Value of information

An innovative approach to prioritizing comparative effectiveness research

AHRQ Annual MeetingSeptember 29, 2010

Organizers & Presenters

William Lawrence, MD, MS Joanna E. Siegel, RN, SM, SD Ava John-Baptiste, PhD David O. Meltzer, MD, PhD Gillian D. Sanders, PhD

Session Overview

The promise and challenge of using value of information to inform comparative effectiveness research priorities

Ava John-Baptiste, PhD

Value of Information Analysis to Inform Priorities for Health Research: Moving from Theory to Practice

David O. Meltzer, MD, PhD

Using Value of Information to Prioritize Future Research: A Case Study

Gillian Sanders, PhD

Session Goals

Outline the theoretical basis of VOI Describe use of VOI Discuss barriers to applying VOI Consider possible solutions Present AHRQ funded VOI research

Research

Can improve health care decision making

… at a cost

Prioritizing Research

Research topics– Span a variety of conditions– Pertain to a variety of populations and

subgroups– Prevention, diagnosis and treatment – Drugs, devices, procedures or strategies

How can research funding organizations systematically target investments in research where the

impact of reducing the uncertainties in decisions will have

the greatest benefits?

Topic

For diabetic patients, what is the effectiveness of between visit patient outreach compared to standard patient care on adherence to therapy?

Topic

What is the comparative effectiveness of typical and atypical antipsychotics for schizophrenia, bipolar disorder and other disorders?

Topic

What is the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass grafting for coronary artery disease?

AHRQ Priority Setting Criteria

Appropriateness Importance

– Disease burden– Cost– Stakeholder support– Uncertainty/controversy

Desirability of new research Feasibility Potential value

Value of Information

A measure of the value of acquiring more information to better inform a health care decision

…based on an estimate of the foregone benefit of making the wrong decision

Value of Information

Health care decisions are uncertain We choose what we believe is the best option With more information we may choose a different

option

Value of Information = p Wrong Decision x Expected Value Wrong Decision

VOI Components

1. Decision with two or more options 2. A model relating the expected value of

each option to uncertain parameters3. A method of calculation

Expected Value

ModelParameters + Uncertainty

Value of Information = p Wrong Decision x Expected Value Wrong Decision

Opportunities

Encourages structured decision making Potential to increase transparency Can quantify research benefits relative to

Potential to reduce uncertainty Impact on decision making Cost

Challenges

Complex models are resource intensive Simple models may exclude important

elements of expected value Estimating uncertainty can be difficult

Questions?

Comments?