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.

Monday, 23 April 2018

March’s CEAs, systematic reviews and epidemiological models in LMICs

To help us keep on top of current research in low and middle-income countries, we are running a monthly search of research that is aligned to our core research interests.  It's a simple search strategy, with those published last month that are most aligned to our interests listed below.  The full list of articles is kept in our "Searches archive" in the right-hand column.
  • Cazarim MS, Pereira LRL. Cost-effectiveness analysis of pharmaceutical care for hypertensive patients from the perspective of the public health system in Brazil. PloS one. 2018;13(3):e0193567.
  • Loganathan T, Ng CW, Lee WS, Hutubessy RCW, Verguet S, Jit M. Thresholds for decision-making: informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia. Health policy and planning. 2018;33(2):204-14.
  • Luz PM, Osher B, Grinsztejn B, Maclean RL, Losina E, Stern ME, et al. The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil. Journal of the International AIDS Society. 2018;21(3):e25096.
  • Pang B, Zhao LH, Li XL, Song J, Li QW, Liao X, et al. Different intervention strategies for preventing type 2 diabetes mellitus in China: A systematic review and network meta-analysis of randomized controlled trials. Diabetes, obesity & metabolism. 2018;20(3):718-22.
  • Zeng W, Li G, Ahn H, Nguyen HTH, Shepard DS, Nair D. Cost-effectiveness of health systems strengthening interventions in improving maternal and child health in low- and middle-income countries: a systematic review. Health policy and planning. 2018;33(2):283-97.

Thursday, 19 April 2018

Vacancy at HEDS - Research Associate / Fellow in Health Econometrics

HEDS are advertising for a Research Associate / Fellow in Health Econometrics. 

Grade 7 Research Associate £30,688 to £38,833 per annum with the potential to progress to £42,418 through sustained exceptional contribution. 

Grade 8 Research Fellow £39,992- £47,722 per annum, with the potential to progress to £53,691 through sustained exceptional contribution.

Closing Date: 17th May 2018

Image of ScHARR - Regent Court
ScHARR - Regent Court
Summary: We are seeking to appoint an Econometrician at either Research Associate (Grade 7) or Research Fellow (Grade 8) level. The post is within the Health Economics and Decision Science (HEDS) section of the School of Health and Related Research (ScHARR). You will join a small research group within HEDS and be managed by Dr Monica Hernandez. You will work as a specialist in the econometrics of health, supporting a range of projects that each aim to develop and apply new and existing econometric methods to a range of health issues. You will be responsible for contributing to this programme of methodological and applied work, developing, testing, refining and applying a range of microeconometric techniques. Applications include modelling health state utility values, joint modelling of wellbeing and utility measures, and the analysis of non-randomised data. You will be actively encouraged to develop your own methodological interests and to provide specialist support to health economists and decision modellers in the HEDS section.

This is an opportunity for a very technical applicant to work on high impact studies in the area of health economics. We welcome applications from those currently involved in other areas of econometrics and will provide training to those coming from outside the health field. A PhD in microeconometrics or similar experience is required for this role. We build teams of people from different heritages and lifestyles from across the world, whose talent and contributions complement each other to greatest effect. We believe diversity in all its forms delivers greater impact through research, teaching and student experience. This post is fixed term for 3 years working full time

The supporting documentation can be viewed and the on-line application accessed via the following link:   https://tinyurl.com/ybfkpj9w

Come join us.

Wednesday, 18 April 2018

Recommendations for an NHS England algorithm to use disease-modifying drugs to treat multiple sclerosis

This document is open for consultation until the 5th May.  It’s not entirely clear how they were constructed….that can’t be right, can it?

March’s CEAs.....

