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20/33 Reducing overtreatment

 

Contents

We understand that many people will be prioritising NHS work and supporting COVID 19 research during the current pandemic. It is NIHR policy that these should always be the priority as reinforced by our April Programme Director’s message. It is also NIHR policy https://www.nihr.ac.uk/documents/qanda-on-the-impact-of-covid-19-on-research-funded-or-supported-by-nihr/24467 to keep the future research pipeline healthy and to support the research community. Please also note that these first stage applications do not need to contain a large amount of detail and that we only ask for estimates of costs at this stage.

Introduction

The aim of the HTA Programme is to ensure that high quality research information on the effectiveness, costs and broader impact of health technology is produced in the most efficient way for those who use, manage, provide care in or develop policy for the NHS. Topics for research are identified and prioritised to meet the needs of the NHS. Health technology assessment forms a substantial portfolio of work within the National Institute for Health Research and each year about fifty new studies are commissioned to help answer questions of direct importance to the NHS. The studies include both primary research and evidence synthesis.

This is a brief of broader scope from which the HTA programme is interested in potentially funding more than one proposal. Potential applicants should note that the programme also has a number of specific commissioning briefs, currently open or planned, which may be applied to separately from this call.

We are interested in proposals for the evaluation of strategies and interventions to identify and de-intensify overtreatment. Applicants should clearly define and justify their choice of patient group, study design and outcome measures, and explain how the research will fit into the remit of the HTA programme. Primary research, including randomised and hypothesis-testing observational studies, and evidence syntheses will be considered. We are looking for studies where there is equipoise around the advantages and risks of continued treatment, with the potential to change clinical practice.

Examples of topics of interest include, but are NOT limited to:

  • Studies concerning the optimisation of treatment schedules, as in shorter courses of treatment or reducing the dosage of long-term therapies.
  • Trials of long-term treatments where the evidence of benefits and harms are lacking.
  • Evaluating the safety and effectiveness of withdrawing treatments associated with increased risks at particular timepoints, for example leading up to surgery or during pregnancy.
  • Evaluating interventions or tests to identify individual patients unlikely to benefit from continued treatment, or who may otherwise benefit from de-escalation of treatment.
  • Reducing treatment burden associated with polypharmacy.

Applications to this call are expected to evidence strong patient and public involvement (PPI) from an early stage, particularly around the acceptability of the proposed treatment strategies.

Rationale

For some interventions that are known to be effective, the optimal dose and duration of treatment remains unclear. The issue of risk-benefit analysis is particularly complex for those treatments associated with serious adverse events or side-effects. Where there is clinical equipoise around the possible risks and advantages associated with continued treatment, there may be a rationale for research into treatment deintensification, which aims to decrease treatment-related morbidity without compromising efficacy.

The aim of this brief is to address research questions around optimising care for patients who may be experiencing overtreatment. For the purposes of this brief, overtreatment is considered to be the continuation of treatment for which a diagnosis is ‘correct’, but the treatment has an uncertain probability of benefitting an individual patient further. This includes both chronic and acute treatments but does not include issues of over-diagnosis.

Outcomes are expected to centre around benefits to patients, such as the mitigation of adverse events and improving quality of life; health benefits to wider society, for example antibiotic stewardship, may also be relevant. Although not the focus of this call, resource use and cost savings to the NHS are likely to form part of any effectiveness analysis.

The NIHR Efficacy and Mechanism Evaluation (EME) programme is inviting applications to evaluate novel interventions in this area (link). In light of potential evidence gaps relating to treatments already in use in the NHS, the HTA programme is running this parallel call to invite applications for high quality research into the evaluation of strategies and interventions to identify and de-intensify overtreatment, taking into account published and ongoing research in the field. 

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the Funding opportunities page.  To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 23 September 2020. Applications will be considered by the HTA Funding Committee at its meeting in November 2020.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

IMPORTANT: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in March 2021.

Applications received electronically after 1300 hours on the due date will not be considered.

Should you have any queries please contact us:

Email:

htagb@nihr.ac.uk 

Telephone:

General Funding Committee 02380 595630