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Operant Protocols for Assessing the Cost-benefit Analysis During Reinforced Decision Making by Rodents
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Globally optimal trial design for local decision making.

Simon Eckermann1, Andrew R Willan

  • 1Flinders Centre for Clinical Change and Health Care Research, Flinders University, Adelaide, SA, Australia. simon.eckermann@flinders.edu.au

Health Economics
|April 26, 2008
PubMed
Summary

Optimizing health technology assessment (HTA) trial design across jurisdictions maximizes information value. Global trial design increases expected net gain significantly compared to local designs, improving resource allocation and avoiding market failures.

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Area of Science:

  • Health Economics
  • Clinical Trial Design
  • Decision Analysis

Background:

  • Value of information (VOI) methods guide efficient trial design by maximizing expected value relative to cost.
  • Current health technology assessment (HTA) frameworks often assume trial commissioning is restricted to within a single jurisdiction.
  • This limitation can lead to suboptimal trial designs and inefficient allocation of research resources.

Purpose of the Study:

  • To extend the framework for optimal trial design and decision-making to encompass cross-jurisdictional collaboration.
  • To identify an optimal global trial design for health technology assessment, considering multiple countries.
  • To demonstrate the financial benefits of a globally coordinated approach to clinical trials.

Main Methods:

  • The study extends existing value of information frameworks to incorporate multi-jurisdictional trial design.
  • A case study is presented for external cephalic version (ECV) in breech presentations, comparing US, UK, and Australian decision-making contexts.
  • The methodology involves calculating expected net gains from both locally and globally optimal trial designs.

Main Results:

  • A globally optimal trial design for ECV across the US, UK, and Australia yields an expected net gain of US$1.14 million.
  • This represents a substantial increase from the US$0.72 million expected gain from locally optimal trial designs.
  • The global approach enhances efficiency by reflecting the value of non-rival information and optimizing sample allocation.

Conclusions:

  • Globally optimal trial design significantly improves upon within-jurisdiction designs by leveraging shared information and resources.
  • This approach avoids market failures such as free-rider effects and inefficient cost spreading.
  • Implementing globally optimal trial designs leads to more efficient health technology assessment and better decision-making.