Methods of extrapolating RCT evidence for economic evaluation

Abstract

Treatment costs and benefits have to estimated when they are unknown beyond a certain time period, and the appropriate time the costs or benefits last is judged by NICE to be longer. This may add uncertainty to NICE s decison making process about whether or not the treatment should be funded, as there are usually various ways of obtaining these estimates. The research project will review and compare the different approaches and recommend the best ways of undertaking the estimation for different situations.

Technical Summary

Extrapolation of evidence over time is common in work which informs the NICE decision-making process on cost-effectiveness of health technologies. Although a variety of methods and approaches to extrapolation are used, little research has been conducted into the effect of this methodology on the decision process. This research will review the current methodology for extrapolation used in health economic modelling and develop a taxonomy of methods and approaches. The resulting categories will be critically reviewed using a set of structural uncertainty criteria developed for the purpose. The results will be illustrated using case-studies which will be selected for the particular analyses that need to be demonstrated. The results of this research will be reported and synthesised for dissemination in typical scientific forums.

Publications

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Benaglia T (2015) Survival extrapolation in the presence of cause specific hazards. in Statistics in medicine

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Jackson C (2017) Extrapolating Survival from Randomized Trials Using External Data: A Review of Methods. in Medical decision making : an international journal of the Society for Medical Decision Making

 
Description Citation in Pharmacoeconomics
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description NICE DSU Cancer Modelling Master Class
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact People attending were from NICE - the technical analysts and their senior managers. The knowledge and skills imparted should widen the knowledge base of survival analysis methods and options in this key regulatory body in the UK.
 
Description NICE Methods Guide Update 2012
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guidance committee
Impact Contributions to the NICE methods guide update committee on survival modelling by John Stevens and presentation on adjusting for crossover and Nick Latimer respectively Input, drafting and co-authorship of the sections in the new NICE methods guide on survival modelling and crossover by Prof Steve Palmer and Nick Latimer Impact - Material added to this guidance which is read and used by every pharmaceutical company and medical device manufacturer that submits to NICE for approval of its health technology to be used in the NHS in England and Wales.
 
Description MRC Network of Hubs for Trials Methodology Research: Workshops, Small projects, Other Hub Network Events
Amount £12,260 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 01/2013 
End 12/2016
 
Description NIHR Doctoral Research Fellowship
Amount £269,498 (GBP)
Funding ID DRF-2016-09-119 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 01/2017 
End 12/2019
 
Title Data Extraction on Methods of Extrapolation 
Description Data Extraction Database on Methods of Extrapolation used in around 180 Heath technology Assessment reports 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact None as yet 
 
Title Taxonomy of Extrapolation Methods 
Description A structured listing of methods which might be used to extraplate RCT evidence for health technology assessments 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact None as yet Plan to use to provide recommendations to pharma companies submitting to NICE and reimbursement authorities world-wide 
 
Description Health Economics and Decision Science Seminar in the School of Health and Related Research at University of Sheffield 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Kate Ren gave a talk on an alternative approach to extrapolate treatment effects given published Kaplan-Meier curves with around 40 participants. There was a good 15 minutes questions and discussion time.

Presented an alternative method and there was a lot of interests in the presentations.
Year(s) Of Engagement Activity 2013
 
Description NICE Methods Guide Update 2012 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Contributions to the NICE methods guide update committee on survival modelling by John Stevens and presentation on adjusting for crossover by Nick Latimer. Input, drafting and co-authorship of the sections in the new NICE methods guide on survival modelling and crossover by Prof Steve Palmer and Nick Latimer

Material added to this guidance which is read and used by every pharmaceutical company and medical device manufacturer that submits to NICE for approval of its health technology to be used in the NHS in England and Wales.
Year(s) Of Engagement Activity 2012