HEDS is part of the School of Health and Related Research (ScHARR) at the University of Sheffield. We undertake research, teaching, training and consultancy on all aspects of health related decision science, with a particular emphasis on health economics, HTA and evidence synthesis.

Thursday, 20 October 2016

2nd Panel on Cost-Effectiveness in Health and Medicine

After three years for deliberation, they’ve reported!  For those of you unaware of the history, the 1st Panel was convened in 1993 and introduced a set of methods that were widely used and pre-dated just about all reimbursement guidelines.  They introduced the concept of a reference case!

The guidelines have been updated.  Most of the recommendations (which are in an e-Appendix) are largely unchanged, but here’s the most important changes that I can see…..
  • Two reference cases
  • Inclusion of an impact inventory
  • Inclusion of future
  • Design and analysis protocols
  • Decision model recommendations
  • Reporting checklist
  • Unrelated health care costs included in additional years of life
  • CEACs and CEAFs
  • Value of information analysis
There is a downside to this of course……I’m going to have to re-write my lectures on our International Health Technology Assessment suite of teaching!

Wednesday, 19 October 2016

Stephen Senn inaugural lecture….

…titled "Numbers needed to mislead, meta-analysis and muddled thinking".  Stephen is an Honorary Professor in the Design, Trials and Statistics section of ScHARR.

The lecture is on Wednesday 26 October 2016, 17.15-18.00 and followed by a wine reception.  The lecture is in Lecture Theatre 4, The Diamond. All are welcome to attend.  Please confirm your attendance, using the on-line booking form here.

The abstract to his lecture is below:
'The ardent espousal by the evidence based medicine movement of numbers needed to treat (NNT) as a way of making difficult statistical concepts simple and concrete, has has the unintended consequence of sowing confusion. Many users, including many in the evidence based movement themselves, have interpreted these statistics as indicating what proportion of patients benefit from treatment. However, they cannot deliver this information.

I shall explain this, with the example of a recent Cochrane Collaboration meta-analysis of paracetamol against placebo in trials of tension headache for which the plain language summary claimed:

'The outcome of being pain free or having only mild pain at two hours was reported by 59 in 100 people taking paracetamol 1000 mg, and in 49 out of 100 people taking placebo (high quality evidence), meaning that only 10 in 100 people benefited because of paracetamol 1000 mg.'

With the aid of a simple model also illustrated (just for fun) by a simulation, I shall show that the plain language conclusion is plain wrong. The observed facts do not necessarily mean that only 10 in 100 people benefited.

I conclude that the combination of arbitrary dichotomies and NNTs has a dangerous ability to deceive and may be leading us to expect much more of personalised medicine than it can deliver'

Image: The Diamond by Kyle Emmerson

Tuesday, 18 October 2016

Proceedings of Sheffield PROMs Conference 2016

Abstract from the Conference held on 9th June 2016 are now available in Health and Quality of Life Outcomes via here.  The papers are listed below.
  • Using computerized adaptive testing
  • Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy?
  • “Am I going to get better?” - Using PROMs to inform patients about the likely benefit of surgery
  • Identifying Patient Reported Outcome Measures for an electronic Personal Health Record
  • Examining the change process over time qualitatively: transformative learning and response shift
  • Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voice
  • Development of the Primary Care Outcomes Questionnaire (PCOQ)
  • Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems
  • Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level
  • Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study
  • eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patients
  • Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom
  • Cross-sectional and longitudinal parameter shifts in epidemiological data: measurement invariance and response shifts in cohort and survey data describing the UK’s Quality of Life
  • Patient-reported outcomes within health technology decision making: current status and implications for future policy
  • Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England dataset
  • Where patients and policy meet: exploring individual-level use of the Long-Term Conditions Questionnaire (LTCQ)

Monday, 17 October 2016

Threshold for NICE Highly Specialised Technologies

NICE and NHS England are consulting on a proposal to introduce a cost effectiveness level of £100,000 per QALY for NICE’s Highly Specialised Technologies (HST) programme.

The consultation, here, is open until 13th January 2017.

New ‘light touch’ appraisal process for NICE?

