New HEDS Discussion Paper - Value-adaptive clinical trial designs for efficient delivery of research – actions, opportunities and challenges for publicly funded trials

New HEDS Discussion Paper - Value-adaptive clinical trial designs for efficient delivery of research – actions, opportunities and challenges for publicly funded trials

Dr Laura Flight is the lead author on a new published HEDS Discussion Paper; 'Value-adaptive clinical trial designs for efficient delivery of research – actions, opportunities and challenges for publicly funded trials'

HEDS Discussion Paper Series

Abstract

Value-adaptive designs are a set of emerging methods for efficient clinical trial design that aim to maximise expected population health for the money being spent. They involve adaptive data collection processes that consider the costs of research, the expected value of information from data collection, and the health technology assessment decisions around cost-effectiveness. 

This topic is important to clinicians practising in publicly funded healthcare systems as they rely on evidence-based treatment strategies that have been shown to be effective in comparison to alternative interventions. Therefore, more efficient, and accurate research studies potentially offered by value-adaptive designs can feed into real decisions and implementation in the care provided by the National Health Service (NHS). Doing so offers the potential to save research costs, to bring the better technology to patients sooner, and to reduce the number of patients randomised into the trial. 

In this article, we review these emerging methodologies, summarise recent methodological advances, and assess the opportunities they offer for improving the efficiency of publicly funded trials. We also discuss the steps that might be taken by funders, clinicians, trial teams, the public and healthcare decision makers to successfully deploy these methods.

Download the publication via our White Rose Open Access Repository

HEDS Discussion Paper Series

Dr Laura Flight

New HEDS Discussion Paper - Development of the Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel), an Individual Patient Simulation Model for Investigation of the Cost-effectiveness of Personalised Screening and Surveillance Strategies

New HEDS Discussion Paper - Development of the Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel), an Individual Patient Simulation Model for Investigation of the Cost-effectiveness of Personalised Screening and Surveillance Strategies

Chloe Thomas, Olena Mandrik and Sophie Whyte

Dr Chloe Thomas

Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel) is an individual patient simulation model built in the R programming language, which has been designed to enable comparison of the effectiveness, cost-effectiveness and resource use of different personalised screening and surveillance strategies for colorectal cancer (CRC). The model simulates the life course of patients representing the population of England, who each have a set of individual characteristics which determines their cancer risk and response to screening and surveillance. The model has a lifetime horizon and takes an NHS perspective.

Download the HEDS Discussion Paper here

New HEDS Discussion Paper - Explaining national differences in the mortality of Covid-19: Individual patient simulation model to investigate the effects of testing policy and other factors on apparent mortality

Explaining national differences in the mortality of Covid-19: Individual patient simulation model to investigate the effects of testing policy and other factors on apparent mortality

Jonathan A Michaels, Matt D Stevenson

Abstract

Professor Jonathan Michaels    

There has been extensive speculation on the apparent differences in mortality between countries reporting on the confirmed cases and deaths due to Covid-19. A number of explanations have been suggested, but there is no clear evidence about how apparent fatality rates may be expected to vary with the different testing regimes, admission policies and other variables. An individual patient simulation model was developed to address this question. Parameters and sensitivity analysis based upon recent international data sources for Covid-19 and results were averaged over 100 iterations for a simulated cohort of over 500,000 patients.

Different testing regimes for Covid-19 were considered; testing admitted patients only, various rates of community testing of symptomatic cases and active contact-tracing and screening.

Professor Matt
Stevenson

In the base case analysis, apparent mortality ranged from 10.5% under a policy of testing only admitted patients to 0.4% with intensive contact tracing and community testing. These findings were sensitive to assumptions regarding admission rates and the rate of spread, with more selective admission policies and suppression of spread increasing the apparent mortality and the potential for apparent mortality rates to exceed 18% under some circumstances. Under all scenarios the proportion of patients tested in the community had the greatest impact on apparent mortality.

Whilst differences in mortality due to health service and demographic factors cannot be excluded, the current international differences in reported mortality are all consistent with differences in practice regarding screening, community testing and admission policies.

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HEDS Discussion Paper Modelling alcohol use behavior at population scale based on social role theory: An exploratory agent-based model

HEDS Discussion Paper

Modelling alcohol use behavior at population scale based on social role theory: An exploratory agent-based model

Download the paper from here

Abstract

Purpose: The relationships between social roles and patterns of alcohol use have been explored empirically within the alcohol research community; however, the mechanisms by which social roles impact on alcohol consumption, and vice versa, remain poorly theorized. We present a set of mechanisms based on social role theory to describe how social roles interact with alcohol use behaviors at population-level.

Methods: An agent based model was implemented in RepastHPC to simulate dynamic social role change underlying drinking behaviors over time. The model was used to explore population-level alcohol use in San Diego County.

Data: The agent-based model was parameterized using the 1980 US Census, the 1980 National Survey on Drug Use and Health (NSDUH), and longitudinal data from the Panel Study of Income Dynamics. Model outputs were compared to repeated cross-sectional data from NSDUH, 1980-2000.

Results: The model produced time trends for the average number of social roles in SDC over time, with drinkers consistently having a lower number of roles, on average, compared to the total population. Dynamics in the number of social roles were associated with smaller-scale trends in drinking prevalence and average weekly quantity. Model fit was reasonable compared to NSDUH observations on drinking prevalence, but less satisfactory for drinking quantity.

Conclusion: A baseline model has been produced that can examine quantitative, mechanism-based explanations for how changes in social roles impact on alcohol use, and vice versa. Further research is needed to calibrate the model to empirical data, and extend the capabilities of the model structures.

Conflict of interest statement: The authors declare that no relationship exists that could be viewed as presenting a potential conflict of interest.

Topic: Drinking cultures

HEDS Discussion Papers available on Open Access database

HEDS produces its own series of discussion papers which started way back in 2001 with a paper by Professor John Brazier, who is now the Dean of ScHARR. The complete series of 137 papers can now be accessed on our own institutional White Rose open access repository. The collection can be viewed and downloaded by going to here

The first HEDS Discussion Paper 

The series is intended to promote discussion papers in progress. The Views expressed are those of the authors, and therefore should not be quoted without their permission. However, comments are welcome and we ask that they be sent direct to the corresponding author.