Title: Prioritising research for an entire clinical area (atopic eczema) using value of information methods
Funder: Department of Health and Social Care

Abstract: Guidelines require cost-effectiveness analyses to be used to inform decisions about how to allocate the healthcare budget [1]. However, such explicit methods aren't routinely used to inform research funding decisions [2], meaning that the research budget may not be delivering value for money. This reflects the relative newness and complexity of value of information (VoI) methods as used to inform whether further research into a decision problem is justified. There is also a need for more applied studies using VoI to explore how the practical challenges of using the method can be overcome and to increase analytical capacity. This proposal will develop existing VoI methods so that they can be applied across a clinical area (Eczema) to identify what research should be prioritised to help improve value and reduce waste within the research funding budget. An iterative approach to decision making will be used. The key research questions are: 1. Developing an economic model for eczema: What are the costs and benefits of interventions for eczema? 2. How can VoI methods be used to inform prioritisation of research funding across a clinical area? In particular, could VoI methods be useful in helping to prioritise the treatment uncertainties identified by James Lind Alliance Priority Setting Partnerships? 3. What are the future research priorities within the eczema field? 4. How do the CHU-9D and ADQoL compare in terms of practicality, responsiveness and validity? 5. How sensitive are VoI estimates to the different distributional assumptions made in the model-based approach versus the trial-based approach? The modelling process in Work Package 1 involves Understanding the decision problems; Developing, implementing and validating the economic model of eczema; and Model analysis, reporting and engaging with the decision(s). Best practice guidelines on economic modelling will be used to develop a decision-analytic model to evaluate the expected long-term costs and benefits of eczema, including the ISPORSMDM Modelling Good Research Practices Task Force 2012 recommendations [3-12]. Cutting-edge methods of conceptual modelling will be used to design the model [8, 13], which will be finalised after a review of existing eczema economic models and consideration of alternative model structures and data sources. Estimates for model parameters will be identified and selected from primary and secondary research; routine data sources; and expert clinical input following recommended methods [13, 14]. The conceptual model will be implemented using appropriate software and credibility demonstrated in terms of transparency and validation [5]. Work Package 1 will produce a disease-based economic model for eczema, a prioritisation list for eczema research, and act to demonstrate how these methods might be integrated into other James Lind Alliance (JLA) priority setting partnerships for other conditions. Work package 2 is complementary to WP1, designed to (i) produce two publishable systematic reviews on costs and outcomes to support the use of economic methods in eczema research and to populate relevant model parameters in WP1; (ii) use data from on-going NIHR trials to assess the comparative performance of a generic utility instrument (CHU-9D) and a disease-specific instrument (ADQoL) compared to the Eczema Area Severity Index in terms of practicality, responsiveness and validity using appropriate statistical analysis; and (iii) Estimate VoI statistics from the CLOTHES trial using a trial-based approach in order to compare estimates to those from the model-based approach in WP1 to test the sensitivity of estimates to choice of approach and to provide predictive validity of the model. This will be the first-time VoI methods are applied across a clinical area, extend the JLAs work, and conducted for eczema to inform best use of available research funds to advance the care of patients with eczema.

Lay abstract: Economic analysis is used to inform decisions allocating healthcare budgets but not routinely for allocating health research budgets. This proposal aims to advance a method known as 'value of information' analysis using it to prioritise research funding across an entire clinical area (atopic eczema) for the first time. Current evidence (on the costs and benefits associated with different treatments) will be used to develop an economic model (a simplification of the real world decision problem faced by decision makers). The model can produce estimates of the value of future research to help maximise the benefits obtained from research budgets.

Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: SKIN;GENERIC HEALTH RELEVANCE