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Welcome to thesummer 2008HEDS newsletter.In this issue wefocus on our PhDprogramme.PhD studies are afundamental partof the section with

both students and staff candidates forPhD awards making major contributionsto our developing research. The PhDprogramme on quality of life measuresand health outcomes valuation is awell-developed area. Under ProfessorJohn Brazier, students have been at theleading edge in studying methodologiesthat are now, and will continue to beapplied across the whole world.The programme around methods foreconomic evaluation in primary researchis also substantial, particularlyconcerning the statistical issues aroundcost and quality of life data. The decisionmodelling programme and areas around

Bayesian statistics in health economicsare more recent but fundamentallyimportant areas too, as is work lookingat the interaction between informationscience, systematic review and the needfor evidence in decision models. We areactively engaged in seeking more fundingfor PhD studentships from a range ofsources and we welcome students fromall over the world. We currently have11 PhD students plus 7 staff undertakinga PhD (5 of which are Fellowships), andour strategic aim is to double the totalnumber over the next three to five years.Having been awarded my own doctorateduring the last semester, I can say frompersonal experience that studying for aPhD in HEDS is both challenging andrewarding.

Alan Brennan

HEDS NEWSLETTER Summer 2008 Vol 3.1

A FEWWORDS FROM THE DIRECTORAWARDS AND ACHIEVEMENTS

Congratulations to Alan Brennan, who has recently beenawarded his PhD by the University of Sheffield.

John Brazier has been awarded a grant of £7,814 over12 months by the Arthritis Research Council to work withfour other researchers on “General population values forrheumatoid arthritis health states: making them betterinformed.”

Jessica Headey, the Lancaster MSc student who did herdissertation with HEDS last year, has won the OR Society MayHicks prize for best MSc dissertation of 2007. She waspresented with her award in Sheffield at Easter.

John Brazier’s article on the estimation of a preference-basedmeasure of health from the SF-36 (J Health Econ2002;21(2):271-292) was identified by ESI Special Topics(January 2008) in its Fast Moving Fronts section. See hiscommentary on the paper at: www.esi-topics.com/fmf/2008/january08-JohnBrazier.html

CHEBS UPDATE

Centre for Bayesian Statistics in Health EconomicsFollowing the early retirement of Professor O'Hagan, JohnStevens has taken over as CHEBS' Director and JeremyOakley has assumed the role of Deputy Director. The vision tobe internationally recognised as one of the leading centres forresearch into the application of Bayesian methods in healtheconomics and related research remains the same.www.shef.ac.uk/chebs/

John Stevens and Jason Madan gave a course in BayesianMethods in Health Economics from 14-16 July 2008 in Sydneyfor the Australian Pharmaceutical Biostatistics Group (APBG).

STOP PRESS!New short courseA 2-day course on health state utilities is to be run by HEDSat The University of Sheffield on 17-18 November 2008.All enquiries to Liz Marsden (e.marsden@sheffield.ac.uk)Further details can be found at: www.shef.ac.uk/scharr/sections/heds/shortcourses/hsu.html

HESGAugust 2008: Aberdeen, January 2009: Manchester,July 2009: Sheffield. HEDS are delighted to announce thatwe will be hosting the Health Economists' Study Groupconference Wednesday 22 July - Friday 24 July 2009 inSheffield. Further details will appear on this web page overtime: www.shef.ac.uk/scharr/sections/heds/hesg09

Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, Regent Street, Sheffield S1 4DA www.shef.ac.uk/heds

HealthEconomics &DecisionScience.ScHARR

MASTERS COURSES MSc in Economics and Health Economics

The MSc Economics & Health Economics hasbeen awarded nine full time UK studentshipsacross 3 years.

