Meeting round-up: ISPOR Europe 2018 (part 2)

Have you missed ISPOR Europe 2018 but are eager to know all about it? Time to continue reading! In yesterday’s post, I wrote about ISPOR’s outstanding short-course on causal inference and the superb sessions I had attended on day 1. This blog post is about day 2, Tuesday 13th, which was another big day.

The second plenary session was on fairness in pharmaceutical pricing. It was moderated by Sarah Garner, with presentations by many key stakeholders. The thought-provoking discussion highlighted the importance of pharmaceutical pricing policy and the large role that HTA can have in shaping it.

Communicating cost-effectiveness analysis was the next session, where myself, together with Rob Hettle, Gabriel Rogers and Mike Drummond, discussed the pitfalls and approaches to explaining cost-effectiveness models to non-health economists. This was a hugely popular session! We were delighted by the incredibly positive feedback we received, which reassured us that we are clearly not alone in finding it difficult to communicate cost-effectiveness analysis to a lay audience. We certainly feel incentivised to continue working on this topic. The slides are available here, and for the audience’s feedback, search on twitter #communicateCEA.

The lunch was followed by the open meeting of ISPOR Women in HEOR Initiative with Shelby Reed, Olivia Wu and Louise Timlin. It is really encouraging to see ISPOR taking a proactive stance to gender balance!

The most popular session in the afternoon was Valuing a cure: Are new approaches needed, with Steve Pearson, Jens Grueger, Sarah Garner and Mark Sculpher. The panel showed the various perspectives on the pricing of curative therapies. Payers call for a sustainable pricing model, whilst pharma warns that pricing policy is necessarily linked to the incentives for investment in research. I agree with Mark in that these challenges are not unique to curative therapies. As pharmaceutical therapies have greater health benefits but at large costs, it is pressing that cost-effectiveness assessments are also able to consider the opportunity cost of funding more costly treatments. See here for a roundup of the estimates already available.

I then attended the excellent session on Drug disinvestment: is it needed and how could it work, moderated by Richard Macaulay. Andrew Walker explained that HTA agencies’ advice does not always go down well with local payers, highlighting this with an amusing imaginary dialogue between NICE and a hospital. Detlev Parow argued that payers find that prices are often unaffordable, hence payment schemes should consider other options, such as treatment success, risk-sharing agreements and payment by instalments. Bettina Ryll made an impressive case from the patients’ perspective, for whom these decisions have a real impact.

The conference continued late into the evening and, I suspect, long into the early hours of Wednesday, with the ever-popular conference dinner. Wednesday was another day full of fascinating sessions. The plenary was titled Budget Impact and Expenditure Caps: Potential or Pitfall, moderated by Guillem López-Casasnovas. It was followed by inspiring sessions that explored a wide range of topics, presented by the top experts in the relevant fields. These really delved into the nitty-gritty on subjects, such as using R to build decision models, the value of diagnostic information, and expert elicitation, just to name a few.

I don’t think I’m just speaking personally when I say that ISPOR Barcelona was an absolutely brilliant conference! I’ve mentioned here a few of the most outstanding sessions, but there were many, many more. There were so many sessions at the same time that it was physically impossible to attend all of those with a direct relevance to my research. But fortunately, we can access all the presentations by downloading them from the ISPOR website. I’ll leave the suggestion to ISPOR here, that they should think about filming some of the key sessions and broadcasting them as webinars after the conference. This could create a further key resource for our sector.

As in previous editions, ISPOR Barcelona truly confirms ISPOR Europe in the top HTA conferences in Europe, if not the world. It expertly combines cutting-edge methodological research with outstanding applied work, all with the view to better inform decision making. As I’m sure you can guess, I’m already looking forward to the next ISPOR Europe in Copenhagen on the 2nd-6th November 2019, and the amazing sessions which will indubitably be featured!

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Meeting round-up: ISPOR Europe 2018 (part 1)

ISPOR Europe 2018, which took place in Barcelona on the 10th-14th November, was an exceptional conference. It had a jam-packed programme on the latest developments and most pressing challenges in health technology assessment (HTA), economic evaluation and outcomes research. In two blog posts, I’ll tell you about the outstanding sessions and thought-provoking discussions in this always superb conference.

For me, proceedings started on Sunday, with the excellent short-course Adjusting for Time-Dependent Confounding and Treatment Switching Bias in Observational Studies and Clinical Trials: Purpose, Methods, Good Practices and Acceptance in HTA, by Uwe Siebert, Felicitas Kühne and Nick Latimer. Felicitas Kühne explained that causal inference methods aim to estimate the effect of a treatment, risk factor etc. on our outcome of interest, controlling for other exposures that may affect it and hence bias our estimate. Uwe Siebert and Nick Latimer provided a really useful overview of the methods to overcome this challenge in observational studies and RCTs with treatment switching. This was an absolutely brilliant course. Highly recommended to any health economist!

