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, 26 April 2018

NICE say “yes” to cabozatinib and “erm” to vandetanib

Cabozantinib and vandetanib for treating unresectable locally advanced or metastatic medullary thyroid cancer was recently appraised by NICE.  Sheffield was the ERG for this appraisal with Paul Tappenden, Chris Carroll, Jean Hamilton, Eva Kaltenthaler and Ruth Wong undertaking the research.

NICE were unable to release any recommendations on vandetanib and so it was split into a separate appraisal [ID1415].  This appraisal is still ongoing.

Wednesday, 25 April 2018

New projects: New NICE topic - Sodium zirconium cyclosilicate for treating hyperkalaemia

ScHARR-TAG has been allocated the following STA topic:

Sodium zirconium cyclosilicate for treating hyperkalaemia

Tuesday, 24 April 2018

Cost effectiveness methodology for vaccination programmes

A consultation process is underway.  The report sets out recommendations from the independent CEMIPP group that was set up by the government to consider whether the method for appraising cost effectiveness of vaccination programmes should change.  Why?

“In 2014, after considering whether or not vaccination should be introduced to protect children against meningococcal disease group B, the JCVI asked that the methodology they use to appraise vaccination programmes be reviewed to see if the rules for determining the cost-effectiveness of new or existing programmes should differ from those used for appraising other health-related activities that use public resources.

The Cost-Effectiveness Methodology for Immunisation Programmes and Procurement (CEMIPP) group was set up as a result. It was chaired by John Cairns, a professor of health economics at the London School of Hygiene and Tropical Medicine, and consisted of other academic health economists as well as representatives from bodies such as the JCVI and NICE and analysts from the Department of Health and Social Care and Public Health England. Some stakeholders, including the pharmaceutical industry and some charities, also had an opportunity to feed in views.

The CEMIPP group considered whether there are ways in which the economic evaluation of immunisation programmes differ sufficiently from that of other health related activities using public resources such that the methods for appraising costeffectiveness in vaccination should differ to those used for the wider health system. This independent group submitted its report to the Department in July 2016”

The consultation closes on the 21st May.

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: 23rd 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 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 economic and public health topics. You will be responsible for contributing to this programme of methodological and applied work, developing, testing, refining and applying a range of microeconometric techniques. 

A key project you will be involved in involves modelling spatial and temporal variations in alcohol consumption typologies using non-randomised data, but other applications include modelling health state utility values and joint modelling of wellbeing and utility measures. You will be actively encouraged to develop your own methodological interests and to provide specialist support to public health analysts, health economists and decision modellers across ScHARR. 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. Ideally you will hold PhD in microeconometrics or have similar experience. 

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