1. Value of information An innovative approach to prioritizing comparative effectiveness research AHRQ Annual Meeting September 29, 2010

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

3. 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

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

5. Research Can improve health care decision making Can improve health care decision making … at a cost

6. Prioritizing Research Research topics Research topics – Span a variety of conditions – Pertain to a variety of populations and subgroups – Prevention, diagnosis and treatment – Drugs, devices, procedures or strategies

7. How can research funding organizations systematically target investments in research where the impact of reducing the uncertainties in decisions will have the greatest benefits?

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

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

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

11. AHRQ Priority Setting Criteria Appropriateness Appropriateness Importance Importance – Disease burden – Cost – Stakeholder support – Uncertainty/controversy Desirability of new research Desirability of new research Feasibility Feasibility Potential value Potential value

12. Value of Information A measure of the value of acquiring more information to better inform a health care decision 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 …based on an estimate of the foregone benefit of making the wrong decision

13. Value of Information Health care decisions are uncertain Health care decisions are uncertain We choose what we believe is the best option We choose what we believe is the best option With more information we may choose a different option With more information we may choose a different option Value of Information = p Wrong Decision x Expected Value Wrong Decision

14. VOI Components 1. Decision with two or more options 2. A model relating the expected value of each option to uncertain parameters 3. A method of calculation

15. Expected Value Model Parameters + Uncertainty Value of Information = p Wrong Decision x Expected Value Wrong Decision

16. Opportunities Encourages structured decision making Encourages structured decision making Potential to increase transparency Potential to increase transparency Can quantify research benefits relative to Can quantify research benefits relative to Potential to reduce uncertainty Potential to reduce uncertainty Impact on decision making Impact on decision making Cost Cost

17. Challenges Complex models are resource intensive Complex models are resource intensive Simple models may exclude important elements of expected value Simple models may exclude important elements of expected value Estimating uncertainty can be difficult Estimating uncertainty can be difficult

18. Questions? Comments?