This ESRC recognised postgraduate course isrun in collaboration with the Department ofEconomics at the University of Sheffield, andaims to train health economists with strongfoundations in theoretical economics andeconometrics. We have won nine full time UKstudentships across 3 years, from the 2008/9intake, funded by the National CoordinatingCentre for Research Capacity Development,under the joint NIHR/MRC/ESRC Initiative forDeveloping Research Capacity in Economics ofHealth. This is in addition to the MRC AdvanceCourse Masters studentships that we currentlyhave. Further details can be found at:www.shef.ac.uk/economics/prospectivetpg/courses/msc_economics_health.html

or you can contact Aki Tsuchiya direct:A.Tsuchiya@sheffield.ac.uk

MSc Health Economics & DecisionModelling

This is the only Masters programmein the UK dedicated to the practicalapplication of mathematicalmodelling to inform healthcaredecision making.

There is a national shortage ofqualified specialists at postgraduatelevel and we are keen to engage withhealthcare related organisations thatconsider providing sponsorship.

To find out more, please visit thecourse website:www.sheffield.ac.uk/scharr/prospective_students/masters/hedsmsc

To express an interest in sponsoringopportunities, please send an emailto: scharrtu@shef.ac.uk

HEDS Research Update

ScHARR-TAG is a group within HEDS which undertakes reviews of theeffectiveness and cost effectiveness of health care interventions for the NHSR&D Health Technology Assessment Programme on behalf of a range of policymakers, including the National Institute for Health and Clinical Excellence (NICE),and for the National Coordinating Centre for Health Technology Assessment(NCCHTA). Current technology assessment reports (TARs) include:

• Intensity modulated radiotherapy for breast cancer

• Intensity modulated radiotherapy for prostate cancer

• Intensity modulated radiotherapy for head and neck cancer

• Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin.

ScHARR-TAG will shortly be working on two single technology appraisals (STAs)for NICE:

• Liposomal muramyl tripeptide phosphatidyl ethanolamine as an addition toadjuvant therapy for newly diagnosed, non-metastatic, resectableosteosarcoma

• Venous thromboembolism – rivaroxaban.

Current and forthcoming work for the HTA includes four full reports:

• Vitamin K to prevent fractures in older women

• Aspirin in the primary prevention of cardiovascular disease

• Enhanced imaging techniques in the assessment of axillary lymph nodemetastases

• Risk factor assessment tools in the prediction of osteoporotic fractures.

and two short reports:

• Lipid-lowering therapy to prevent cardiac events

• Avoiding and identifying errors in modelling.

Recently completed TARs include predicting prognosis in prostate cancer,oseltamivir, amantadine and zanamivir for influenza prophylaxis (update), androutine antenatal anti-D prophylaxis (update). Recently completed STAs include:febuxostat for the management of hyperuricaemia in patients with gout, anddabigatran for the prevention of deep vein thrombosis after hip and kneereplacement surgery in adults.

More information can be found at the ScHARR-TAG website:www.shef.ac.uk/scharr/scharr-tag

HEDS has recently succeeded in winning four majorgrants from the Health Technology AssessmentProgramme. John Brazier and Tracey Young areworking with two external researchers on thedevelopment of the DEMQoL, and with Aki Tsuchiyaon developing and testing methods for derivingpreference-based measures of health from condition-specific measures (with Michael Barkham of theDepartment of Psychology). Roberta Ara, JohnBrazier and Andrew Booth, together with colleaguesfrom Leicester, are investigating the clinical and costeffectiveness of using drugs in treating obese patientsin primary care. In addition, John has a grant to workon social care outcome measurement. These fourgrants total £676,935.

Alan Brennan, Katherine Stevens,Mike Gillett andAbdullah Pandor are members of a team ofresearchers, led by Alan, which was recently awarded£72,833 (ScHARR proportion) to work for DiabetesUK conducting a randomised controlled trialcomparing structured education (the KICk-OFFcourse) with standard care in 11-16 year olds withType 1 Diabetes (T1DM) on intensive insulin therapy.

HEDS researchers have also recently won a numberof consultancy grants. Sue Ward, Ron Akehurst andHazel Pilgrim are working on a proposal for thepreparation of the NICE submission for nilotinib(Tasigna) for the treatment of chronic andaccelerated phase CML for imatinib resistant orimatinib intolerant patients.

