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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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