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

在所有的社会中，人们都认识到改善人口的重要性--S的健康，但我们准备在医疗保健上花费多少是有限度的。像NICE这样的组织帮助决定哪些医疗保健选择(例如新药或医生)代表着最物有所值。NICE在研究的基础上提出了他们的建议，这些研究考虑了不同选择的相对成本，但也考虑了它们对人的改善程度？S健康。然而，人们对这些研究的科学质量表示担忧。收集证据的一种方法是通过一项名为？集群随机试验？的研究。这项研究是专门设计的，目的是试图给出准确的结果。然而，为了提供准确的结果，使用适当的分析方法也是至关重要的。使用这些方法的研究？集群随机试验？在评估成本和结果时，没有使用适当的方法来报告结果。这项研究的一个关键特点是，患者接受哪种药物或服务取决于他们去哪个医院(例如医院)就诊。然而，这些研究没有认识到，与到其他医院就诊的患者相比，处于特定集群(例如医院)的患者彼此之间可能更相似(例如在社会背景方面)。一个很大的担忧是，通过使用这些不适当的方法，研究提供了不准确的结果。这项研究将开发谨慎的科学方法，利用这些集群随机试验来比较成本和健康结果。它会在不同的情况下仔细考虑这些新方法，找出哪种方法是最好的。我们将接受已经提供结果的研究，并使用这些新方法重新进行研究。我们将在不同的医疗领域(例如产科服务、心脏病、睡眠障碍)测试这些方法。这项研究将提供在不同情况下哪种方法最好的建议。这项研究将提供指导和培训机会，教未来的研究人员如何使用这些新方法。这项调查将为国际期刊撰写科学出版物。我们还将通过我们的项目网站为政策制定者和公众提供有关方法的信息。通过提供更好的方法来决定应该提供哪些药物和卫生服务，本研究将有助于确保稀缺的卫生保健资源得到最好的利用，以改善人口S的健康。

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.