Malcolm Whitfield has been awarded a grant bySheffield PCT to develop the evidence base for worldclass commissioning in public health. This is a publichealth sector partnership.

Ron Akehurst, Roberta Ara, Rachid Rafia, JohnBrazier and Robin Purshouse are modelling the costeffectiveness of idebenone in Friedreich's Ataxia forTakeda.

Jim Chilcott is currently working on two consultancyprojects: one with Sophie Whyte on colorectalscreening modelling work in collaboration with theNCRI in Cork for the HIQA/NCRI, and anotherworking with Paul Tappenden, Katy Cooper and anexternal researcher on colonic cancer modelling forColonix Ltd.

Silvia Hummel and Andrew Rawdin are working ona proposal to develop UK versions of Excel-basedcost-effectiveness and budgetary-impact models forlapatinib (Tyverb®/Tykerb®) in first line hormoneresponsive advanced or metastatic breast cancer. Thisis for Policy Analysis International (GlaxoSmithKline).

PUBLICATIONS

A database of all publications produced by currentand former members of HEDS can be accessed viathis webpage: http://ogma.shef.ac.uk/scharrpub/

THE CHILD HEALTH UTILITY 9D (CHU9D)

A new generic paediatric health related quality of life measure for use ineconomic evaluation: The Child Health Utility 9D (CHU9D)

Katherine Stevens from HEDS was awarded an MRC Special Training Fellowship in 2005 todevelop a paediatric health related quality of life measure for use in economic evaluation.The project has now come to an end, and the measure is available for use in economicevaluation.

What is the CHU9D?

The CHU9D is a paediatric generic preference based measure of health related quality oflife. It consists of a descriptive system and a set of preference weights, giving utility valuesfor each health state described by the descriptive system, allowing the calculation ofquality adjusted life years (QALYs) for use in cost utility analysis.

Further information

Please see www.chu9d.org for further information or contact Katherine StevensK.Stevens@Sheffield.ac.uk

SCHARR TECHNOLOGY ASSESSMENT GROUP RECENT GRANTS

HEDS Research UpdateHEDS PhD Students

Heather Brown: Spousal Correlations in Physical Activity: Evidence from the HILDA Heather is looking at differentfactors affecting the relationship between disability and labour market participation in Germany, the US and the UK,using the British Household Panel Study, GSOEP (Germany), the Panel Study for Income Dynamics (US), and also theCNEF file. Heather is conducting quantitative research using econometric methodology. She is currently analysing theinteractions between spouses regarding the decision to partake in physical activity - an important lifestyle characteristicthat can impact overall health, emotional well-being, and even productivity. Increasing physical activity participation ofworking age adults is an important policy initiative for both the public and private sector because of the health andlabour market effects of a sedentary lifestyle. Currently, physical activity levels remain low amongst individuals living indeveloped countries, and efforts to promote participation in physical activity are more likely to be effective if theyaddress the needs and interests of a particular target group. This research aims to better understand how householddynamics affect individuals' physical activity decisions, to create effective policy that will increase the number ofindividuals who engage in regular physical activity.

Helen McTaggart Cowan: The Impact of Informing the General Population on Quality of Life Values: A CaseStudy using Rheumatoid Arthritis Health States Leading researchers advocate that quality of life (QOL) values foreconomic evaluation should be obtained from the general population rather than from patients. This is based on thepremise that, in a publicly funded healthcare system, decisions should be based on the general population’s values.However, previous work has found that these values differ markedly from those obtained from patients, whose viewsmay be distorted by the level of their adaptation to the disease. The general population, on the other hand, will likelyhave limited knowledge of, or experience with, the disease under investigation. These differences question whether thegeneral population values are suitable within a decision-making context. This project investigates the impact on QOLvalues of informing respondents from the general population about disease adaptation in a specific condition: in thisstudy, rheumatoid arthritis (RA).

