EEPRU Publication: Economic analysis of the prevalence and clinical and economic burden of medication error in England

Economic analysis of the prevalence and clinical and economic burden of medication error in England

This paper's objective is to provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.

To read the publication, please click here.

For the project page, please click here.

To sign up to the EEPRU mailing list, please visit http://www.eepru.org.uk/ and scroll down to "subscribe".

EEPRU Report - Burden and Effectiveness of Interventions to Address Overprescribing

Burden and Effectiveness of Interventions to Address Overprescribing

Overprescribing, also known as problematic polypharmacy, refers to when people take too many medicines or when people do not get the full benefit from their medicines. This project aims to summarise the evidence on the burden of problematic polypharmacy and the effectiveness of interventions to address it. The project involves a rapid review of systematic reviews and new scoping searches.

To read the full report, please click here


To sign up to the EEPRU mailing list, please visit http://www.eepru.org.uk/ and scroll down to "subscribe".

Full-time, three year PhD studentships in Health Economics

PhD studentships as part of the Policy Research Unit in Economic Methods of Evaluation in Health & Care Interventions

We are offering up to two fully-funded, full-time, three year PhD studentships in Health Economics. We will provide the successful student with the opportunity to study in an area of health economics of direct relevance to the work of the Policy Research Unit (PRU). You will be based in the section of Health Economics and Decision Science (HEDS) which is part of the School of Health and Related Research (ScHARR), at the University of Sheffield.  

Potential research topic areas are:

• Valuing well-being alongside health
https://www.findaphd.com/phds/project/valuing-well-being-alongside-health-what-can-and-should-be-done/?p110553 

• Capturing caregiver burden within the new eQALY measure
https://www.findaphd.com/phds/project/capturing-caregiver-burden-within-the-new-eqaly-measure/?p110557


• Valuation of severe health states

https://www.findaphd.com/phds/project/valuation-of-severe-health-states/?p110558  

These are on a competition funded basis.


You will be supervised by a team from within the PRU in conjunction with others from ScHARR. The supervisory team will be selected to reflect the research interests and expertise necessary, according to the chosen PhD topic. We will also involve advisors from the Department of Health and Social Care as part of your supervisory team. 

The studentship will include tuition fees (at the home/EU student rate: applications from elsewhere are welcome but would need to self-fund the difference in fees) plus an annual maintenance grant (at the Research Council Doctoral Stipend rate which is currently £15,009 for the year 2019/20). In addition, there is an annual Research Training Support Grant of £750 to cover other expenses such as conference attendance, training courses, equipment and books.

Candidates must have a First or Upper Second-Class Honours Degree, and a Merit at masters or significant, relevant work or research experience.


Enquiries:
Please contact Professor Allan Wailoo (a.j.wailoo@sheffield.ac.uk) for more information about these studentships before submitting an application. 

How to apply:
To apply, complete a University Postgraduate Research Application form available here: www.shef.ac.uk/postgraduate/research/apply 

Clearly state the title of the studentship, the prospective main supervisor and select ScHARR as the department.

You will also need to include:
• a covering letter explaining why you wish to apply for this studentship.
• a copy of your CV.

Closing date for applications: Friday July 12th 2019 at 5pm. Interviews for short-listed candidates are expected to take place within 2-3 weeks of that date. 

Latest date for commencing PhD: 1st January 2020.

EEPRU Update

EEPRU

The University of York and University of Sheffield are to jointly provide a five-year NIHR Policy Research Unit in "Economic Methods of Evaluation in Health and Social Care Interventions" starting January 2019.

Be one of the first to read our reports and publications by signing up today at eepru.org.uk   

More than 200 million medication errors occur in NHS per year

A new study has revealed an estimated 237 million medication errors occur in the NHS in England every year, and avoidable adverse drug reactions (ADRs) cause hundreds of deaths. Researchers from HEDS alongside colleagues from the Universities of York and Manchester report that an estimated 712 per year deaths result from avoidable ADRs. However, researchers say that ADRs could be a contributory factor to between 1,700 and 22,303 deaths a year.

