Health Economics: events
Health Economics Seminar Series
The Health Economics Seminar Series offers a great opportunity to engage with active research in Health Economics. External speakers are invited to present recent or ongoing research for 50 minutes followed by questions from the audience. Please check back regularly for updates.
Please find below the confirmed dates and speakers for the coming season. Do please save the dates and hope to see many of you in the seminars.
Date: 11 March, 2019, 11.00 - 12.30
Room: Jean McFarlane 2.329
Speaker: James Buchanan
Title: Improving the health economics evidence base for genomic testing
Date: 15 April, 2019, 11.00 - 12.30
Room: Zochonis TH C
Speaker: Michael Drummond
Title: How Do You Maximize the Chances of Your Paper Being Published?
A major activity of health service researchers is the publication of their research in peer-reviewed journals. There is a myriad of journals with different requirements, but little is known about the ways in which journals interpret their requirements and the criteria that submissions should meet in order to be accepted. Value in Health is an established health services research journal, receiving around 1000 submissions per year, with an impact factor of 5.49. In this seminar, one of the Editors-in- Chief of Value in Health will share a few thoughts on the criteria the journal uses to assess papers and the key features of the assessment process that potential authors should be aware of. There will be ample opportunity to discuss how these decision processes can be improved in the future.
Date: 20 May, 2019, 11.00 - 12.30
Room: Zochonis TH C
Speaker: Padraig Dixon
Title: The causal effect of adiposity on inpatient hospital costs: Mendelian Randomization analysis of over 300,000 individuals from the UK Biobank cohort
Estimates of the marginal effect of measures of adiposity such as body mass index (BMI) on healthcare costs are important for the formulation and evaluation of policies targeting adverse weight profiles. Many if not all existing estimates of this association are affected by endogeneity bias caused by simultaneity, measurement error and omitted variables. We used a novel identification strategy that largely avoids these issues – random germline genetic variation in an instrumental variable analysis – to identify the presence and magnitude of the causal effect of BMI on inpatient hospital costs. We also used variant-level data to undertake much richer testing of the sensitivity of results to potential violations of the instrumental variable assumptions (especially the exclusion restriction) than is possible with existing approaches. Using data on over 300,000 individuals participating in the UK Biobank cohort,including admissions data recorded in Hospital Episode Statistics, we found effect sizes for the marginal unit of BMI over 50% as large as multivariable effect sizes. These effects attenuated somewhat under sensitivity analyses, but effect sizes remained larger than multivariable estimates for all but one estimator. There was little evidence for non-linear effects of BMI on hospital costs. Multivariable Mendelian Randomization analysis suggested that the direct effect of body fat percentage on hospital costs is limited, and body fat percentage probably does not mediate the effects of BMI on hospital costs. This work is the first to use genetic variant-level data in a Mendelian Randomization framework to estimate the causal effect of BMI (or any other disease/trait) on healthcare costs. This type of analysis can be used to inform the cost-effectiveness of interventions and policies targeting the prevention and treatment of overweight and obesity, and for setting research priorities. The methods can be applied to many other traits, behaviours and diseases.
Date: 10th June, 2019, 11.00 - 12.30
Room: Jean McFarlane
Speaker: Laura Bojke
Date: 29 January 2018, 11.30 – 13.00.
Room: Jean McFarlane G.306A
Speaker: John Buckell (Yale University)
Title: “Smokers’ cigarette choices and risk perceptions: Experimental evidence on US adults”
Abstract: Smoking is the largest avoidable cause of death in developed countries. E-cigarettes have emerged as a rival to combustible cigarettes that could help reduce the harm to smokers. Accordingly, policymakers are considering a number of market interventions to promote public health. To deploy policy effectively, policymakers must understand behavior and a key driver of behavior is risk perception. In the US, the FDA has several policy options for influencing risk perceptions of cigarettes and e-cigarettes. However, this issue is complex given uncertainty surrounding the health risks of e-cigarette use. In this study, we provide policy evidence by conducting a discrete choice experiment (DCE) on a representative sample of 2,031 US adult smokers and recent quitters. We model the effects of relative risk perceptions on cigarette choice behavior, allowing for the full range of individuals’ beliefs about the health risks of smoking and ‘vaping’; and inertia in smokers’ cigarette type choices. We estimate the extent to which smokers must believe combustible cigarettes are more harmful than e-cigarettes before they switch to e-cigarettes. Overall, two types of smoker are found: those willing to switch and those that are not. Inertia appears to be a leading driver of this behavior. Further, the results indicate that many more smokers would switch to e-cigarettes if risk perceptions were in line with current science on the relative health harms. Thus, policies that target relative health risk perceptions have potential as a policy tool for tobacco control.
