NIHR Health Technology Assessment (HTA) funded studies: Completing the journey from research suggestion to dissemination of research

Transcription

1 NIHR Health Technology Assessment (HTA) funded studies: Completing the journey from research suggestion to dissemination of research Sheetal Bhurke, Amanda Blatch-Jones, Andrew Cook, Sally Bailey, Anna Tallant Research Evaluation, on Trials Research and Studies Programme Coordinating Centre

2 What is Research on Research? NIHR The National Institute for Health Research (NIHR) is funded through the Department of Health to improve the health and wealth of the nation through research Research Programmes NETS Efficacy & Mechanism Evaluation (EME) Programme in partnership with the MRC Health Service & Delivery (HS&DR) Programme Health Technology Assessment (HTA) Programme Public Health Research (PHR) Programme Systematic Reviews Programme (SRP) Research on Research Research on Research (RoR) is an internal programme to conduct high quality research to help inform, improve and make recommendations on the management of NIHR research Programmes and the projects they fund.

3 Context

4 Adding Value in Research Developed from Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet 2009; 374 (9683):86-89.

5 RoR Studies How Cochrane reviews inform the NIHR Health Technology Assessment Programme commissioning process Sheetal Bhurke, Ria Osbourne and Sally Bailey The value of research recommendations to generate and initiate new research use of Cochrane Reviews Use of prior research to help inform the design and planning of a trial

6 Methods Assessment of relevance: Review of NETS management systems (October 1999 to December 2013) for submitted research recommendations from Cochrane reviews (commissioned work stream) Appropriateness of trial design: Two cohorts of HTA funded randomised controlled trials (commissioned and researcher led work streams): 2006 to 2008 (replication of Jones et al.) 2013 (to assess improvements over time)

7 Results Assessment of relevance 74 Cochrane review research recommendations prioritised and commissioned by the NIHR HTA programme during studies were funded against the Cochrane review research recommendations: - 20 were published before 2012 (10 primary research and 10 secondary research) Further assessment required.

8 Secondary Research Example NIHR HTA secondary research studies - prioritised through Cochrane - 2 Cochrane recommendations based on further cost-effectiveness research - 8 Cochrane recommendations for primary research but the HTA programme justified the need for an evidence synthesis or an economic modelling study. For example, the Cochrane review (Gibbs 2003) suggested an urgent need for better quality randomised controlled trial on the routine treatments for common warts, particularly cryotherapy. The HTA project by Thomas 2006 (Effectiveness and costeffectiveness of salicylic acid and cryotherapy for cutaneous warts. An economic decision model, Health Technol Assess, 2006; 10 (25)) The HTA Commissioning Brief stated, There was an uncertainty as to whether cryotherapy is more effective than topical salicylic acid and the HTA Programme is considering commissioning a randomised controlled trial. However, given its higher costs, cryotherapy would have to be substantially more effective to be cost-effective. We are seeking analysis using an economic model of whether such a result is plausible enough to justify the trial.

9 NIHR HTA trials informing the updated Cochrane Reviews 7 reviews updated since the publication of the relevant NIHR HTA studies 5 reviews included the NIHR HTA studies in the updated version 1 review changed their conclusions after inclusion of the NIHR HTA study 1 review changed their conclusion based on the NIHR HTA study only

10 Results - Appropriateness of trial design Cohort I Cohort II Screened 57 funded applications Screened 36 funded applications Excluded n = 10 Excluded n = 2 Included n = 47 Included n = 34

11 Results - Appropriateness of trial design Jones Cohort I Cohort II Did not reference a systematic review 11 trials (23%) 5 trials (11%) 0 trials (0%) Referenced a systematic review 37 trials (77%) 42 trials (89%) 34 trials (100%) Referenced more than one systematic review 15 trials (41%) 30 trials (77%) 20 trials (65%) Total Cochrane reviews referenced

12 Outcomes Appropriateness of research recommendations to inform the development of high priority questions Accessibility of research outputs to help inform and add value to current knowledge Value and importance of systematic reviews to help inform current research Compliance by applicants to support primary research application by using existing systematic review evidence Is the question relevant? What does existing evidence say? Contributing to and updating what?

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