Two studentships are available as part of the MATCH programme in Birmingham:
1. Economic evaluation of optional treatments - whose preferences should be used?
2. The horizon in medical devices and an evaluation of the Headroom Method of early economic evaluation.
These are 3-year studentships offering fees and an annual stipend of £13,300.
Due to the nature of the funding, the studentship is restricted to UK/EU students who have not previously been registered for a research degree. The start date is flexible, but the studentships must be taken up by 1 October 2009.
Details:
1. MATCH PhD Studentship: Economic evaluation of optional treatments - whose preferences should be used?
Background
Economic evaluations of medical technologies (treatments) must use a measure of health benefit for the outcome of the treatment. Such measures are commonly computed by attaching numerical weights to the different health/disease states that can arise, calibrated to reflect the preferences either of a general population or of a particular patient group. In practice the values that patients attach to given states of health may depend on their clinical predicament (e.g. age, sex and the stage/severity of their disease). Such variation is commonly reflected in the preference weights used for economic evaluations. However, individual preferences will often differ between patients in a particular clinical group. Furthermore it is plausible that the profile of preference-weights belonging to an individual patient will influence his or her decision to accept a particular medical procedure. It is clear that some patients choose to undergo radical surgery where others (in the same clinical predicament) choose not to. Examples include gastric banding for obesity, mastectomy for women at high genetic risk of breast cancer, and many radical treatments for potentially fatal conditions. This means that the health-benefits of these procedures to those who actually undergo them are likely to be greater than would be anticipated using average preference-weights across the whole clinical group. This additional value is ignored in conventional economic evaluations, leading to the presence of "Split-Choice" bias.(1,2) The overall aim of the project is to document and quantify the effects of this bias on economic assessments conducted from the perspective of healthcare providers such as the NHS.
Project Ouline
-To identify economic studies of device-based treatments which are declined by a sizeable proportion of eligible patients and to investigate the sensitivity of the economic evaluations to the preference-weights assumed. The sensitivity analysis will be tied into patient choice using published data if available or by developing the models proposed by Lilford et al.(2)
-To conduct empirical studies in real populations (patients and/or members of the public) to support the relationship between preference weights and choice of treatment. This will entail the design, administration and analysis of questionnaires concerning real or hypothetical treatment options, together with the elicitation of preference-weights for health states using the time trade-off (or other) method.
The person
The student should have a strong quantitative bent with interests in statistics and healthcare evaluation. A first degree in statistics or economics would be ideal, but the project will suit someone with appropriate interests who is seeking to move into healthcare evaluation.
References
(1) Lilford, Girling, Stevens et al (2006) Adjusting for treatment refusal in rationing decisions. BMJ 332: 542-4
(2) Lilford, Girling, Braunholtz et al (2007) Cost-utility analysis when not everyone wants the treatment: modelling split-choice bias. Med Decis Making. 27: 21-26
2.The horizon in medical devices and an evaluation of the Headroom Method of early economic evaluation
Background
A key priority for the medical devices sector is getting new and improved devices to the market more quickly so that health benefits can be realised. One of the tools provided by the MATCH collaboration (see below), the Headroom Method1;2, is designed to provide device developers with an early and rapid assessment of the potential cost-effectiveness of a device. This tool helps developers decide whether to continue development of a device given their current level of evidence as to the costs and benefits of the device. While the headroom calculation can be updated as more evidence comes to light, it is not known how well initial estimates of headroom predict later estimates of cost-effectiveness.
Project Outline
-To review the horizon in medical devices by identifying devices in early stage clinical trials and, by investigating the devices, classify them according to key criteria such as technology, condition, new/improved device, level of competition and available evidence on effectiveness and cost-effectiveness. The results of this process will be used to assess the likely impacts of the new/improved devices on health outcomes and the potential costs to the NHS.
-To select a number of case studies from those identified and apply the Headroom Method of early economic evaluation (as well as other approaches to preliminary economic evaluation). The devices will then be followed up through the trials, MHRA CE marking assessment process and, where applicable, the NICE Technology Appraisal process. As part of this process, the types of study accepted by these bodies will also be classified and reviewed. Further evidence and other information for the device, such as marketing and pricing strategies, will also need to be identified. The development of the device and the external evidence on cost-effectiveness will provide initial evidence of the validity of the Headroom Method and on the characteristics of a successful device.
There will be an opportunity to coordinate this work with that of the Horizon Scanning Unit at The University of Birmingham. Opportunities for working with the manufacturers of a device will be explored, as will observations of the MHRA and NICE approval processes.
The person
The studentship would suit a student with good quantitative and investigative skills (such as a first degree in statistics or economics) and who is keen to learn about economic evaluation in the medical devices sector.
References
(1) Cosh E, Girling A, Lilford RJ, McAteer H, Young T. Investing in new medical technologies: A decision framework. Journal of Commercial Biotechnology 2007; 13(4):263-271.
(2) McAteer H, Cosh E, Freeman G, Pandit A, Wood P, Lilford RJ. Cost-effectiveness analysis at the development phase of a potential health technology: Examples based on tissue engineering of bladder and urethra. Journal of Tissue Engineering and Regenerative Medicine 2007; 1:343-349.
The MATCH collaboration
MATCH (Multi-disciplinary Assessment of Technology: Centre for Healthcare) is an EPSRC funded collaboration between 4 universities (Birmingham, Brunel, Nottingham and Ulster) and a number of industrial partners. (see http://www.match.ac.uk) The collaboration now in its 6th year, is concerned with the development and evaluation of medical devices, and particularly with the interplay between public, commercial and collective concerns. The projects fall into the strand associated with Economic Evaluation, which currently employs 7 researchers and 2 funded studentships.
Enquiries to:
Alan Girling (1.Optional Treatments) [log in to unmask] (tel 0121 414 7495) or
Dr Celia Brown (2.Horizon in medical devices) [log in to unmask] (tel 0121 414 6043)
To apply, please send a CV, covering letter and names & addresses (including email) of two referees to Alan Girling or Dr Celia Brown, Public Health Building, The University of Birmingham, Edgbaston, Birmingham B15 2TT.
The closing date: Monday 22nd June 2009. Interviews will be held in the period 1st-10th July 2009.
The successful candidate will be required to complete the standard University postgraduate application form in due course.
For more information about postgraduate study at Birmingham, please see: http://www.postgraduate.bham.ac.uk/
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