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The place of minimal access surgery amongst people - University of

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									Preference Elicitation and Assessment of Technologies
(PEAT) Programme
Project No:               B1.37                                                  Projects completed

Project Title:            The place of minimal access surgery amongst people with gastro-
                          oesophageal reflux disease - a UK collaborative study (the REFLUX
                          trial)

Grant Applicants /        Campbell, M., Grant, A. (HSRU, University of Aberdeen) Martin, I.
Principal Investigators   (University of Auckland, New Zealand) Sculpher, M. (Centre for Health
(place of work):          Economics, York) Krukowski, Z. (Grampian University Hospitals Trust,
                          Aberdeen) Heading, R. (Edinburgh Royal Infirmary, Edinburgh) Darzi, A.
                          (St Mary's Hospital, London) Russell, I. (University of York) and Vale, L.
                          (HERU /HSRU)

HERU Investigators:       Vale, L. and Kilonzo, M.

HERU Research             Assessment of Technologies
Theme:

Source of Funding and     NIHR HTA Programme - £933,894
Total Awarded:

Amount of HERU            £9,573
Funding:

Objectives:               To clarify the optimal place of minimal access surgery (as an alternative to
                          expensive long-term medical management) within the NHS.

Outline:                  The advent of minimal access techniques has greatly enhanced the
                          potential value of surgery for persistent gastro-oesophageal reflux disease
                          (GORD). The study involved the evaluation of clinical effectiveness and
                          safety within a pragmatic trial, and the assessment of cost-effectiveness,
                          likely patient preferences, and the implications of more extensive future
                          use of surgery, within an economic evaluation. The HERU component of
                          this study was to elicit, using Discrete Choice Experiment methodology,
                          the strength of preference for alternative methods of management amongst
                          participants in the study.

Outcome and               Relative to a best-case situation the trial arm associated with the highest
Translation:              mean utility was ‘preferred medicine’ and the lowest mean utility was for
                          ‘randomised surgery’. The results were strongly influenced by pre
                          treatment preferences, and receipt of treatments was associated with
                          considerable disutility. Clinicians should therefore pay close attention to
                          patient choice in decisions regarding which type of treatment to provide.
                          Because the surgical option is more costly than medical management and
                          it is uncertain whether it would be cost-effective in the long-term, the
                          HTA programme is now funding a follow-up of participants. This work
                          will be undertaken by the HSRU in collaboration with Health Economics,
                          York.
Start Date:            January 2000
Duration of Project:   6.5 years

Project Phase:

Publications:          Grant, A., Wileman, S., Ramsay, C., Bojke, L., Epstein, D., Sculpher, M.,
                       Macran, S., Kilonzo, M., Vale, L., Francis, J., Mowat, A., Krukowski, Z.,
                       Heading, R., Thursz, M., Russell, I. and Campbell, M. on behalf of the
                       REFLUX trial group. The effectiveness and cost-effectiveness of minimal
                       access surgery amongst people with gastro-oesophageal reflux disease – a
                       UK collaborative study. The REFLUX trial. Health Technology
                       Assessment. 2008; 12(31): 1–214.

                       Grant, A., Wileman, S., Ramsay, C., Mowat, N., Krukowski, Z., Heading,
                       R., Thursz., M., Campbell, M. and the REFLUX Trial Group (Vale, L.)
                       Minimal access surgery compared with medical management for chronic
                       gastro-oesophageal reflux disease: UK collaborative randomised trial.
                       British Medical Journal. 2008; 337(7686): a2664.

                       Reflux Trial Group. (Vale, L. and Kilonzo, M. members) The place of
                       minimal access surgery amongst people with gastro-oesophageal reflux
                       disease – a UK collaborative study. The REFLUX Trial. Report submitted
                       to NHS R&D HTA Programme, October 2006.

                       Cooper, K.G., Sambrook, A., Campbell, M.K., Cook, J.A., Kilonzo, M.
                       and Vale, L. The Endometrial Ablation Study: A randomised comparison
                       of treatment in the postmenstrual phase: Clinical outcomes, patient
                       acceptability and cost. Report submitted to the Chief Scientist Office of the
                       Scottish Executive Health Department, April 2007.

Other Dissemination    Kilonzo, M. Using Discrete Choice Experiments to measure preferences
Activities:            for treatment options an application to gastro-oesophageal reflux disease.
                       Health Services Research Unit. University of Aberdeen, March 2007.

								
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