Dear All,

As the next LHEG meeting is fast approaching I wanted to share with you the details of the talks. We will have three talks, scheduled as follows:

- 5-5.45pm: Judite Gonçalves

Title: "Do fossil fuel subsidies crowd out health expenditure? A country-level longitudinal analysis"

Abstract: Background: Countries spend massive amounts annually subsidizing fossil fuels, at the expense of the planet’s and populations’ health. At the same time, many of them have not attained Universal Health Coverage (UHC). Potentially, fossil fuel subsidies (FFS) dollars could be repurposed for the achievement of UHC. This study aims to determine the extent to which FFS crowd out health expenditure. Methods: We combined health expenditure data from the WHO, FFS data from the IMF, and other information from the WB and other sources to form a panel dataset covering 116 countries over the period 2015-2019. We created a novel instrumental variable, capturing countries’ exposure to international energy trade (i.e., net energy imports), combined with changes in the international crude oil price, to identify exogeneous shifts in FFS. Panel data models, controlling for several observed confounders as well as country fixed effects, combined with the instrumental variable, allowed us to determine the causal impact of expansions in FFS on health expenditure. Findings: An exogenous 1% increase in FFS, caused by rising international oil prices and weighed by countries’ exposure to international energy trade, reduces domestic health expenditures by 0.05% (p<0.01). Interpretation: FFS in 2022 exceeded one trillion USD, representing a 100%growth rate from the previous year. According to our estimate, this could translate into a sizeable 5% crowding-out of health spending. FFS are hindering progress towards UHC by taking money away from health.

- 5.45-6.30pm: Katharina Hauck

Title: "Integrated economic-epidemiological modelling for pandemic preparedness", with Patrick Doohan and Rob Johnson.

Abstract: The COVID-19 pandemic led to a boom in the development of integrated economic-epidemiological models. This reflects the close interdependence of public health outcomes and the economy and the concern of policy makers to balance lives and livelihoods when implementing pandemic mitigation. Integrated econ-epi model are simulation tools that can project the health, economic and educational costs of pandemics, explore characteristics that makes countries particularly vulnerable of experiencing high pandemic costs, evaluate optimal pandemic mitigation that balances between competing dimensions of societal welfare, and calculate the return-on-investment to pandemic preparedness. Katharina, Patrick and Rob will present Imperial College’s integrated econ-epi model DAEDALUS and focus on two practical applications of the model that informed the work of the G20 Joint Taskforce on Health and Finance.

-6.30-7.15pm: David Lugo-Palacios

Title: "Using real-world data to emulate randomised controlled trials: a target trial framework for health technology assessment", with Patrick Bidulka, Orlagh Carroll, Karla Díaz-Ordaz, Andrew Briggs, Amanda Adler, Anirban Basu, Richard Grieve, Stephen O’Neill