Of the total estimated 237 million medication errors that occur, researchers found that almost three in four are unlikely to result in harm to patients, but there is very little information on the harm that actually happens due to medication errors.

This led researchers to review studies related to the harm caused to patients from ADRs. As well as the number of deaths reported, they also showed that avoidable ADRs had significant cost implications, at £98.5 million per year, but this could be significantly higher.

Fiona Campbell, Research Fellow from HEDS, said: “Measuring harm to patients from medication errors is difficult for several reasons, one being that harm can sometimes occur, when medicines are used correctly, but now that we have more understanding of the number of errors that occur we have an opportunity to do more to improve NHS systems.”

CC BY 2.0 e-Magine Art http://bit.ly/2EVwvc3

The economic impact of medication errors varied widely, from £60 per error for inhaler medication, for example, to more than £6 million in litigation claims associated with anaesthetic errors. The team is calling for more work to be done on finding cost-effective ways of preventing medication errors and their potential harm to patients.

The report, which reflects on 36 studies that detail medication error rates in primary care, care homes and secondary care, showed that the most errors with potential to cause harm happen in primary care (71 per cent), which is where most medicines in the NHS are prescribed and dispensed.

Errors were more likely to occur in older people and in patients with multiple conditions and using many medicines. 

Professor of Health Economics at the University of York, Mark Sculpher, said: “Although these error rates may look high, there is no evidence suggesting they differ markedly from those in other high-income countries. Almost three in four errors would never harm patients and some may be picked up before they reach the patients, but more research is needed to understand just how many that is.”

Rachel Elliott, Professor of Health Economics from the University of Manchester said “The NHS is a world-leader in this area of research, and this is why we have a good idea about error rates. There is still a lot to do in finding cost-effective ways to prevent medication errors. What this report is showing us is that we need better linking of information across the NHS to help find more ways of preventing medication errors.”

The report, funded by the UK Department of Health Policy Research Programme, will be unveiled at the World Patient Safety Science and Technology Summit and is published by the Policy Research Unit in Economics Evaluation of Health and Care Interventions (EEPRU).

Staff and students in the University of Sheffield‘s School of Health and Related Research (ScHARR) work together to tackle some of the world’s biggest health challenges to improve the health and care of people in the UK and around the world.

You can read the report here

New project: Exploring the face validity of ReQoL items with 16-18 year olds

A research team funded by the DH through the Policy Research Unit in Economic Evaluation of Health and Care interventions (EEPRU), is currently developing a patient reported outcome measure (ReQoL), to assess recovery and quality of life for people with mental health difficulties.

Image: WordShore

The government's Children and Young People’s Mental Health Taskforce has suggested extending Child and Adolescent Mental Health Services (CAMHS) to young people up to 25 years of age (DH, 2015b). Extended CAMHS services will require outcome measures suitable for the 16-25 year old population that are able to reliably measure change in older adolescents and younger adults. It is important therefore to establish the face validity of ReQol with the 16+ CAMHS population.

Sixty-one potential items for the ReQoL outcome measure were presented to seventeen Child and Adolescent Mental Health Service (CAMHS) users, using either interview or quasi-focus group methods. Content analysis was used to help make decisions on which items to include in the next stages of the measure development.

Young people aged 16-18 have also been included in subsequent stages of the instrument development and a pilot focus group has taken place with CAMHS clinicians to understand issues of clinical appeal and utility. Further focus groups are being planned.

Value of implementation

The Department of Health's Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU), recently completed a programme of work examining the value of investing in greater implementation of health interventions.  The programme consisted of a review, the development of a framework and the application of the framework in two case studies.  The reports are listed below, whilst the full reports are available here.

• Essat M, Faria R, Gomersall T, Grimm S, Keetharuth A, Walker S, Dixon S, Palmer S, Sculpher M.  Getting cost-effective technologies into practice: the value of implementation.  Report on initial scoping review for Phase 1. 
• Walker S, Faria R, Dixon S, Palmer S, Sculpher M.  Getting cost-effective technologies into practice: the value of implementation.  Report on framework for valuing implementation initiatives. 
• Faria R, Walker S, Whyte S, Dixon S, Palmer S, Sculpher M.  Getting cost-effective technologies into practice: the value of implementation.  An application to novel anticoagulants in the prevention of stroke and systemic embolism.
• Whyte S,  Dixon S, Faria, Walker S, Palmer S, Sculpher M.  Getting cost-effective technologies into practice: the value of implementation.  An application to B-type natriuretic peptide (BNP) testing in diagnosing chronic heart failure.

