropriate critical appraisal tool/framework.
This should include:
• A succinctcritical appraisal of the paper including strengths and limitations.
• The gaps in this analysis which could be addressed by adapting or undertaking a new health economic analysis using a decision analytical model.
Section B: Produce a maximum 1,250 word modelling plan for your proposed health economic analysis to fill the gaps in the analysis and address the decision problem.
Provide a fully labelled outline of your proposed model structure
Consider the following, alongwith other relevant features, in your modelling planThe aim of the analysis
• Patient population and any sub-groups to be considered in the analysis.
• Intervention(s) and comparator
• Outcomes
Model structure
• The structure of the proposed model (include an outline model structure in your report) with a short description of the treatment pathways to be modelled and health states.
• Report the computer package you will use to undertake your analysis.
• State the proposed setting ( country and health service sector) time horizon and perspective for your model with justification
Model assumption
Briefly describe the main assumptions you will make in your model.
Collection of data inputs
• Resource use and costs—the data and methods you will use to cost up each of your treatment and pathways describing how you will assign values e.g. unit costs and potential sources of information.
• Clinical data required and which sources of data you would consider and why (including any ranking) e.g. meta-analysis, single RCT, observational, registry data etc.The types of data needed to populate the model e.g. transition probabilities, morbidity, mortality should be outlined
• Health utilities- the data and methods you will use to populate your model e.g. baseline utility scores, utility decrements as a result of VTE. Describe the preferred method of capturing utilities to be used.
• Any discounting to be applied
Analysis
Reporting of base case results
How will the cost-effectiveness be presented, what would be done in the case of dominance?
Sensitivity analysis
Outline the sensitivity analyses to be undertaken to address uncertainty in your model.
Feasibility
Outline what could be the potential challenges e.g. obtaining high quality clinical evidence
YOU MUST USE THIS
Section A: Critical appraisal of the economic evidence (1,250 words maximum)
Summary of the paper (provide a short summary only)
Critical appraisal tool /framework used (with reference):
Summary of key points of critique (use the selected tool/framework to structure your critique). Bullet points are acceptable but please provide a clear explanation of your point of critique with supporting arguments. Provide references where possible to support your argument.
Summary of quality (provide a short summary on the overall quality of the paper and the key gaps that should be addressed in a further health economic analysis )
YOU MUST FILE OUT IT
Section 2: Health economics modelling plan (1,250 words maximum)
Aim of the proposed analysis
Proposed model structure (include an outline of your proposed structure
Key model assumptions
Model inputs
Resource use and Costs
Clinical data
Health utilities
Analysis (specify e.g. incremental cost per QALY)
Reporting of base case results
Sensitivity analyses to be undertaken
Potential feasibility issues (e.g. challenges that you may have such as obtaining high quality clinical evidence)
YOU MUST DRAW IT
Section B: Model structure (please append a copy to your report)
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