ISPOR conferences usually start early and finish late with loads of exceptional sessions. On Monday, I started the conference proper with the plenary Joint Assessment of Relative Effectiveness: “Trick or Treat” for Decision Makers in EU Member States, moderated by Finn Børlum Kristensen. There were presentations from representatives of payers, HTA agencies, EUnetHTA, pharmaceutical industry and patients. The prevailing mood seemed to be of cautious anticipation. Avoiding duplication of efforts in the clinical assessment was greatly welcomed, but there were some concerns voiced about the practicalities of implementation. The proposal was due to be discussed soon by the European Commission, so undoubtedly we can look forward to knowing more in the near future.

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My next session was the fascinating panel on the perils and opportunities of advanced computing techniques with the tongue-in-cheek title Will machines soon make health economists obsolete?, by David Thompson, Bill Marder, Gerry Oster and Mike Drummond. Don’t panic yet as, despite the promises of artificial intelligence, I’d wager that our jobs are quite safe. For example, Gerry Oster predicted that demand for health economic models is actually likely to increase, as computers make our models quicker and cheaper to build. Mike Drummond finished with the sensible suggestion to simply keep calm and carry on modelling, as computing advances will liberate our time to explore other areas, such as the interface with decision-makers. This session left us all in a very positive mood as we headed for a well-earned lunch!

There were many interesting sessions in the afternoon. I chose to pop over to the ISPOR Medical Device and Diagnostic Special Interest Group Open Meeting, the ISPOR Portugal chapter meeting, along with taking in the podium presentations on conceptual papers. Many of the presentations will be made available in the ISPOR database, which I recommend exploring. I had a wonderful experience moderating the engaging podium session on cancer models, with outstanding presentations delivered by Hedwig Blommestein, Ash Bullement, and Isle van Oostrum.

The workshop Adjusting for post-randomisation confounding and switching in phase 3 and pragmatic trials to get the estimands right: needs, methods, sub-optimal use, and acceptance in HTA by Uwe Siebert, Felicitas Kühne, Nick Latimer and Amanda Adler is one worth highlighting. The panellists showed that some HTAs do not include any adjustments for treatment switching, whilst adjustments can sometimes be incorrectly applied. It reinforced the idea that we need to learn more about these methods, to be able to apply them in practice and critically appraise them.

The afternoon finished with the second session of the day on posters. Alessandro Grosso, Laura Bojke and I had a poster on the impact of structural uncertainty in the expected value of perfect information. Alessandro did an amazing job encapsulating the poster and presenting it live to camera, which you can watch here.

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In tomorrow’s blog post, I’ll tell you about day 2 of ISPOR Europe 2018 in Barcelona. Tuesday was another big day, with loads of outstanding sessions on the key topics in HTA. It featured my very own workshop, with Rob Hettle, Gabriel Rogers and Mike Drummond on communicating cost-effectiveness analysis. I hope you will stay tuned for the ISPOR meeting round-up part 2!

Meeting round-up: Health Economists’ Study Group (HESG) Summer 2018

HESG Summer 2018 was hosted by the University of Bristol at the Mercure Bristol Holland House on 20th-22nd June. The organisers did a superb job… the hotel was super comfortable, the food & drink were excellent, and the discussions were enlightening. So the Bristol team can feel satisfied with a job very well done, and one that has certainly set the bar high for the next HESG at York.

Day 1

I started by attending the engaging discussion by Mark Pennington on Tristan Snowsill’s paper on how to use moment-generating functions in cost-effectiveness modelling. Tristan has suggested a new method to model time-dependent disease progression, rather than using multiple tunnel states, or discrete event simulation. I think this could really be a game changer in decision modelling. But for me, the clear challenge will be in explaining the method in a simple way, so that modellers will feel comfortable in trying it out.

It was soon time to take the reins myself and chair the next session. The paper, by Joanna Thorn and colleagues, explored which items should be included in health economic analysis plans (HEAPs), with the discussion being led by David Turner. There was a very lively back-and-forth on the role of HEAPs and their relationship with the study protocol and statistical analysis plan. In my view, this highlighted how HEAPs can be a useful tool to set out the economic analysis, help plan resources and manage expectations from the wider project team.

My third session was the eye-opening discussion of Ian Ross’s paper on time costs of open defecation in India, led by Julius Ohrnberger. It was truly astonishing to learn how prevalent the practice of open defecation is, and the time costs involved to find a suitable location. The impact of which would never have crossed my mind without this fascinating paper.