A consultation is open on a proposal that treatments that are likely to have a cost per QALY (quality adjusted life year) of up to £10,000 would be dealt with more quickly under a ‘lighter touch’ process.

Sir Andrew Dillon, NICE chief executive, said: “We want to be more agile and flexible in the way we make decisions about new drugs, medical devices and diagnostics, so that patients can get access to them more quickly and the NHS can manage its resources fairly and efficiently. NICE and NHS England have worked together to develop these proposals.”

The consultation, here, is open until 13th January 2017.

Image: DSC_0052 by Ajith K

Thursday, 13 October 2016

Double Research Innovation Grants from Alcohol Research UK

Alcohol Research UK
Alcohol Research UK
Researchers in the Sheffield Alcohol Research Group in ScHARR have recently been awarded two Research Innovation Grants from Alcohol Research UK. These grants are awarded to projects which take a novel approach to address alcohol-related problems and which aim to improve public knowledge on alcohol.

In a time when increasing demands are being placed on ever more stretched NHS budgets, alcohol places a substantial burden on the healthcare system, estimated at over £3.3billion each year. Alcohol is also a major driver of socioeconomic inequalities in health, which place an additional burden on society. The successful grants, which will run for 18 months, will provide new evidence to policy makers and healthcare professionals on the impact of alcohol on Primary Care and the potential of Primary Care-based interventions to alter this.

Duncan Gillespie
Duncan Gillespie
The first project, led by Duncan Gillespie and involving researchers at the Universities of Sheffield and Nottingham, aims to quantify the burden that alcohol places on primary care in England. The project will develop methods to estimate the financial costs of Primary Care consultations, including prescribing, that occur because of alcohol consumption. 

"We are developing new methods to make use of a vast dataset of primary care records in collaborations with partners at the Universities of Nottingham and Newcastle." (Duncan Gillespie)

The findings will help to engage Primary Care professionals and policy makers as stakeholders in alcohol harm reduction. 

"This is an opportunity to understand the financial burden that alcohol imposes on primary care, and the actions that primary care practitioners are taking to reduce this burden." (Duncan Gillespie)

Colin Angus
Colin Angus
The second project, led by Colin Angus and involving researchers at both the Universities of Sheffield and Newcastle, will look at the extent to which Screening and Brief Interventions (SBIs) in Primary Care impact on alcohol-related inequalities in health. SBIs form a major part of NICE guidelines on the management of hazardous and harmful drinking in Primary Care, yet delivery rates remain low. This project will analyse Primary Care records together with a range of national survey data to understand how current SBI delivery and potential alternative delivery strategies are likely to impact on population health and NHS costs as well as on health inequalities. These findings will help local and national policy makers design more effective and cost-effective SBI policies and potentially reduce inequalities in health.

Wednesday, 12 October 2016

Recording of Professor Eva Kaltenthaler Inaugural Lecture - Assessing the evidence: a NICE journey

HEDS professor Eva Kaltenthaler was our latest esteemed colleague to deliver a ScHARR Inaugural Lecture where she described her work as a systematic reviewer undertaking technology appraisals for the National Institute for Health and Care Excellence (NICE).

Professor Kaltenthaler discussed the process used to assess new treatments for use in the NHS and changes to research methods in systematic reviewing as well as changes to the NICE technology appraisal process over the past 15 years. She outlined her involvement in a range of research projects exploring the methods used in technology appraisal. Professor Kaltenthaler also briefly outlined her earlier work using mixed methods research to study hygiene behaviour.

We captured the 40 minute lecture which you can watch below.

September’s CEAs.....