Our quick search for CEA’s published in March uncovered 55 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.
  • Kay E, Owen L, Taylor M, Claxton L, Sheppard L. The use of cost-utility analysis for the evaluation of caries prevention: an exploratory case study of two community-based public health interventions in a high-risk population in the UK. Community dental health. 2018;35(1):30-6.
  • Leurent B, Gomes M, Carpenter JR. Missing data in trial-based cost-effectiveness analysis: An incomplete journey. Health economics. 2018.
  • Penaloza-Ramos MC, Jowett S, Sutton AJ, McManus RJ, Barton P. The Importance of Model Structure in the Cost-Effectiveness Analysis of Primary Care Interventions for the Management of Hypertension. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2018;21(3):351-63.
  • Walter E, Dellago H, Grillari J, Dimai HP, Hackl M. Cost-utility analysis of fracture risk assessment using microRNAs compared with standard tools and no monitoring in the Austrian female population. Bone. 2018;108:44-54.

Monday, 16 April 2018

New estimate suggests a quarter of the world's population has latent tuberculosis

Following on from an earlier blog post on this site, HEDS Pete Dodd, University of Sheffield and Rein Houben, London School of Hygiene & Tropical Medicine have written a piece for The Conversation. about the new estimate that suggests a quarter of the world's population has latent tuberculosis

In rich countries, tuberculosis is sometimes thought of as a thing of the past, the disease that claimed Keats, Poe, Chopin. But globally, TB is today the number one infectious killer, causing an estimated 1.8m deaths in 2015.

Unlike many bugs, infection with the bacterium that causes TB doesn’t usually result in disease. The usual dictum is that only 10% of people who are infected will ever develop TB, but this may occur many years after initial infection. The flip side of this is that latent infection with Mycobacterium tuberculosis is far more common than the disease – and it is commonly stated that a third of all people worldwide carry it.
However, the last systematic attempt to estimate the number of latent TB infections was 20 years ago. Since then, many things have changed. The world population has increased by over 20% and grown older; in China, the median age has increased by ten years over this period. At the same time, children make up nearly half of the population in most sub-Saharan countries in Africa.

The fraction of people with TB disease has declined, despite upswings associated with HIV in some regions through the nineties. Developing new ways to address the pool of latent TB infection is now seen as an emerging front in its control. Clearly it’s time to reevaluate the “one-third” figure, which has become an oral tradition.

In a new paper published in PLOS Medicine, we reconstructed the “force of infection” for TB – the chance that an individual would become infected with Mycobacterium tuberculosis – in 180 countries (equivalent to about 99% of the world’s population) over the past 80 years. We approached this by compiling data from surveys testing for latent infection, largely prior to 1990. After 1990, we used estimates from the World Health Organisation on the prevalence of TB, and data relating prevalence to infection risk. The further back our estimates went, the more uncertain they became, especially for countries where data is sparse. So we took account of this uncertainty in our analyses. Applying these historical trends in infection risk to the demographic breakdowns of each country, we could work out what proportion of people in each age group was likely to have a latent TB infection.

We found that closer to a quarter of today’s global population has a latent TB infection – around 1.7 billion people. More than 80% of this burden is concentrated in Asia and Africa, where it is usually concentrated in older age groups as the prevalence of infection increases with age. Despite this, we estimate that nearly 100m children (more than the entire population of Germany) already carry a latent TB infection.

Country overlaps with TB, multi-drug resistant TB, and HIV related TB. WHO Global Tuberculosis Report 2016

We also worked out that even if all TB transmission stopped tomorrow, the current pool of 1.7 billion latent infections alone would prevent the number of those with TB from reaching the global targets set by the World Health Organisation for 2035, and the vision for TB elimination by 2050.

It is clear that if we really want to make TB a disease of the past, we will need to address this pool of 1.7 billion. New diagnostic tools are needed accurately to identify those individuals with latent TB infections that are likely to progress to disease, and new tools are needed to safely treat them. Only then can the current guidelines for latent TB infection be expanded from their focus on relatively small high risk groups (for example recent close contacts of individuals with TB or those infected with HIV) to reach a wider population.
The ConversationThe sheer numbers of those infected show that TB is not only still with us, it also needs to become a priority if we are going to address this ancient disease that still infects over a billion people, including 100m children, and causes more than 10m cases of disease and nearly 2m deaths each year. It’s much more than a numbers game, TB is a deadly reality.
Pete Dodd, Research Associate in Health Economic Modelling, University of Sheffield and Rein Houben, Associate Professor in Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine

This article was originally published on The Conversation. Read the original article.