HEDS at ISPOR

6 workshops, 3 issues panels, 3 research podiums and 13 posters.  Or see us at Booth 129.  This is all neatly summarized in in the slides below.

If this isn’t friendly to your device, details are below: 

Workshops

Monday (W3) 16:45-17:45
Navigating the waters of economic evaluations of medical devices
Praveen Thokala

Tuesday (W7) 08:45-09:45
Statistical challenges in HTA
Nick Latimer

Tuesday (W8) 08:45-09:45
The economic evaluation of diagnostics: challenges and methods for assessing value
Ron Akehurst

Tuesday (W11) 08:45-09:45
Multiple challenges in capturing utilities for paediatric conditions
John Brazier

Wednesday (W24) 13:34-14:45
Methods for dealing with treatment switching in clinical trials
Nick Latimer

Wednesday (W25) 13:45-14:45
Navigating the pitfalls around progression-free survival estimation
John Stevens

Issues panels

Tuesday (IP7) 13:45 - 14:45
Making value-based pricing a reality
John Brazier (panelist)

Tuesday (IP8) 13:45-14:45
How are the results from HTA methodology research implemented in the updates of HTA guidelines?
Allan Wailoo (panelist)

Wednesday (IP17) 10:00 - 11:00
How can health economic modellers win the trust of decision makers?
Paul Tappenden (panelist)

Research Podiums

Monday (M01) 14:15-15:15
A guide to adjusting survival time estimates to account for treatment switching in randomised controlled trials
Nick Latimer

Monday (PP2) 14:15-15:15
Multinational consistency of a discrete choice model in quantifying health states for the extended 5-level EQ-5D
Ben van Hout

Monday (CL3) 15:30-16:30
Validation of surrogate endpoints in advanced solid tumours: systematic review of statistical methods, results and implications for policy makers.
Paul Tappenden

Posters

Monday (PRS6) Discussion: 13:15-14:15
Systematic review of colistimethate sodium dry powder and tobramycin dry powder antibiotics for pseudomonas aeruginosa lung infection in cystic fibrosis
Sue Harnan

Monday (PRS38) Discussion: 13:15-14:15
The cost-effectiveness of dry powder antibiotics for the treatment of pseudomonas aeruginosa in patients with cystic fibrosis
Paul Tappenden

Monday (PCN89) Discussion: 18:30-19:30
Economic evaluation of an electrical impedance spectoscopy (EIS) device used as an adjunct to colposcopy
Alice Bessey

Monday (PCN97) Discussion: 18:30-19:30
A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer
Roberta Ara

Monday (PCN107) Discussion: 18:30-19:30
Economic evidence of surgical procedures in cancer:
a systematic literature review
Hasan Basarir

Monday (PCN121) Discussion: 18:30-19:30
Evaluating the cost effectiveness of gene expression profiling and immunohistochemistry tests
Rachid Rafia

Tuesday (PHP216) Discussion: 12:45-13:45
Comparing the value of different HTA decision making process: evaluating the evaluators
Allan Wailoo

Tuesday (PCV90) Discussion: 18:00-19:00
Issues with cost-effectiveness modelling of diagnostic tests – case study of ischaemic cardiomyopathy
Praveen Thokala

Tuesday (PCV105) Discussion: 18:00-19:00
Telemonitoring after discharge from hospital with heart failure – cost-effectiveness modelling of alternative service designs
Praveen Thokala

Tuesday (PMS61) Discussion: 18:00-19:00
Health economic modelling of sequential therapies for rheumatoid arthritis: A systematic review
Jon Tosh

Wednesday (PRM32) Discussion: 12:45-13:45
Development of the ScHARR Health Utilities Database (HUD)
Angie Rees

