1. HERG/MRC Scholarship No 1	

This scholarship (available from October 2007) addresses the following
subject: 

"An Investigation into Methods for Measuring QALYs in the Economic
Evaluation of Public Health Programmes" 

Overview of thesis  
The approach recommended by NICE and other bodies when undertaking
cost-effectiveness analyses is to measure the incremental cost per QALY
gained of the intervention under study versus an appropriate comparator.
In the case of public health interventions the use of QALYs is often
problematic due to difficulties in linking the outcomes of
interventions, commonly measured at the intermediate level, to the QALYs
gained. The aims of this thesis are (1) to investigate methods for
estimating the change in HRQOL associated with public health programmes,
and (2) to use these methods to assess the incremental cost per QALY
gained of public health programmes. The thesis will involve regression
analysis of survey data.

Supervisors: 
S. Morris, Reader 
J. Fox-Rushby, Professor of Health Economics 

Contact 
Interested applicants are welcome to contact Dr Stephen Morris (Tel +44
(0)1895 265462 [log in to unmask]) or Professor Julia
Fox-Rushby (Tel +44 (0)1895 266864 Fax +44 (0)1895 269708 or
[log in to unmask]) for an informal discussion. 

2. HERG/MRC Scholarship No 2	

This scholarship (available from October 2008) addresses the following
subject: 

"An economic analysis of vertical inequity in the use of health care
services in England"

Overview of thesis  
The pursuit of equity is a key objective of many healthcare systems and
has received special emphasis in the National Health Service in England.
In economic studies of equity in health care use, it is usual to
differentiate between inequality (which arises when different
individuals consume different amounts of health care), horizontal
inequity (when use is affected by non-need variables that ought not to
affect use), and vertical inequity (when individuals with different
levels of need do not receive appropriately different amounts of health
care). There has been little analysis of vertical inequity because, as
well as making value judgements about which variables are need variables
(and so ought to affect use) and which are non-need variables (and so
ought not to), judgements are also required about the way in which use
ought to vary among individuals with different needs. The small number
of international studies that have investigated the issue test the
necessary but not sufficient condition for vertical equity that use
should increase with morbidity. An exception is Sutton (Sutton M.
Vertical and horizontal inequity aspects of socio-economic inequity in
general practitioner contacts in Scotland. Health Economics 2002; 11:
537-549), who identifies and measures vertical inequity in Scotland
using health survey data by imposing a restriction on the health
elasticity of health care. Further work on vertical inequity is
justified because there are no estimates for England and because
horizontal inequity, which has been the focus of previous work,
represents only a partial assessment of overall inequity in health care
use.

Supervisors: 
S. Morris, Reader
M. Buxton, Professor of Health Economics & Director HERG 

Contact 
Interested applicants are welcome to contact Dr Stephen Morris (Tel +44
(0)1895 265462 [log in to unmask]) or Professor Martin Buxton,
Director of HERG ([log in to unmask] ) for an informal
discussion. 


3. MATCH/HERG PhD Vacancy	

Overview of thesis

"The iterative evaluation of health technologies during their
development and marketed life-cycle"

Developing a new health technology is costly and risky. Therefore, most
medical device companies operate some form of staged decision-making
development process that is regularly reviewed and decisions are taken
as whether and how to proceed. These decisions are based on the
available information regarding costs and potential future benefits of
the device. Currently, economic evaluation of health care technologies
tends to focus on the period immediately before or after marketing, and
principally reflects the growing requirements for cost-effectiveness
evidence to meet the decision-making/advisory needs of central
reimbursement or market access agencies and/or the more diffuse needs of
specific potential users considering purchase. Production of this
evidence may often be the first time that the conceptual framework of
economic evaluation has been applied to the product, despite the fact
that there have been proposals that economic evaluation should be used
iteratively through the product life-cycle, and some reported examples
of this happening.

This PhD will review the methods and concepts, including the use of
formal Bayesian approaches, to build on the increasing information
available as the product is developed. It will aim to characterise what
this process might look like in practice and how it might best be used
to inform both internal (commercial) decisions regarding the investment
in development and trialling of products, and then feed through to
provide the basis for appropriate external appraisal of the product. It
is anticipated that the thesis will involve one or more examples of the
application of this iterative and cumulative process to specific
technologies, and the aim will be to indicate how they might be used in
practice in a 'routine' context.

Supervisors:
Professor Martin Buxton
Dr. Lotte Steuten

Contact:
Applications should be addressed to the MATCH Project Manager Elizabeth
Deadman, School of Information Systems, Computing and Mathematics
Brunel University, Uxbridge, UB8 3PH, email
[log in to unmask]

________________________________________________

Nicky Dunne
HERG Manager
Health Economics Research Group
Brunel University
Uxbridge
Middlesex UB8 3PH, UK

Tel:    +44 (0)1895 265443
Fax:   +44 (0)1895 269708
Email: [log in to unmask]