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Photo of Keble College taken from the quadrangle

Meeting round-up: HESG Summer 2023

Author: Matthew Napier

For our first ever HESG we had the privilege of visiting a (very) sunny Keble College, Oxford. Beautiful classical architecture with verdant green quads, a setting akin to Hogwarts, where health economics is the star of the show... What's not to love?!

Day 1 started with an interesting double session on the importance of communicating the results of research. Discussions ensued on balancing getting research into the public domain and influencing the policy debate with ensuring this is done in the 'right way'. Many attendees were concerned that going through certain outlets (we won't name any names), as well as potentially simplifying the nuances of the debate at hand, may cause a loss of respect in the academic community. A fine line to tread indeed!

The presenter, a journalist, stated that we tend to ignore or perhaps not care about journalism and public debate. However, when economists asked him how they could better engage journalists, and if there were any avenues of contact, he had no concrete answers. This points to a deeper issue surrounding research in general; it’s not that researchers don’t want to engage with the public, it's that they don’t know how to with limited time and very little external assistance.

In the sweltering heat of our crowded seminar rooms, which had little to no air conditioning or fans, our dedication to the field was tested. Were the papers and discussions interesting enough to distract us from the humid tropical weather?

Apart from punting on the Thames in the evening and having a guided tour of the colleges from our Oxford alumni colleague and fellow HESG first-timer Fred McElwee, another firm highlight of day 1 was the session ‘Policy restrictions and COVID-19 outcomes’ by Laia Maynou. Going into HESG we thought we would isolate ourselves from COVID-19-themed sessions. However, after looking closer at the paper and realising the potential policy implications, it caught our attention.

The paper looked at the effect of lockdown restrictions on health outcomes, as well as the effect in the opposite direction. An extremely ambitious task due to lockdowns occurring at different points in time over the study period leading to problems with isolating effects. The findings show the expected direction of the effect (in both directions), although the absolute effect of lockdowns on both deaths and cases was surprisingly fairly modest. Cue the insightful discussions and suggestions on the potential policy implications, and as is tradition, whether an inappropriate instrument was chosen (a fair comment given the level of noise in the data).

On day 2, I (Matthew) could not have found a more relevant session than that of Paola Cocco’s paper. I am, myself, researching early economic modelling in developing target product profiles (TPPs) for oncology diagnostics. What a coincidence! The paper modelled the potential cost-effectiveness of a new risk prediction test for urological cancers, the PinPoint Test, in the UK. The test categorises patients as high, medium, or low risk, allowing those at higher risk to be prioritised for a test in secondary care. The discrete event simulation model predicted that more people with cancer would be diagnosed with the PinPoint Test, within the two-week waiting time target of the NHS. This demonstrates the potential of the test to help achieve this repeatedly missed target for the NHS, especially because the model demonstrated a greater effect on poorer-performing providers. However, translating this into improved health outcomes is often the challenge with diagnostics, particularly in this instance where the care pathway is unchanged and the improved timing of the diagnosis is the only added clinical value. And with the exploratory analysis showing very limited life year gains, it will remain a challenge indeed.

Our final session of the event was a paper by our bright colleague (and tour guide), Fred McElwee. In this paper, an extension of a paper by Philip Clarke and Laurence Roope, McElwee aims to further define and evaluate ‘health poverty’ in the US using the Foster-Greer-Thorbecke poverty measures and NHANES data. The ultimate aim is to define health poverty and to encourage its evaluation in more populations and diseases to identify those with higher mortality hazards. Interesting debate followed on the concept of the measure itself, and of its necessity. Should health poverty be characterised by mortality only, or should morbidity play a part? Should health poverty thresholds be absolute or relative (which is directly tackled in the paper)? Is there a need to use the measure when health determinants such as smoking and age are already well known?

These questions are perhaps too much to tackle here, but what we can say is that we were very proud of our colleague for submitting the paper and inviting the hornet’s nest. We personally find the concept fascinating, distinct from economic poverty and aggregating health determinants for noble purposes, though the concept does need more evidence to support its utility.

Other highlights included Charlie Moss’s paper on the effect of public health expenditure on suicide rates, Anita Charlesworth's discussion of Laura Anselmi's paper on the causes of variation of secondary care in England and Yoojung Che's paper on the use of RWE for estimating relative treatment effects discussed by James Mason.

As expected, most sessions focused far more on the methodology of papers and concepts behind the hypotheses than the policy implications overall. It is a study group, after all, and we’re trying to improve each other's papers and skills; every discussant and attendee was respectful and the academic energy was palpable.

Topping off our time at HESG was the formal evening meal where we both got to familiarise ourselves with some of the amazing people in the field, followed by our subsequent night out on Thursday. We were told by colleagues that the HESG crowd was lively, and we’d have to agree! Kudos to the Oxford organisers for such a great conference and all round lovely couple of days! The food, venue, and weather were spot on... a hard act to follow in the winter, though we’re sure that’ll be a great one too.

Image credit: Liz Smith (CC BY-NC-ND 2.0)

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