Abstract: Background: Reimbursement agencies may use estimates of comparative effectiveness from electronic health records (EHRs) to complement those from randomised controlled trials (RCTs). These nonrandomised studies (NRS) can consider populations, comparator treatments and endpoints excluded from RCTs but relevant to the decision problem.  However, due to inappropriate study design, estimates of effectiveness from NRS may be biased, for example, because of confounding by indication. Target trial emulation, in which RCT principles are applied to an NRS, ‘benchmarks’ results against those from published trials, and can alleviate these biases, but has been rarely used in health technology assessment (HTA). For HTA purposes, the target trial framework requires extension to recognise the decision context. Objectives: To illustrate a target trial approach for assessing the effectiveness of alternative second-line treatments for type 2 diabetes mellitus (T2DM), using regression and local instrumental variable (LIV) approaches to address confounding and heterogeneity. Methods: The target trial emulation used EHR data from the Clinical Practice Research Datalink (CPRD) for England from 2011 to 2015. First, we used a published RCT to inform the target trial protocol including the definition of the target population (‘restricted population’). In the second phase, we relaxed the eligibility criteria used in the pivotal RCT eligibility criteria to study a population that reflects clinical practice in the UK (‘general population’). We emulated randomised treatment assignment using two methods: regression adjustment using ordinary least squares (RA-OLS) which assume no unobserved confounding, and a local instrumental variable (LIV) approach that can address unobserved confounding. The instrument – the historical prescribing preference of the clinical commissioning group (CCG) who deliver local health services – was assumed to encourage choice of one of the antidiabetic drugs of interest without directly influencing the outcome (i.e. change in HbA1c). Average treatment effects (ATEs) were obtained from the two methods and compared to the RCT estimate to assess their agreement. Group ATEs were also estimated to explore heterogeneity across subgroups. Results: The target trial design replicated the main eligibility criteria of the pivotal RCT within the CPRD data. These criteria was used to identify 6,497 individuals in the restricted population which was defined as a subpopulation of the general population in CPRD (13,240 individuals). The IV strongly predicted choice of second-line treatment (F-statistic > 1,100), and balanced key prognostic variables. In the restrictive population subgroup, the RA-OLS and LIV approaches both provided ATEs, that were within 95% confidence interval of the RCT estimate. For the ‘general population’, the RA-OLS analysis suggested that sulfonylureas led to improved glycaemic control versus dipeptidyl peptidase-4 inhibitors, while the LIV suggested no significant difference between both treatments with evidence of heterogeneity according to baseline HbA1C.
Conclusion: Emulating RCTs with EHRs can provide decision-makers with additional evidence about relative effectiveness to that available from RCTs. We discuss how this approach can be extended to include a wider range of treatment comparators, endpoints, and settings and help provide the requisite evidence to personalise treatment choices.


Please register here if you wish to join: https://cityunilondon.eu.qualtrics.com/jfe/form/SV_0NSWrZxY49LJoY6

Details regarding the venue are in the email below. Informal drinks will follow after 7.15pm.

We hope to see you next Thursday!

All the best,
Victoria and the CHEC team

Department of Economics |City, University of London
CHEC: https://researchcentres.city.ac.uk/health-economics#unit=people

-----Original Message-----
From: London Health Economics Group <[log in to unmask]> On Behalf Of Victoria Serra-Sastre
Sent: Friday, September 22, 2023 3:16 PM
To: [log in to unmask]
Subject: upcoming LHEG meeting - 2 November 5-7.15pm at Imperial College Business School

CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.


Dear All,

We hope you are doing well!

Please save the date for the first LHEG meeting of the academic year! The meeting with be on the 2nd November 5-7.15pm and it will be hosted by the Centre for Health Economics & Policy Innovation (CHEPI) at Imperial College Business School.

We will have a slightly different format, and have three talks rather than the usual two presentations. We have three fantastic talks lined up. David Lugo-Palacios (LSHTM), Katharina Hauck (Imperial College London) and Judite Goncalves (Imperial College London) have kindly agreed to present some of their work. We will circulate titles and abstract closer to the date.

The talks will be in room LTUG. This is located in the Business School (South Kensington campus). You will find directions here: https://www.imperial.ac.uk/business-school/about-us/locations/

Please register if you wish to attend by following this link: https://cityunilondon.eu.qualtrics.com/jfe/form/SV_0NSWrZxY49LJoY6.

As usual, there will be some informal drinks after the talks.

Please join us for the meeting and we hope to see you there!

All the best,
Victoria and the CHEC team

Department of Economics |City, University of London
CHEC: https://researchcentres.city.ac.uk/health-economics#unit=people

########################################################################

To unsubscribe from the LHEG list, click the following link:
https://www.jiscmail.ac.uk/cgi-bin/WA-JISC.exe?SUBED1=LHEG&A=1

This message was issued to members of www.jiscmail.ac.uk/LHEG, a mailing list hosted by www.jiscmail.ac.uk, terms & conditions are available at https://www.jiscmail.ac.uk/policyandsecurity/