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Decisions amd uncertainty

M Violato, H Dakin, U Chakravarthy, B C Reeves, T Peto, R E Hogg, S P Harding, L J Scott, J Taylor, H Cappel-Porter, N Mills, D O'Reilly, C A Rogers, S Wordsworth
OBJECTIVES: To assess the cost-effectiveness of optometrist-led follow-up monitoring reviews for patients with quiescent neovascular age-related macular degeneration (nAMD) in community settings (including high street opticians) compared with ophthalmologist-led reviews in hospitals. DESIGN: A model-based cost-effectiveness analysis with a 4-week time horizon, based on a 'virtual' non-inferiority randomised trial designed to emulate a parallel group design. SETTING: A virtual internet-based clinical assessment, conducted at community optometry practices, and hospital ophthalmology clinics...
October 24, 2016: BMJ Open
Thomas Butt, Adnan Tufail, Gary Rubin
Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de novo utility values in AMD. We describe how utility values have been used in healthcare decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed, and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utilities for use in healthcare decision making relating to treatments for AMD...
February 2017: Applied Health Economics and Health Policy
(no author information available yet)
A loss of visual acuity due to macular oedema is a complication of retinal vein occlusion. Vision improves spontaneously within 3 to 6 months in about 50% of cases. There are no drugs with proven benefits in this setting. In addition to its indications in the treatment of age-related macular degeneration (AMD) and diabetic macular oedema, ranibizumab, an anti-VEGF antibody, has now been approved in the European Union for the treatment of visual impairment associated with macular oedema due to retinal vein occlusion...
September 2012: Prescrire International
Getnet D Betrie, Solomon Tesfamariam, Kevin A Morin, Rehan Sadiq
Acid mine drainage (AMD) is a global problem that may have serious human health and environmental implications. Laboratory and field tests are commonly used for predicting AMD, however, this is challenging since its formation varies from site-to-site for a number of reasons. Furthermore, these tests are often conducted at small-scale over a short period of time. Subsequently, extrapolation of these results into large-scale setting of mine sites introduce huge uncertainties for decision-makers. This study presents machine learning techniques to develop models to predict AMD quality using historical monitoring data of a mine site...
May 2013: Environmental Monitoring and Assessment
Jonathan Karnon, Carolyn Czoski-Murray, Kevin J Smith, Christopher Brand
BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness. It is likely that treatment of AMD at earlier stages is more effective than later treatment; thus, screening for AMD should be considered. The aim of this study was to develop a natural history model of AMD to estimate the cost-effectiveness of screening. METHODS: A hybrid cohort/individual sampling decision analytic model was developed. Primary data sets, expert elicitation, and data from the literature were used to populate the model...
May 2009: Medical Decision Making: An International Journal of the Society for Medical Decision Making
J Karnon, C Czoski-Murray, K Smith, C Brand, U Chakravarthy, S Davis, N Bansback, C Beverley, A Bird, S Harding, I Chisholm, Y C Yang
OBJECTIVES: To estimate the cost-effectiveness of screening for age-related macular degeneration (AMD) by developing a decision analytic model that incorporated and assessed all of the National Screening Committee criteria. A further objective was to identify the major areas of uncertainty in the model, and so inform future research priorities in this disease area. DATA SOURCES: Major databases were searched in March 2004 and updated in January 2005. REVIEW METHODS: Systematic literature reviews covered the epidemiology and natural history of AMD, the screening and treatment effectiveness and health-related quality of life relating to AMD...
June 2008: Health Technology Assessment: HTA
Laura Bojke, Karl Claxton, Mark J Sculpher, Stephen Palmer
The authors report an analysis that was developed as part of a pilot study examining the use of decision analysis and value-of-information methods to inform research prioritization decisions for the UK health care system. This analysis was conducted to inform decision makers whether additional research on screening for age-related macular degeneration (AMD) would be worthwhile and to demonstrate the benefits and feasibility of using such analytic methods to inform policy decision within the time-lines demanded by existing procedures...
January 2008: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Sorrel E Wolowacz, Neil Roskell, Steven Kelly, Fiona M Maciver, Chris S Brand
BACKGROUND: Age-related macular degeneration (AMD) is the primary cause of vision loss in the elderly and results in significant economic and humanistic burden. The selective vascular endothelial growth factor inhibitor, pegaptanib (Macugen) is indicated for patients with neovascular AMD. Guidance is needed regarding the cost effectiveness of treatment, any variation between sub-populations of differing clinical characteristics and the optimum duration of treatment. OBJECTIVE: To estimate the cost effectiveness of pegaptanib versus best supportive care (BSC) for AMD from the perspective of the UK government, and to evaluate the impact of patient characteristics and differing treatment discontinuation scenarios...
2007: PharmacoEconomics
B Foot, R Foy, U Chakravarthy, R Wormald
AIM: New therapies are often introduced into the NHS prior to full evaluation, leading to inequities in provision. Uncertainty exists regarding the value of photodynamic therapy in the treatment of neovascular age-related macular degeneration. We ascertained the availability of this treatment and the information used to inform clinical policy. METHODS: A postal survey of all clinical directors/lead consultants in the UK sought data on which (if any) patients were referred or treated with PDT by their unit, the sources of evidence informing clinical policy and the threshold of clinical benefit at which respondents would support the use of PDT...
July 2002: Eye
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