Friday, 13 April 2018

Website of the Month - Office of Health Economics News Site

This month's useful web resource is the news pages for the Office of Health Economics. The news site is updated weekly and provides information on upcoming seminars, new papers and other information of interest to the health economist environment.

Image of the OHE News web pages
© OHE.org
About the OHE
OHE provides authoritative resources, research and analyses in health economics, health policy and health statistics both through our independent research and in our consultancy. Our work informs decision making about health care and pharmaceutical issues at the UK, regional and international levels.


Wednesday, 11 April 2018

New methods paper on Sampling Ordered Parameters in Probabilistic Sensitivity Analysis

Image of Dr. Shijie Ren
Dr. Shijie Ren

Dr. Shijie Ren (also known as Kate Ren) has recently published a paper with some colleagues from HEDS and the University of Glasgow proposing a new method of sampling ordered parameters for use in cost-effectiveness analysis. Their new approach, known as the difference method (DM), is designed to address the difficulties of sampling parameters with a constraint in probabilistic sensitivity analysis, e.g., sampling utility associated with different severity levels of a disease.

Dr. Ren, who specialises in the application of Bayesian methods in health economics, argues that “Typical sampling approaches often lack either statistical or clinical validity.  For example, sampling using a common number generator results in extreme dependence, and independent sampling can lead to realisations with incorrect ordering.”

The DM approach uses a “difference parameter” to sample the parameters of interest; a method which generates ordered parameters with greater validity for use in probabilistic sensitivity analysis.

The article, published in Pharmacoeconomics, is available open-access and can be found (along with a Microsoft Excel workbook to implement the method) at http://dx.doi.org/10.1007/s40273-017-0584-3

Tuesday, 10 April 2018

PhD Studentship in Health Economics and Decision Science (HEDS)

iMAGE OF Regent Court - ScHARR
Regent Court - ScHARR
PhD Studentship in Health Economics and Decision Science (HEDS) in conjunction with the National Institute for Health and Care Excellence (NICE)
Proposed start date: 1st January 2019 (latest) 
Project details: 
We are offering a fully-funded, full-time, three year PhD studentship in Health Economics. The position is jointly funded by NICE and the University of Sheffield. We will provide the successful student with the opportunity to study in an area of direct relevance to NICE policy. 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. We welcome applications to undertake methods research in the following areas: the design and assessment of risk-sharing schemes in Health Technology Assessment, the value of data sharing from clinical trials and observational studies, methods for examining the relationships between outcome measures used in the assessment of health technologies. 
Image of Professor Allan Wailoo
Professor Allan Wailoo
You will be supervised by Professor Allan Wailoo 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. 

Staff from NICE will also be part of the supervisory team, helping to ensure that the research addresses issues of relevance to the Institute. You will be given the opportunity to spend time at NICE to gain insights into the way the Institute operates and to disseminate your research work with other staff at the Institute and its partners. 

About ScHARR: 
With over 300 multidisciplinary staff, and 450 postgraduate students from more than 50 countries around the world, it is the focus for a large, diverse and internationally recognised programme of health services and public health research, knowledge transfer and research led teaching. Its research informs, at both patient and population levels, the way in which health care should be delivered. It studies and evaluates health, healthcare, health services and health policy from the broadest possible range of clinical, economic and social perspectives. 
In the recent assessment for the quality of research in the UK (REF2014), ScHARR was ranked in the top six universities for the volume of world leading research being conducted here. 
For more information about ScHARR visit: http://www.shef.ac.uk/scharr/ 

Entry Requirements: 
Candidates must have a first or upper second class honours degree, and a Merit at masters or significant, relevant work or research experience. 

