DEVELOPING APPROPRIATE ANALYTICAL METHODS FOR COST-EFFECTIVENESS ANALYSES THAT USE CLUSTER RANDOMISED TRIALS

点击翻译按钮获取中文摘要

In all societies, people recognise the importance of improving the population?s health, but there are limits on how much we are prepared to spend on health care. Organisations such as NICE, help decide which health care options (e.g. new drugs or doctors) represent the best value for money. NICE make their recommendations, based on studies that consider the relative costs of different options, but also how much they improve people?s health. However, there are concerns about the scientific quality of these studies. One way of collecting the evidence is through a study called a ?cluster randomised trial?. This study is specially designed to try and give accurate results. However, for the study to provide accurate results it is also essential that it uses appropriate methods of analysis. Studies that have used these ?cluster randomised trials? to assess costs and outcomes have not used appropriate methods to report their results. A key feature of this study is that which drug or service a patient receives depends on which cluster (e.g. a hospital) they attend. However, these studies have not recognised that patients who are in particular cluster (e.g. a hospital) are likely to be more similar (for example in their social background) to each other, than to patients attending other hospitals. A big concern is that by using these methods which are inappropriate, the studies are providing inaccurate results. This research will develop careful scientific methods for studies that compare costs and health outcomes using these ?cluster randomised trials?. It will find out which of these new methods is the best by carefully considering them in different situations. We will take studies that have already provided results, and redo them using these new methods. We will test the methods across different medical areas (e.g. maternity services, heart disease, sleeping disorders). The research will provide recommendations on which method is best under different circumstances. The study will provide instructions and training opportunities to teach future researchers how to use these new methods. The investigation will produce scientific publications for international journals. We will also provide information on the methods for policy-makers, and members of the public via our project website. By providing better methods for deciding which drugs and health services should be provided, this research will help to ensure that scarce health care resources are used in the best ways for improving the population s health.