My last session of the day took in the discussion by Aideen Ahern of the thought-provoking paper by Tessa Peasgood and colleagues on the process of identifying the dimensions that should be included in an instrument to measure health, social care and carer-related quality of life. Having an extended QALY-weight for health and care-related quality of life is almost the holy grail in preference measures. It would allow us to account for the impact of interventions in these two very related areas of quality of life. The challenge is in generating an instrument that it is both generic and sensitive. This extended-QALY weight is still under development at this point, with the next step being to select the final set of dimensions for valuation.

The evening plenary session was on the hot-button topic of “Opportunities and challenges of Brexit for health economists” and included presentations by Paula Lorgelly, Andrew Street and Ellen Rule. We found ourselves jointly commiserating about the numerous challenges that are being posed due to the increased demand of health care and decreased supply of health care professionals. But it wasn’t all doom and gloom fortunately, as Andrew Street suggested that future economic research may use Brexit as an exogenous shock. Clearly this is not enough for comfort but left the room in a positive mood to face dinner!

Day 2

It was time for one of my own papers on day 2, as we started with Nicky Welton discussing the paper by Alessandro Grosso, myself and other colleagues on the structural uncertainties in cost-effectiveness modelling. We were delighted that we received excellent comments that will help to improve our paper. The session also prompted us to think about whether we should separate the model from the structural uncertainty analysis element and create 2 distinct papers. This would allow us to explore and extend the latter even further. So, watch this space!

I attended Matthew Quaife’s discussion next, on the study by Katharina Diernberger and colleagues of expert elicitation to parameterise a cost-effectiveness model. Their expert elicitation had a whopping 47 responses, which allowed the team to explore different ways to aggregate the answers and demonstrate their impact on the results. This paper prompted a quick-fire discussion about how far to push decision modelling if data are scarce. Expert elicitation is often seen as the answer to scarce data but it is no silver bullet! Thanks to this paper, it is clear that the differing views among experts make a difference to the findings.

I continued along the modelling topic with the next session I’d chosen: Tracey Sach’s discussion on Ieva Skarda’s and colleagues excellent paper simulating the long-term consequences of interventions in childhood. The paper prompted a lot of interest regarding the use of the results to inform the extrapolation of trials with a short time duration. The authors are looking at developing a tool to facilitate the use of the model by external researchers, which I’m sure will have a high take-up.

After lunch, I attended Tristan Snowsill’s discussion of Felix Achana and colleagues’ paper on regression models for analysis of clinical trials data. Felix and colleagues propose multivariate generalised linear mixed effects models to account for the centre-specific heterogeneity and simultaneous estimation of the effect on the costs and outcomes. Although the analysis is quite complex, the method has strong potential to be very useful in multinational trials. I was excited to hear that the authors are developing functions in Stata and R, which will make it much easier for analysts to use the method.

Keeping to the cost-effectiveness topic, I then attended Ed Wilson’s discussion on the paper by Laura Flight and colleagues on the risk of bias of adaptive RCTs. The paper discusses how an adaptive trial may be stopped early depending on interim analysis. However, our attention must be drawn to the caveat that conducting multiple interim analysis requires adjustment for bias to inform the economic analysis. This is an opportune paper as we are seeing the use of adaptive trial designs rise, and definitely one I’ll make a note to refer to in the future.

For my final session of the day, I discussed Emma McManus‘s paper on establishing a definition of model replication. Replication has been subject to increased interest by the scientific community but its take-up has been slow in health economics, the exception being cost-effectiveness modelling of diabetes. Well done to Emma and the team for bringing the topic to the forum! The ensuing discussion interestingly revealed that we can often have quite different concepts of what replication is and its role in model validation. The authors are working on replicating published models, so I’m looking forward to hearing more about their experience in future meetings.

Day 3

The last day got off to a strong start when Andrew Street opened with a discussion of Joshua Kraindler and Ben Gershlick‘s study on the impact of capital investment on hospital productivity. The session was both thought-provoking and extremely engaging, with Andrew encouraging our involvement by asking us all to think about the shape of a production function, in order to better interpret the results. This timely discussion was centred around the challenges in measuring capital investment in the NHS, given the paucity of data.

My final session was Francesco Ramponi’s paper on cross-sectoral economic evaluations, discussed by Mandy Maredza. This session was quite a record-breaker for HESG Bristol, enjoying probably the largest audience of the conference. Opportunely, it was able to shine a spotlight on the interest in expanding economic evaluations beyond decisions in health care, and the role of economic evaluations when costs and outcomes relate to different budgets and decision makers.

This HESG, as always, was a testament to the breadth of topics covered by health economists, and their hard work in pushing this important science onward. I’m now very much looking forward to seeing so many interesting papers published, many of which I will certainly use and reflect upon with my own research. Of course, I’m also very much looking forward to the next new batch of new research at the HESG in York. The date is firmly in my diary!

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