HEHTA’s work is centred around eight core and interconnected research themes, five of which provide innovative and methodological foundations for our work, and reflect our commitment to the development of the field of HTA.
Global HTA (GHTA)
Programme Lead: Eleanor Grieve
The use of Health Technology Assessment (HTA) continues to grow internationally. Whilst resources are finite in every setting, there is much diversity in the role and application of HTA. The Global HTA programme critiques HTA in different contexts, exploring variation between high-income countries as well as looking in-depth as to how and why decision-making in healthcare may differ amongst low- and middle-income countries (LMICs). Given the global reach of HTA, methodological implications are also considered with a particular focus on LMICs. The theme will draw upon HEHTA’s research from a global perspective, working in particular with major stakeholders including NICE International and the Gates Foundation as well as utilising staff members’ expertise in delivering training in HTA beyond the UK.
Emma McIntosh, Professor of Health Economics, HEHTA, IHW, will lead the £2million National Institute for Health Research (NIHR) Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania: a mixed methods study at the University of Glasgow.
As Director of the Global Health Research Group, Emma said, “In line with the remit of the NIHR call to support academic groups to expand into Global Health, this group represents an exciting new collaboration between the Universities of Glasgow and Newcastle and the Kilimanjaro Clinical Research Institute (KCRI) in Tanzania. Against a background of the ever-increasing burden of arthritis in low and middle-income countries, our Global Health Research Group aims to identify and measure the prevalence, economic, health and quality of life impact of arthritis in Tanzania. With a focus on arthritis prevention and intervention development plans in the Tanzanian setting, our research will directly inform an area of significant unmet need in sub-Saharan Africa. We will also deliver teaching and training in the social sciences, including health economics methods, and train early/mid-career Tanzanian researchers and clinicians in conducting research. Our research and training plans will not only contribute to the development of sustainable capacity for tackling a wider range of non-communicable disease problems in Tanzania but contribute to the existing research of Prof Iain McInnes who directs the Arthritis Research UK Centre of Excellence for Rheumatoid Arthritis (University of Glasgow). We very much look forward to developing a successful working relationship with our colleagues at KCRI to deliver this important research in addition to establishing a Tanzanian centre for excellence in social science research.”
More information on the recent awards by NIHR can be found here https://www.nihr.ac.uk/funding-and-support/global-health-research/funding-calls/units-and-groups/outcomes.htm.
Economics of precision medicine (EPM)
Programme Lead: Neil Hawkins
Population health will be improved by identifying treatments that have favourable risk-benefit or cost-effectiveness ratios for individual patients(1). This is described as stratified, precision, or personalised medicine and is underpinned by subgroup analyses. One of the challenges of precision medicine is to distinbuish between chance variation and 'real' reproducible subgroup effects. Unreliable subgroup analysis may harm patients and waste scarce resources - not least through futile confirmatory trials. HEHTA is hosting an MRC funded research project investigating the use of fully Bayesian methods to increase the reliability of subgroup selection. In addition, we are investigating the implications of precision medicine for study design (2) and technology pricing (3).
(1) Fletcher C, Chuang-Stein C, Paget M, Reid C, Hawkins N. Subgroup analyses in cost-effectiveness analyses to support health technology assessments. Pharm Stat 13(4):26-74.
(2) Woods B, Veenstra D, Hawkins N (2011). Prioritising pharmacogenetic research: A value of information analysis of CYPD2D6 testing to guide breast cancer treatment. Value in Health, 14(8), 989-1001.
(3) Hawkins NS, Scott DA. Reimbursement And Value-Based Pricing : Stratified Vpdy-Effectiveness Analysis May Not Be The Last Word. 2011;698(June 2010):688-98.
Economics of population health (EPH)
Programme Lead: Emma McIntosh
Population health is concerned with the study of social and environmental influences on physical and mental health and well-being. It is widely acknowledged that ‘up-stream’ influences such as early life experiences, the social and economic conditions in which people live and environmental exposures affect wellbeing. Population health research aims to improve the health of the public through clinical, public health interventions or dental public health including those that may be delivered outside conventional health services. The Economics of Population Health (EPH) programme at HEHTA is concerned with the development of methods and related empirical work associated with the economic evaluation of such ‘up-stream’ population health interventions.
Analysis of Linked health DAta (ALDA)
Programme Lead: Jim Lewsey
The ALDA programme encompasses all research work in HEHTA that is associated with statistical, epidemiological and economic analysis of linked health data sets. Growth in the number, variety, complexity and availability of linked data sets has led to an increase in the range of research questions that can be answered using such sources. Our team has a wealth of expertise and experience in this field – for example data manipulation and identifying cohorts within linked data sets; regression modelling of panel data sets; outcome measurement, costing and developing decision analytic models using linked data sets.
Economic evaluation alongside clinical trials (EEACT) & Decision Analytic Modelling
Programmes Lead: Kathleen Boyd
Economic Evaluation Alongside Clinical Trials
The Economic Evaluation alongside Clinical Trials Programme encompasses all research work associated with conducting an economic appraisal as part of a clinical trial. Although modelling methods may still be required to provide a comprehensive appraisal, the characterising feature is the inclusion of an economic component to the trial and the availability of experimental data on both costs and effects of treatment.
Decision analytic modelling (DAMSEl)
The DAMSEl Programme encompasses research work associated with conducting an evaluation using modelling or simulation methods. Modelling can be used as the whole framework for an evaluation, such as exploring the potential impact of a new, untested methodology. Alternatively, modelling could be used as part of a clinical trial-based evaluation to extrapolate intermediate trial endpoints to final health economic outcomes. The DAMSEl programme cuts across and interacts with many of the other programmatic themes of HEHTA.
Evidence synthesis (ES)
Programme Lead: Olivia Wu
There is an indisputable need for evidence-based clinical practice and healthcare policies. Evidence synthesis, including systematic review and meta-analysis of relevant data, comprise an important set of tools to ensure healthcare decisions are informed by a systematic evaluation of available evidence. The Evidence Synthesis Programme at HEHTA encompasses all research work associated with combining multiple sources of evidence for clinical and economic evaluations. Alongside the newly formed NIHR Complex Reviews Support Unit (CRSU), this Programme will explore challenges in combining complex data types and structure, through both methodological and applied work.
Incorporating perspectives and experiences (IPE)
Programme Lead: Evi Germeni
The aim of the “Incorporating Perspectives and Experiences” Programme is to promote and develop the application of qualitative methodologies to HTA. Qualitative research is useful for investigating stakeholder behaviours (patients, clinicians and decision makers) and contextual aspects of evaluations and HTA.
Within the IPE theme, research focuses on the development and application of qualitative methodologies to conceptual modelling, decision making, trial recruitment and trial design, developing measures, evidence synthesis, engaging stakeholders, and process evaluation. The theme offers a toolkit to support work across HEHTA's other themes, and evidence the real-life, practical experiences of health interventions spanning a range of clinical areas.