Liu, Yifeng;
(2021)
Efficiency in mental health randomised trials.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Randomised controlled trials (RCTs) are perceived as the gold standard for assessing therapeutic interventions. Modern randomised trials often involve extensive collaboration of different areas of expertise and can result in high costs in design and conduct. This thesis discusses different aspects in which RCTs in mental health could be improved with better efficiency, in line with a case of research into antipsychotic discontinuation and reduction intervention, which is an RCT funded by the National Institute of Health Research (NIHR). To begin with, the thesis investigates the effectiveness and cost-effectiveness of different strategies which may improve recruitment into and retention in randomised trials in mental health in a systematic review. There is not enough evidence on “Study within a Trial” to compare the effectiveness of recruitment and retention intervention in mental health trials. Further research in this area could highlight the possibilities of using strategies that are most suitable to trial design and population characteristics. Secondly, this thesis takes a “real world evidence” perspective to inform RCTs using a decision analytic model which compares the cost-effectiveness of antipsychotic reduction and discontinuation strategy and the standard maintenance strategy, under the current £20,000 – £30,000/QALY willingness to pay threshold. Thirdly, following the decision analytic model, this thesis discusses to what extent decision uncertainty under certain willingness to pay threshold could be reduced by further research, and the expected value of reducing uncertainties on certain parameters in the decision model, using the Value of Information analysis framework. It could help trialists with the design of future RCTs in line with the standard sample size calculation to determine the economic benefit of the RCT. Decision then can be made by the worthiness of conducting an RCT to reduce the uncertainty regarding the adoption of new intervention.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Efficiency in mental health randomised trials |
| Event: | UCL |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10140893 |
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