Title: Self-Employment and Health: Evidence from UK Panel Data
Abstract: Analysing nationally representative panel data, this paper explores the relationship between health and self-employment. Since 2001, self-employment rates in the UK have been increasing, a trend that was accelerated by the recession in 2008, and reached a record high in 2016. Initially, this paper aims to ascertain the impact health status has on the propensity to be self-employed. It then goes on to explore the impact health has on a range of self-employment outcomes, including, for example, the number of employees, net profit and income. Preliminary results suggest that poor health reduces the likelihood of an individual being self-employed compared to being employed. Moreover, self-assessed health, as opposed to more objective measures of health, seems to have an inverse relationship with self-employment performance.
Date: 26 March 2018, 11.30 – 13.00.
Room: Jean McFarlane 2.327
Speaker: Veline L’Esperance (King’s College)
Title: What is the cost of ‘outstanding’? A national study estimating the relationship between general practice funding and Care Quality Commission ratings in England.
English general practices received capitation funding of £4842 million in 2016. Given the widening gap between the demand for healthcare and the ability of the NHS to provide (and finance) those services, it is important to understand whether funding affects outcomes. This is the first study to examine the relationship between practices’ funding and their quality rating by the Care Quality Commission.
CQC data were gathered from practices with completed CQC reports from November 2014 to December 2017 (n= 7310, 95% of all practices). CQC inspection outcomes are based on five domains: caring, effective, responsive, safe and well-led. Each domain is assigned one of four ratings: outstanding, good, requires improvement and inadequate. Each practice is also assigned an overall rating based on these scores.
Practice funding data were extracted from the National Health Applications and Infrastructure Services and covered the financial years (2013/14 – 2016/7).
A set of practice and demographic covariates which may confound the relationship between funding and CQC ratings were incorporated in the analysis as control variables. The model was also adjusted for the year the inspection was undertaken and a general practice uplift for that year. Ordered logistic regression models were estimated to test the hypothesis that general practice funding (capitation funding) is associated with CQC inspection ratings.
Practices rated outstanding had greater mean capitation funding per patient compared to those rated inadequate across each of the domains: caring; effective; responsive; safe; well-led and overall.
Practice characteristics such as training practice status, dispensing status, list size per general practitioner and employed staff, ethnicity distribution, and single-handed practices affected CQC ratings.
These findings demonstrate that higher mean capitation funding per patient was associated with higher ratings across all CQC domains and in the overall practice rating. Further understanding of the characteristics of practices rated outstanding may play a role in improving the inspection process currently in place.
Pharmaceutical treatments for cancer have a number of distinguishing features. Although not individually unique to cancer, their extent and joint presence makes the economic evaluation of these treatments distinctive.
• Comparators [clustering of several therapies and sequential decision making, increasing use of combination therapies with implications for treatment costs, and evidence synthesis, shifting line of treatment]
• Modelling methods [partitioned survival analysis is widely used, extrapolation of survival is frequently challenging, treatment switching is relatively common]
• Valuation of health outcomes [poorer data post-progression, adverse events common but poorly valued, mapping from condition-specific data to generic preference-based measures is common]
• Estimating the cost of treatment [estimation of cost of intervention and of comparator can be challenging – variation in time to treatment discontinuation, dose reductions, wastage/sharing, importance of subsequent treatment costs]
• Decision-making context there are significant differences from other treatments (at least in England) [guidance on life-extending end-of-life treatments, cancer drugs fund, extensive use of patient access schemes and managed access agreements, greater NHS England participation in decision-making process]
• Prices tend to be high, and increasing over time. Increasing use of targeted therapies, combination therapies, fragmentation of markets combined with rise of multiple indications has implications for pricing.
This seminar will highlight these features using recent NICE appraisals and propose a number of changes to the appraisal process to facilitate the evaluation of new pharmaceutical treatments for cancer.
Several departments and centres run their own events which may be of interest:
Check these links regularly to stay up-to-date.