Expert elicitation to inform a cost effectiveness analysis of screening for renal cancer: methodological and practical considerations

Background: Population screening for renal cell carcinoma (RCC) using ultrasound has the potential to improve survival outcomes; however a cost-effectiveness analysis (CEA) has yet to be performed. Due to the lack of existing evidence, we performed structured expert elicitation to derive unknown quantities to inform the CEA. Objectives: To elicit the cancer stage distribution (proportion of individuals with each stage of cancer) for different RCC screening scenarios and the annual transition probabilities for undiagnosed disease becoming diagnosed in the NHS. Methods: The study design and reporting adhered to the Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations. The elicitation was conducted face-to-face or via telephone between each individual expert and the facilitator, aided by online material. For multinomial data, Connor Mosimann and modified Connor Mosimann distributions were fitted for each expert and for all experts combined using mathematical linear pooling. Results: A total of 24 clinical experts were invited, and 71% participated (7 urologists, 6 oncologists, 4 radiologists). The modified Connor Mosimann distribution provided the best fit for the majority of elicited quantities. Greater uncertainty was noted for the elicited transition probabilities compared to the elicited stage distributions. Conclusion: We performed the first expert elicitation of RCC screening parameters, crucial information which will inform the CEA of screening. Additionally, the elicited quantities may enable future health economic evaluations assessing the value of diagnostic tools and pathways in RCC

On the influence of building design, occupants and heat waves on comfort and greenhouse gas emissions in naturally ventilated offices. A study based on the EN 15251 adaptive thermal comfort model in Athens, Greece

According to the Intergovernmental Panel on Climate Change the buildings sector has the largest mitigation potential for CO2 emissions. Especially in office buildings, where internal heat loads and a relatively high occupant density occur at the same time with solar heat gains, overheating has become a common problem. In Europe the adaptive thermal comfort model according to EN 15251 provides a method to evaluate thermal comfort in naturally ventilated buildings. However, especially in the context of the climate change and the occurrence of heat waves within the last decade, the question arises, how thermal comfort can be maintained without additional cooling, especially in warm climates. In this paper a parametric study for a typical cellular naturally ventilated office room has been conducted, using the building simulation software EnergyPlus. It is based on the Mediterranean climate of Athens, Greece. Adaptive thermal comfort is evaluated according to EN 15251. Variations refer to different building design priorities, and they consider the variability of occupant behaviour and internal heat loads by using an ideal and worst case scenario. The influence of heat waves is considered by comparing measured temperatures for an average and an exceptionally hot year within the last decade. Since the use of building controls for shading affects thermal as well as visual comfort, daylighting and view are evaluated as well. Conclusions are drawn regarding the influence and interaction of building design, occupants and heat waves on comfort and greenhouse gas emissions in naturally ventilated offices, and related optimisation potential.<br /