Our quick search for CEA’s published in September uncovered 58 articles.   In the right-hand column of this blog is a CEA Archive, which includes our CEA search results by month.  Below are those in our areas of interest.
  • Diaby V, Adunlin G, Ali AA, Zeichner SB, de Lima Lopes G, Kohn CG, et al. Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States. Breast cancer research and treatment. 2016;160(1):187-96.
  • Ekwunife OI, O'Mahony JF, Gerber Grote A, Mosch C, Paeck T, Lhachimi SK. Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations. PharmacoEconomics. 2016.
  • Lindkvist M, Feldman I. Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L. Health and quality of life outcomes. 2016;14(1):134.
  • Machado de Assis TS, Azeredo-da-Silva AL, Werneck GL, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2016;110(8):464-71.
  • Shim E. Dengue Dynamics and Vaccine Cost-Effectiveness Analysis in the Philippines. The American journal of tropical medicine and hygiene. 2016.
  • Verguet S, Kim JJ, Jamison DT. Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial. PharmacoEconomics. 2016;34(9):913-23.
  • Yang MC, Tan EC, Su JJ. Cost-Effectiveness Analysis of Quadrivalent versus Trivalent Influenza Vaccine in Taiwan: A Lifetime Multi-Cohort Model. Human vaccines & immunotherapeutics. 2016:0.
Image: flu vaccine by Penn State

Monday, 10 October 2016

Real World Data: guidance from the DSU

The NICE Decision Support Unit, based in HEDS, has published a report that provides guidance on the use of real world data (RWD) for the estimation of treatment effects in NICE decision making.

It builds on the NICE Decision Support Unit (DSU) Technical Support Document (TSD17) “The use of observational data to inform estimates of treatment effectiveness in technology appraisal: methods for comparative individual patient data” (Faria et al, 2015), which focused on methods commonly used to estimate treatment effects from non-randomised studies, where individual patient data (IPD) is available.

This report expands on the TSD by considering how RWD has been used to inform decision making in seven of NICE’s programmes, how it could have been used and the guidance that NICE currently provides to those responsible for submitting evidence, critiquing evidence and making decisions based on those assessments.

Wednesday, 5 October 2016

Latest Publications from HEDS in September

Here are the latest publications from September, including those 'In Press' by HEDS colleagues and their collaborators. 

Beard, E., Brown, J., West, R., Angus, C., Brennan, A., Holmes, J., … Michie, S. (n.d.). Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England. PLoS One, 11(9), e0160666. JOUR. http://doi.org/10.1371/journal.pone.0160666

De Vocht, F., Brown, J., Beard, E., Angus, C., Brennan, A., Michie, S., … Hickman, M. (2016). Temporal patterns of alcohol consumption and attempts to reduce alcohol intake in England. BMC Public Health, 16(1). http://doi.org/10.1186/s12889-016-3542-7 
BMC Public Health Journal
BMC Public Health

Dixon, P., Hollinghurst, S., Ara, R., Edwards, L., Foster, A., & Salisbury, C. (n.d.). Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial. BMJ Open, 6(9), e012355.. http://doi.org/10.1136/bmjopen-2016-012355
Duncan, R., Essat, M., Jones, G., Booth, A., Woods, H., Poku, E., … Michaels, J. (n.d.). Patient-Reported Outcome Measures for Abdominal Aortic Aneurysm: A systematic review and qualitative evidence synthesis. British Journal of Surgery. (In Press)

Circulation Journal
       Franklin, M., Wailoo, A., Dayer, M. J., Jones, S., Prendergast, B., Baddour, L. M., … Thornhill, M. (n.d.). The cost-effectiveness of antibiotic prophylaxis for patients at risk of infective endocarditis. Circulation Journal. (In Press)

      Gardiner, C., Ingleton, C., Ryan, T., Ward, S., & Gott, M. (2016). What cost components are relevant for economic evaluations of palliative care, and what approaches are used to measure these costs? A systematic review. Palliat Med. http://doi.org/10.1177/0269216316670287

Gibson, L. A., Hernandez, M., Kelly, M. P., & Campbell, M. J. (2016). The effects of breastfeeding on childhood BMI: a propensity score matching approach. Journal of Public Health.  http://doi.org/10.1093/pubmed/fdw093 
Journal of Public Health
Journal of Public Health

McDonagh, J. E., Farre, A., Aldiss, S., Biggs, K., & Campbell, F. (n.d.). Adding to the transitional care evidence base for future national guidance. BMJ, i3710. http://doi.org/10.1136/bmj.i3710