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Meeting round-up: Health Economists’ Study Group (HESG) Summer 2024

For the latest edition of HESG, we were sent to Coventry; the University of Warwick was hosting at their campus conference centre. Imagine something between a 4-star chain hotel and 90s-build university halls. The last time we were there was in 2013. My memory fails me, so I’d be grateful if someone could confirm whether I was actually there.

Perhaps you heard that there was an election last week. Inevitably, it dominated the conversation during the meeting. We speculated about whether there might be some quiet Tories in our midst. The other big theme was the EuHEA clash, gossiping about the people who had chosen EuHEA over HESG, and the burden for those who had decided to brave both.

My colleague Mireia was one of the latter group, and – like many others – was rewarded with train travel difficulties. I had arrived early on Wednesday, always eager for maximum lunch, so I could be the hero on the first day; I stood in for Mireia’s chairing. Fortunately, it was a paper I’d read, and an excellent one for discussion, in which Anne Mason and Alexandra Nazerai explored the meaning and significance of need and demand in the context of social care in England, with a view to informing the measurement of both. It was an opportunity to retrace and reconsider old arguments about the usefulness of ‘need’ as a concept. We were in the biggest room, a fan-style lecture theatre, where I ended up spending most of my time.

Being hosted by Warwick, where lots of good economic evaluation work takes place, applied cost-effectiveness analyses and related studies occupied a more significant proportion of the programme than is typical at HESG. A paper on the first day by Mandana Zanganeh and colleagues allowed us to discuss the inclusion of environmental impacts in economic evaluation. The authors were focused on single vs multiple use endoscopes, but the audience inevitably sought to tackle the topic more broadly.

Lightning talks have become a staple of HESG programmes in recent years, and the standard seems to improve with each iteration. We enjoyed a wide range of topics, from drug pricing to sugar-sweetened beverages, vaccine status to the mental health of NHS staff. I feel a bit uncomfortable about the voting element, as all the presenters deserve praise and I’m not convinced the voting is exclusively on quality. Charles Smith was nevertheless a deserving winner with a Venn diagram that charmed the audience, describing an alternative approach to identifying carer status.

Clearly, I had upset someone from the Local Organising Committee, because I was given both 9 a.m. slots, Thursday for chairing and Friday for discussing. The session I chaired was for James Buchanan‘s paper exploring the challenges associated with evaluating newborn genome sequencing. It was an easy job as lots of people wanted to chip in. The point I found most interesting related to the different decision-makers in this space (e.g. NICE, the NSC, the NHS, and the government), and how – if at all – their evaluation frameworks should align.

The conference centre staff kindly looked after the election night revellers who gathered around Sky News clutching leftover bottles of wine. Some stayed up until Sunak conceded. I got to sleep at a conservative 2:30 a.m., but still felt worse for wear taking on the discussion of Dan Howdon‘s paper first thing on Friday. (But not before a run around campus, through field and forest.) At least the organisers had requested slides a week in advance, so no last-minute prep was required. Unusually, the paper was a direct response to something I had written. To paraphrase Dan, he had to write his paper because mine annoyed him so much. Dan’s paper was about describing and understanding the distinction between the average productivity of the NHS and the cost of producing QALYs at the margin. In particular, it considered the difference between two lines of research from the University of York, one on the average productivity of the NHS, and one on marginal productivity. It’s an important topic, and I really hope the paper sees the light of day, at the very least providing a clear articulation of the differences between these quantitative estimates and the research that produced them. Attendees may have been disappointed that more blood was not spilt.

A lot of papers are discussed at HESG, so everybody can have a different experience. If you’ve read previous editions of this blog post series, you’ll know I like to tease out a headline theme based on my own reading of the programme, the sessions I chose, and the people I spoke to. This meeting seemed to include a large dose of navel-gazing for our discipline; a lot of time was spent on the what, why, and how of health economics, and looking back at history.

Philip Clarke‘s paper (represented by Sophie Cole and Mike Drummond) was an unusual one, essentially providing transcripts from conversations with Mike, Louise Russell, and Milton Weinstein, covering their career trajectories and the direction of cost-effectiveness analysis in general. There was discussion about how the publication should be taken forward, if at all. Authors, if you’re reading this, you need look no further than! Dovetailing this paper was an enlightening and anecdote-heavy session organised by the ECR subcommittee. Mike Drummond spoke about his career as a health economist (and before that as a metallurgical engineer) and shared his insights on carving out your own career path. The session was well attended and it heavily influenced the topics of conversation that were picked up over coffee (and beer). Whether Mike’s experiences are representative of the challenges currently faced by young health economists – or, even, of young health economists 40 years ago – is a big question, but one that’s definitely worth discussing.

Other papers considered similarly ‘meta’ topics, albeit with more practical methodological insights. Hareth Al-Janabi‘s paper looked at improving our understanding of the impact of economic evaluation, building on findings from a series of qualitative interviews with health economists (some of whom were in the room). Liz Goodwin‘s paper took inspiration from a paper I discussed at the last meeting in Exeter, laying out a thorny set of problems for the audience to consider. Specifically, we considered the role of economic evaluation methods in a world of complex interventions and social prescribing. Are randomised trials and cost-effectiveness analyses the right tools? Dan Howdon’s discussion of Liz’s paper was a contender for the best discussion of the meeting, though I’d say he was probably pipped at the post by his colleague Ed Webb, who discussed a paper on inequality aversion in the very first session.

Overall, this was an excellent meeting, a vintage HESG in the classic style. There was plenty of food, unlimited coffee, vegan snacks, and no need to leave the building except to cross the road for the Thursday night dinner. For whatever reason, it excelled in providing opportunities to speak to new people, which is what got me hooked on HESG in the first place. A few years ago, I decided to stop attending every session at HESG meetings, because it is just too exhausting. At this meeting, I unintentionally abandoned this rule, which is surely a signal of a quality programme. I found myself attending every session and – in many cases – I had actually read the paper.

This meeting was also an opportunity to celebrate the career of James Mason, who is retiring after many years of leading the Centre for Health Economics at Warwick. I’ve never worked with James, but I’ve heard wonderful things about his leadership from the likes of Alastair Canaway of this parish. James gave a pre-dessert speech during Thursday night’s dinner. Maybe the wine had gone to my head, but I found it quite moving as he spoke about the value of HESG’s dialectic magnificence, and more personally about his own ‘life hack’ of making generosity his guiding principle. I’ll definitely remember this one.

Featured image: © Philip Halling (cc-by-sa/2.0)

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