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

Please clearly state the title of the studentship and the prospective main supervisor (Professor Allan Wailoo), and select ScHARR as the department. 

You will also need to include: 
• an outline of your proposed PhD study, in line with the research themes described above, of approximately 3 pages of A4. 
• a covering letter explaining why you wish to apply for this studentship. 
• a copy of your CV. 

Funding Notes:
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 £14,777 for the year 2018/19). 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.

Monday, 9 April 2018

Latest Publications from HEDS in March

Once again we explore what new publications have been produced by HEDS in collaboration with colleagues in ScHARR and further afield. Many of these are currently in press, so you can find much of our work in its open access form via our institutional repository. You can view them and many others here.

Image of Journal of Clinical Epidemiology Journal front cover
        Booth, A., Noyes, J., Flemming, K., Gehardus, A., Wahlster, P., Jan van der Wilt, G., Mozygemba, K., Refolo, P., Sacchini, D., Tummers, M., Rehfuess, E., 2018. Structured methodology review identified seven (RETREAT) criteria for selecting qualitative evidence synthesis approaches. Journal of Clinical Epidemiology. doi:10.1016/j.jclinepi.2018.03.003

       Campbell, F., Booth, A., Hackett, S., Sutton, A., n.d. Young people who display harmful sexual behaviors and their families. A qualitative systematic review of their experiences of professional interventions. Trauma, Violence, Abuse.

       Cooper, C., Varley-Campbell, J., Booth, A., Britten, N., Garside, R., 2018. Systematic review identifies six metrics and one method for assessing literature search effectiveness but no consensus on appropriate use. Journal of Clinical Epidemiology. doi:10.1016/j.jclinepi.2018.02.025

Cox, M., O’Connor, C., Biggs, K., Hind, D., Bortolami, O., Franklin, M., Collins, B., Walters, S., Wailoo, A., Channell, J., Albert, P., Freeman, U., Bourke, S., Steiner, M., Miles, J., O’Brien, T., McWilliams, D., Schofield, T., O’Reilly, J., Hughes, R., 2018. The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation. Health Technology Assessment 22, 1–204. doi:10.3310/hta22110

Image of Journal of Medical Economics journal front cover
© Taylor & Francis
Lipton, R.B., Brennan, A., Palmer, S., Hatswell, A.J., Porter, J.K., Sapra, S., Villa, G., Shah, N., Tepper, S., Dodick, D., 2018. Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures: a US societal perspective. Journal of Medical Economics 1–26. doi:10.1080/13696998.2018.1457533

Machaczek, K.K., Allmark, P., Goyder, E., Grant, G., Ricketts, T., Pollard, N., Booth, A., Harrop, D., De-La Haye, S., Collins, K., Green, G., 2018. A scoping study of interventions to increase the uptake of physical activity (PA) amongst individuals with mild-to-moderate depression (MMD). BMC Public Health 18. doi:10.1186/s12889-018-5270-7

Penn, L., Rodrigues, A., Haste, A., Marques, M.M., Budig, K., Sainsbury, K., Bell, R., Ara├║jo-Soares, V., White, M., Summerbell, C., Goyder, E., Brennan, A., Adamson, A.J., Sniehotta, F.F., n.d. NHS Diabetes Prevention Programme in England: formative evaluation of the programme in early phase implementation. BMJ Open 8, e019467. doi:10.1136/bmjopen-2017-019467

Pollard, D.J., Brennan, A., Dixon, S., Waugh, N., Elliott, J., Heller, S., Lee, E., Campbell, M., Basarir, H., White, D., n.d. The cost-effectiveness of insulin pumps compared to multiple daily injections, both provided with structured education, for adults with type 1 diabetes: a health economic analysis of the relative effectiveness of pumps over structured education (REPOSE) randomised controlled trial. BMJ Open. doi:10.1136/bmjopen-2017-016766

Image of Medical Decision Making journal front cover
© SAGE Journals
       Rafia, R., Pandor, A., Davis, S., Stevens, J.W., Harnan, S., Clowes, M., Sorour, Y., Cutting, R., 2018. Obinutuzumab with Bendamustine for Treating Follicular Lymphoma Refractory to Rituximab: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. doi:10.1007/s40273-018-0645-2

