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SUMMARY:Stratification of treatment by disease severity measures – an ap
 plication to treatment for sleep apnoea - Claire Simons\, MRC Biostatistic
 s Unit
DTSTART:20171003T143000Z
DTEND:20171003T153000Z
UID:TALK78731@talks.cam.ac.uk
CONTACT:53591
DESCRIPTION:"Health Economics @ Cambridge":http://www.publichealth.cam.ac.
 uk/health-economics-cambridge/ welcome Claire Simons from the MRC Biostati
 stics Unit\, University of Cambridge. In her talk\, she will talk about th
 e value of providing the right treatment for each sub-group of the populat
 ion and the nature and challenges of such a stratification. Drawing on a c
 ase study of treatment for sleep apnoea\, her work explores issues in the 
 potential stratification of treatment decision by a continuous measure of 
 disease severity.\n\nEveryone is welcome. No sign-up required. More inform
 ation can be found "here":http://www.publichealth.cam.ac.uk/3-october-2017
 -claire-simons/\n\n_Results from a cost-effectiveness analysis show whethe
 r an intervention is cost-effective “on average” for the population st
 udied.  This can lead to a sub-optimal treatment being recommended for som
 e groups in the population.  Exploration of cost-effectiveness within subg
 roups can lead to a more efficient allocation of resources.  Despite the o
 bvious benefits of stratifying treatment and the National Institute of Hea
 lth and Care Excellence (NICE) recommending patient subgroups should be ex
 plored\, this is not regularly implemented._\n\n_This work explores issues
  in the potential stratification of treatment decision by a continuous mea
 sure of disease severity in a case study of treatment for sleep apnoea.  T
 his includes the selection of appropriate data\, modelling how treatment e
 ffects vary with severity\, full quantification of uncertainty\, and effic
 ient calculation of the stratified decision._ \n\n_Literature on the use o
 f Mandibular Advancement Devices (MADs) and Continuous Positive Airway Pre
 ssure (CPAP) as treatments for sleep apnoea were reviewed.  Specifically\,
  evidence was obtained on the Epworth Sleepiness score (ESS)\, a measure o
 f disease severity\, and the impact of treatment on this. Both aggregate a
 nd easily accessible individual participant data from the RCTs were obtain
 ed\, and combined in a series of Bayesian model-based meta-regressions ind
 icating more severe disease\, as indicated by higher baseline ESS\, is rel
 ated to a higher absolute treatment effect.  However\, the strength of thi
 s relationship differs between the two treatments._\n\n_The parameter esti
 mates and posterior distributions from these meta-regressions have been in
 cluded in a cost-effectiveness analysis to quantify the benefit in stratif
 ying the treatment decision.  Using a regression approximation\, we can de
 termine the optimal treatment decision given any value of the continuous s
 tratifying variable without re-running the cost-effectiveness model. There
  is some evidence that MAD is the optimal treatment for those with lower E
 SS values and CPAP for those with higher ESS.  Value of Information ideas 
 have been used to quantify the economic benefits of stratification and pot
 ential research to improve stratified decision-making finding benefit in c
 ollecting information on specific populations and using particular study d
 esigns._
LOCATION:Small Seminar Room\, 1st Floor\, Institute of Public Health\, Uni
 versity Forvie Site\, Robinson Way\, Cambridge
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