Wednesday (PRM178) Discussion: 12:45-13:45
Modelling the relationship between the Womac osteoarthritis index and EQ-5D
Allan Wailoo

Wednesday (PRM230) Discussion: 12:45-13:45
Should there be an option to “unrefer” NICE single technology appraisals: case study of aripiprazole for bipolar I disorder in adolescents
Lesley Uttley

Value Based Pricing methods reports

The Department of Health's Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU)  - a collaboration between the Universities of Sheffield and York – has been working on generating evidence to support the DH’s Value Based Pricing Framework.  Two papers are currently available from the EEPRU publications page:

Brazier J, Rowen D, Mukura C, Whyte S, Keetharuth A, Risa Hole A, Tsuchiya A, Shackley P.  Eliciting societal preferences for burden of illness, therapeutic improvement and end of life for value based pricing: a report of the main survey.  Report for the Department of Health, 2013.

Ara R, Kearns, Mukuria C, van Hout B, Brazier J.  Examining productivity losses associated with health related quality of life using patient and general population data.  Report for the Department of Health, 2013.

A third paper will be available in the next couple of days:

Rowen D, Dixon S, Hernandez M, Mukuria C.  Estimating informal care effects associated with EQ-5D tariff values for use in economic evaluation.  Report for the Department of Health, 2013.

The extent to which this evidence will be used in the VBP framework is not yet known.

Photo credit: Images_of_Money via Flickr Creative Commons

Reimbursement in the Netherlands

John Brazier was invited to present a talk and attend an expert advisory meeting on ‘burden of disease’ at the College Voor Zorgverkeringen in Amsterdam who advise the Government in the Netherlands on reimbursement of new health care technologies for their National Insurance scheme on 15 June 2012.

John's invitation follows his work as part of EEPRU in support of the Department of Health's (DH) ongoing work developing the Value Based Pricing (VBP) scheme.  HEDS has undertaken stated preference work with the DH in order to generate weightings that will be used within VBP.

EEPRU work programme

The Department of Health Policy Research Unit in Economic Evaluation of Health and Care Interventions (or EEPRU) is a collaboration between HEDS at the University of Sheffield and CHE at the University of York.  Its work programme has two broad types of work; responsive and non-responsive projects.  The responsive work tends to relate to a particular policy impertive, and as such, it is expected to be short or medium–term work with little in the way of lead time.

The responsive programme currently consists of one project on Value Based Pricing.

The other work programmes include applied projects relating to obesity, mental health, innovation and cancer awareness.  Additionally, there are methodological projects relating to individualised care, outcomes and inter-sectoral effects.

For more information on the EEPRU work programme, please contact the Unit Administrator, Liz Metham.

DH Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU)

The Unit is a collaboration between the School of Health and Related Research (ScHARR) at the University of Sheffield and the Centre for Health Economics (CHE) at the University of York.  Directed by Professor John Brazier with Professor Mark Sculpher as his Deputy the unit is tasked to undertake economic evaluations of health and care interventions on behalf of the UK Department of Health (DH).

The initial programme relates to obesity, mental health and innovative technologies as well as methodological themes relating to outcomes, individualised health care and intersectoral effects of interventions. However, the work programme is continually developing in line with the needs of the DH. 

In addition to the Directors, the other members of EEPRU in Sheffield are Ron Akehurst, Roberta Ara, Simon Dixon, Anju Keetharuth, Suzy Paisley, Donna Rowen, Paul Tappenden, and Allan Wailoo.  The other members of EEPRU in York are Karl Claxton, Steve Palmer, Nigel Rice and Helen Weatherly.

EEPRU is one of nine new Policy Research Units established by the DH to give support across the full range of health policy issues.  The other Units and principal institutions are in Quality and Outcomes of Person‐Centred Care (University of Kent), Commissioning and the Healthcare System (LSHTM), Policy Innovation Research (LSHTM), Economics of Health and Social Care Systems (University of York), Cancer Awareness, Screening and Early Diagnosis (Barts and the London Queen Mary University of London), Behaviour and Health (University of Cambridge), Maternal Health and Care, (University of Oxford) and Children, Young People and Families (University College London).