       Ren, S., Oakley, J.E., Stevens, J.W., 2018. Incorporating Genuine Prior Information about Between-Study Heterogeneity in Random Effects Pairwise and Network Meta-Analyses. Medical Decision Making. doi:10.1177/0272989X18759488

       Rowen, D.L., Mulhern, B., Stevens, K., Vermaire, E., n.d. Estimating a Dutch value set for the paediatric preference-based CHU-9D using a discrete choice experiment with duration. Value in Health.

Shah, K., Tsuchiya, A., Wailoo, A., n.d. Valuing health at the end of life: A review of stated preference studies in the social sciences literature. Social Science Medicine. doi:10.1016/j.socscimed.2018.03.010

Image of PharmacoEconomics Journal front cover
© Adis
Stevenson, M., Pandor, A., Hamilton, J., Stevens, J., Rowntree, C., Martyn-St James, M., Rawdin, A., Wong, R., 2018. Ponatinib for Treating Acute Lymphoblastic Leukaemia: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. doi:10.1007/s40273-018-0624-7

Uttley, L., Bermejo, I., Ren, S., Martyn-St James, M., Wong, R., Scott, D.L., Young, A., Stevenson, M., 2018. Tofacitinib for Treating Rheumatoid Arthritis After the Failure of Disease-Modifying Anti-rheumatic Drugs: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics 1–10. doi:10.1007/s40273-018-0639-0

Thursday, 29 March 2018

Pete Dodd involved in largest ever study on impact of TB and HIV interventions

Dr Pete Dodd of HEDS is part of a new EUR 12.9 million project, measuring the impact of a combination TB and HIV intervention when delivered to the entire population of 14 urban, high prevalence communities in South Africa and Zambia.
TB and HIV are the leading infectious causes of death worldwide – in 2016 1.7 million people died of TB. For people living with HIV, TB is the most significant co-infection, 40 percent of HIV deaths in 2016 were due to TB. The TREATS project [Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening] was developed in response to this.
“TREATS is a unique opportunity to assess a combined TB and HIV intervention on a massive scale,” said Dr Helen Ayles, TREATS Project Director, Professor of Infectious Diseases at London School of Hygiene & Tropical Medicine and Research Director at Zambart. “It will provide amazing data and hopefully some practical solutions to end TB. TB is a curable illness, but in order to better reach people with treatment, we need to understand the epidemiology of the disease better. This is true active case-finding.”
Dr Pete Dodd
Dr Pete Dodd, Research Fellow, ScHARR

"Globally, one person is dying every 20 seconds or so from TB, which is a curable disease," said Dr Dodd, research fellow in mathematical modelling at ScHARR. "Timely access to diagnosis and appropriate care are huge issues, and in sub-Saharan Africa, HIV is still a major driver of the TB epidemic. This is a tremendously exciting opportunity to find out at scale whether an aggressive combination going out and looking for TB cases, and really ramping up HIV prevention and treatment measures can bend the curve of the TB epidemic in some of the worst affected parts of the world."
We will be using mathematical models of TB and HIV transmission to interpret data from the trial: to better understand the epidemiology and also to unpick to components of the intervention and their effects. We'll be able to assess the cost-effectiveness of these interventions, project their impact if maintained over longer time frames, or if rolled out more widely, and consider what would happen in other settings or with tweaks to their configuration.
TREATS consortium members include: London School of Hygiene &Tropical Medicine, Imperial College London, Zambart, KNCV Tuberculosis Foundation, Sheffield University, the International Union Against Tuberculosis and Lung Disease (The Union), Health Systems Trust, Delft Imaging Systems and QIAGEN.
The EUR 12.9 million project is part of the European & Developing Countries Clinical Trials Partnership, (EDCTP2 programme) supported by the European Union.
For further information, please see the TREATS project webpages.