Yaling Yang: Developing condition-specific preference-based measures of health Yaling has developed twocondition-specific preference-based measures with population value sets, one for asthma and one for overactive bladder(OAB). Methods used to derive the generic preference-based index SF-6D from the SF-36 were employed using existingasthma and OAB-specific health related quality of life instruments. There were three stages, the first stage selecting asubset of items of the original instrument to serve as the dimensions of a trimmed-down descriptive system, and thento decrease the number of severity levels within each dimension. The second stage undertook a survey asking arepresentative sample of the general population to value a selection of states defined by the reduced classificationsystem. The third stage developed a model to predict health state values for all possible states defined by the newclassification system. The resulting scoring algorithm provides a preference-based single index measure for thecalculation of QALYs. The measures will be applied to trial datasets to test the hypothesis that condition-specificpreference-based measures are superior to the generic ones in terms of responsiveness.

Simon Palfreyman: The development of a preference-based disease-specific outcome measure for venous legulcers Simon’s research project is developing a preference-based disease-specific outcome measure for patients withvenous leg ulcers that can be used in the economic evaluation of interventions for venous leg ulcers. The outcome toolconsists of multiple levels and incorporates attributes of care from both patients and clinicians. The attributes of carewere identified from a literature review and qualitative interviews with patients and other stakeholders involved in thecare of patients referred for treatment of their venous leg ulcer. The levels and weighting of each attribute wasdetermined using time trade and discrete choice experiment techniques. The reliability, validity and responsiveness ofthe measure is being evaluated and the tool administered to the target population.

Clara Mukuria: The relationship between health status and well-being Clara is exploring the relationship betweenhealth and happiness using data collected from an ongoing prospective study of patients undergoing knee replacementsurgery and cataract surgery. The study utilises mixed methods; well-being and health information was collected usingquestionnaires and semi-structured interviews. Baseline data collection from 172 participants (87 knee replacement and85 cataract), 14 of whom have been interviewed, was completed in November 2007. Initial results indicate that healthlimitations primarily affect well-being indirectly via activity restriction.

Carl Tilling: The impact of losses in income due to ill health Carl is looking at productivity costs in economicevaluations, and whether respondents in health state valuation exercises take income losses into account, with particularemphasis on time trade-off (TTO). This is an area in which there are very few existing empirical studies. It may also bepotentially policy relevant, particularly if NICE decide that productivity costs are a relevant consideration in economicevaluations, as is the case in many other health systems around the world. Carl recently spent two months at theInstitute for Medical Technology Assessment (IMTA), Erasmus University, Rotterdam, hosted by Dr. Werner Brouwer, anexpert in the field, working on a review article looking at the above issues which will hopefully be published soon, andalso put together a questionnaire for an online survey which will ask respondents a number of different TTO questions inan attempt to decipher what people consider when answering these questions.

To give some idea of the types of PhD research undertaken in HEDS, below are brief descriptions of our students’ work.

HEDS welcomes applicants from the UK and overseas. Supervision leading to an MPhil degree or a PhD degree is offered in a wide range of areasof health services research, health economics and decision science, both theoretical and applied. Full time and part time study is possible. Visit thisweb page for further details and possible topic areas: www.shef.ac.uk/scharr/sections/heds/teaching

NewsletterHEDS

Feedback

HEDS would appreciate your feedback,so if you have any comments, advice orrequests regarding this newsletter, orindeed any future editions, pleaseemail: heds.newsletter@shef.ac.uk

We look forward to hearing from you.

NewsletterHEDS People & Events

NEW ADDITIONS TO HEDSRobin joined HEDS in January 2008 after positionswith Rolls-Royce Marine and PA Consulting Group.He graduated with a PhD in Control SystemsEngineering in 2004 (University of Sheffield). Hisresearch interests include healthcare cost-benefitassessment, multi-objective optimisation andinforming healthcare research priorities.

Rachid joined HEDS in February 2008 havingworked as a health economic consultant. Rachidobtained a Masters in health economics andmanagement at the Sorbonne and completed aninternship at the Sanofi Pasteur. Rachid hasworked mainly on infectious diseases and hisresearch interests include health economics andhealth economic modelling.

