Bayesian Economic Evaluation: Bayesian Economic Evaluation: A Multidisciplinary FutureA Multidisciplinary Future

George Sarna

17 December 2002

Summary

MRC - mission/principles Scientific challenges Links with other organisations MRC support - health economics/statistics What we have tried and what has failed What should we be doing to develop this

field?

MRC Background

Set up in 1914 1 of 6 Research Councils Funded by Government (£350m pa)

Research - Investigator initiated Support high quality research with aim of maintaining

& improving human health Train skilled people Advance & disseminate knowledge & technology to

meet national needs for health, quality of life & economic competitiveness

Principles

Will support good work in all sectors of medical research

Excellence is keyProposals from all areas compete for funding

availableDo not as a rule earmark funds for particular

topics though good proposals in strategic areas may receive priority

Science & Policy Data integration New diagnostics Translation Multidisciplinary working Forging Partnerships Training and retaining

researchers Engaging the public

Post-genome Health of the Public

Individual

UnderstandingHealth & Disease

Cell

Organ

Animal

Genome

Environment

Population

Families

Challenges Ahead

Biomedical Research

“continuum”

prevention diagnosis treatment

Short versus long term funding

Short term versus long term gross research spend (2000/01) - £m

0

50

100

150

200

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300

BHF Wellcome Trust BBSRC CRC Other AMRC MRC

Re

sea

rch

sp

en

d (

£m)

Long term

Short term

Health Services and Public Health

Spend £m

0

5

10

15

20

25

30

35

40

45

50

95/96 96/97 97/98 98/99 99/00 00/01

year

Spend £m

MRC Spend on People & Population Studies

Trial Numbers

0

20

40

60

80

100

120

140

1931-1940 1941-1950 1951-1960 1961-1970 1971-1980 1981-1990 1991-2000

Decade

Nu

mb

ers

Trial Numbers Value of New Awards £m

0

2

4

6

8

10

12

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16

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97/98 98/99 99/00 00/01

Decade

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lue

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Value of New Awards £m

MRC & Clinical Trials

MRC HDs

Gvn - DfID, MoD etcCharitiesINDUSTRY

NICEHTAHDASDONEATMethodology Panel

PARTNERSHIPS

MRC Support

Clinical Trials - 120 ongoing trialsJustification for inclusion/exclusion of health

economics in applications; planned analysesBurden of disease, present and future resource

implications for NHS/economy

MRC Biostatistics Unit (Cambridge)

MRC Health Services Research Collaboration (Bristol)

MRC Clinical Trials Unit (London)

Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002)

MRC/DH funded study - Alan Scott Clinical analysis + cost effectiveness study 6800 deaths in England + Wales in 2000; 2.1 %

of all deaths in men older than 65

Screening study - ultrasound scansRCT of 67800 men aged 65-74 (1997-1999)Randomised to receive scan or notPrimary outcome was mortality related to abdominal

aortic aneurysm

Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002)

Clinical analysis Deaths - 65 (intervention) cf 113 (control) Risk reduction - 53%

Costs Additional cost of screening - £2.2m Cost per life year gained - £28k (4 year follow-up)

and ?? £8k (over 10 years) Both within perceived NHS threshold

Policy/Practice???

What we have tried/failed

Capacity building HSR/Public Health Fellowships MSc courses - medical statistics

Failed Health economics: discipline hopping scheme

Strategic factors

Issue: cost-effectiveness - prioritisation

Career Path and Eligibility for Funding Schemes

NON-CLINICAL CLINICALPhD training ______ Research Studentship ________ Clinical Training Fellowship

Postdoctoral ______ Research Assistant on Grant ___ Research Assistant on GrantPeriod ______ Research Fellowship

______ Career Development Award ____ Clinician Scientist Fellowship______ Senior Fellowship ____________ Senior Fellowship

University/Clinical Appointment * Career Establishment Grant OR

* Co-ordinated Grants SchemeMRC Senior Fellow - Centre Grant(Clinical or Non- - Co-operative GrantClinical) - Development Grant

* Innovation Grant Strategic Project Grant Programme Grant MRC Readership/Professorship

Models for Co-ops(1)

COREstatus only

InfrastructureResource

ME

M

CC MABXBG

Funders’ perspective - What next?

Emerging issues?

What is urgent?

What (else) is needed in terms of infrastructure/resources - ?UK wide

Feedback to funders - advice to applicants

Strategic factors

Issue: cost-effectiveness - prioritisation

Web Page: www.mrc.ac.uk

Email: george.sarna@ headoffice.mrc.ac.uk

Telephone 020 7636 5422

The Medical Research Council

Health Services Research (HSR)

The investigation of the health needs of the community and the efficiency and effectiveness of the provision of

services to meet those needs

Trials

Importance of the Question Burden of ill health - NHS, Community, Family? The right question: clinical, timely, feasible? Prior knowledge & evidence - systematic reviews? Impact? Generalisable? Particularisable?

Design Will the design answer the question? Feasible? Pilot / preliminary data? Staging? Outcome measures? Effect sizes? Sampling size and strategy Bias? Randomisation - 3rd party?

Council Board, Panel and Group Structure

Council

Strategy Development Group

Molecular and CellularMedicine Board

Physiological Medicine and Infections Board

Awards AdvisoryGroup

Neurosciences and Mental Health Board

Health Services and Public Health Board

MRC Advisory Board

Cross-BoardGroup

InnovationGrantPanel

CareerEstablishment

GrantsPanel

Investigator Initiated FundingSchemes for Research

.Programme Grants To support both focussed and more broadly based long term programmes of

research.

Co-operative Group Grants To establish or bring together critical research mass, in ways which add value to

individual research projects and improve the productivity of research environments.

Development Grants – for Co-operative Groups To help get to the point where they can make competitive applications for

funding under the Co-operative Group Grants scheme.

Career Establishment Grants To provide 5yrssupport for scientists recently appointed to University academic

posts to help them to establish themselves as independent research workers capable of winning support in open competition.

.Strategic Grants To support work which makes a specific contribution to MRC’s strategy

Models for Co-ops (2)

COREstatus only

InfrastructureResource

RCTSPG

C

C

SF

Understanding and Treating Brain Diseasee.g. bipolar disorder

Individual

Cell

Brain

Genome Environment

Population

Families

cognitive behavioural therapy

coupletherapy

e.g. depression

e.g. risk behaviour

e.g. Huntington’s

L-Dopa,stem cells

e.g. Parkinson’s publichealth

antipsychoticse.g. schizophrenia

gene therapy parenting

e.g. antisocial behaviour

Finance

Intramural versus extramural gross research spend (2000/01) - £m

0

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100

150

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BHF Wellcome Trust BBSRC MRC CRC

Re

sea

rch

sp

en

d (

£m)

Intramural

Extramural

MRC Corporate Policies & Influences The following represent important elements in the way the MRC

has pursued its mission and national responsibilities to date: Investing in the best science, across the whole field relevant

to human health; Responding to, and balancing the needs of, all stakeholders; Meeting national (health and policy) needs; providing long-

term support and critical mass; Building capacity (through people and in fields of research,

eg Health Services Research); Funding national infrastructures (eg Mary Lyon, Biobank)

and national facilities (eg HGMP) in response to investigator demand.

People

MRC - principles Key scientific challenges ahead Links with other organisations; 'boundaries' MRC support - health economics; statistics How to get support What we have tried and what failed What should the MRC be doing?