Sophie joined HEDS in September 2007 aftercompleting a MMath from the University ofWarwick and a PhD in Pure Mathematics fromBirmingham University. Her research interestsinclude health economic modelling and economicevaluation of cancer therapies and screening.

Alison joined HEDS in March 2008 having workedas a post-doctoral research associate in thePsychology Department. Alison completed a PhDin cognitive developmental psychology atSheffield Hallam University and her researchinterests include mental health, ADHD and autism,cognitive function and low-level vision.

Nick joined HEDS in June 2008. Nick graduatedwith a degree in economics in 2003 (Nottingham)and an MSc in Health Economics in 2004 (York).He has previously worked in industry and as aHealth Economics Fellow at QMUL. While atQMUL he was the principal health economist onthe NICE clinical guideline for osteoarthritis.

Pippa joined HEDS in May 2008 having worked asa Research Fellow at the Centre for EvidenceBased Nursing and Midwifery, University ofNottingham, since 2005. Pippa graduated in 2004with a PhD relating to paediatric emergency careattendance and has worked in paediatric healthservice research since 1996,

HEDS CONFERENCEPRESENTATIONS AND POSTERS

John Stevens gave a presentation on “Assurance in clinical development” atthe PSI Scientific Meeting on Contemporary Issues in Sample Size Estimationin April.

Matt Stevenson and three external colleagues gave an oral presentation atMASHnet in April: “Are single use neurosurgical and posterior eye instrumentscost-effective in stopping iatrogenic vCJD transmission?”

Matt Stevenson also gave an oral presentation at the Hong Kong-ShanghaiInternational Liver Congress in June: “Telbivudine is a cost-effective first-lineoral treatment of patients with chronic hepatitis B (HbeAg+) in the UK.”

ISPOR, TORONTO, MAY 2008

Matt Stevenson, Andrew Rawdin, Jon Karnon (formerly of HEDS) andAlan Brennan presented a poster: “Clopidogrel is cost-effective comparedwith aspirin in UK patients with a myocardial infarction who subsequentlysustain an ischaemic stroke or diagnosis of peripheral arterial disease.”

Matt Stevenson, Ron Akehurst and two external colleagues presented aposter: “Bosentan is a cost-effective treatment for UK patients withpulmonary arterial hypertension of WHO Class III.”

Allan Wailoo was involved in a panel discussion on “What did the MedicareReplacement Drug Demonstration teach us about the role of cost-effectiveness analyses in public policy?” A paper which reports on themodelling work underpinning the presentation was published in April (WailooAJ et al (2008) Biologic drugs for rheumatoid arthritis in the Medicareprogram: a cost effectiveness analysis. Arth Rheum 58(4):939-46). See pressrelease: http://www.blackwellpublishing.com/press/pressitem.asp?ref=1681

HTAI JULY 2008

10 people from HEDS attended HTAi in Montreal in July.

Oral presentations

Paul Tappenden: “Modelling the ‘bigger picture’: using service-level modellingto support consistent resource allocation decisions across whole diseaseareas”

Fiona Campbell: “The evidence straitjacket: use of expert opinion in asystematic review”

Posters

Eva Kaltenthaler: “Evaluating computerised cognitive behaviour programsfor depression and anxiety”

Rachael Jackson: “The clinical effectiveness of oseltamivir, amantadine andzanamivir for the prophylaxis of influenza: a systematic review”

Abdullah Pandor: “Ezetimibe monotherapy for the treatment of primaryhypercholesterolaemia: systematic review and meta-analysis”

Diana Papaioannou: “Identifying the evidence for a health technologyassessment methodological review”

Silvia Hummel: “A systematic review of novel biomarkers as prognostic riskfactors in early, localised prostate cancer”

Roberta Ara: “An economic evaluation of ezetimibe monotherapy forindividuals with established cardiovascular disease in the UK” and “Estimatingthe health benefits and costs associated with ezetimibe co-administered withstatin therapy in patients with established cardiovascular disease”

Please contact the authors if you are interested in any of the above.

Robin Purshouse

Rachid Rafia

Sophie Whyte

Alison Scope

Nick Latimer

Pippa Hemingway