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

Last week’s biannual intellectual knees-up for UK health economists took place at City, University of London. We’ve written before about HESG, but if you need a reminder of the format you can read Lucy Abel’s blog post on the subject. This was the first HESG I’ve been to in a while that took place in an actual university building.

The conference kicked off for me with my colleague Grace Hampson‘s first ever HESG discussion. It was an excellent discussion of Toby Watt‘s paper on the impact of price promotions for cola, in terms of quantities purchased (they increase) and – by extension – sugar consumption. It was a nice paper with a clear theoretical framework and empirical strategy, which generated a busy discussion. Nutrition is a subject that I haven’t seen represented much at past HESG meetings, but there were several on the schedule this time around with other papers by Jonathan James and Ben Gershlick. I expect it’s something we’ll see becoming more prevalent as policymaking becomes more insistent.

The second and third sessions I attended were on the relationship between health and social care, which is a pressing matter in the UK, particular with regard to achieving integrated care. Ben Zaranko‘s paper considered substitution effects arising from changes in the relative budgets of health and social care. Jonathan Stokes and colleagues attempted to identify whether the Better Care Fund has achieved its goal of reducing secondary care use. That paper got a blazing discussion from Andrew Street that triggered an insightful discussion in the room.

A recurring theme in many sessions was the challenge of communicating with local decision-makers, and the apparent difficulty in working without a reference case to fall back on (such as that of NICE). This is something that I have heard regularly discussed at least since the Winter 2016 meeting in Manchester. At City, this was most clearly discussed in Emma Frew‘s paper describing the researchers’ experiences working with local government. Qualitative research has clearly broken through at HESG, including Emma’s paper and a study by Hareth Al-Janabi on the subject of treatment spillovers on family carers.

I also saw a few papers that related primarily to matters of research conduct and publishing. Charitini Stavropoulou‘s paper explored whether highly-cited researchers are more likely to receive public funding, while the paper I chaired by Anum Shaikh explored the potential for recycling cost-effectiveness models. The latter was a joy for me, with much discussion of model registries!

There were plenty of papers that satisfied my own particular research interests. Right up my research street was Mauro Laudicella‘s paper, which used real-world data to assess the cost savings associated with redirecting cancer diagnoses to GP referral rather than emergency presentation. I wasn’t quite as optimistic about the potential savings, with the standard worries about lead time bias and selection effects. But it was a great paper nonetheless. Also using real-world evidence was Ewan Gray‘s study, which supported the provision of adjuvant chemotherapy for early stage breast cancer but delivered some perplexing findings about patient-GP decision-making. Ewan’s paper explored technical methodological challenges, though the prize for the most intellectually challenging paper undoubtedly goes to Manuel Gomes, who continued his crusade to make health economists better at dealing with missing data – this time for the case of quality of life data. Milad Karimi‘s paper asked whether preferences over health states are informed. This is the kind of work I enjoy thinking about – whether measures like the EQ-5D capture what really matters and how we might do better.

As usual, many delegates worked hard and played hard. I took a beating from the schedule at this HESG, with my discussion taking place during the first session after the conference dinner (where we walked in the footsteps of the Spice Girls) and my chairing responsibilities falling on the last session of the last day. But in both cases, the audience was impressive.

I’ll leave the final thought for the blog post with Peter Smith’s plenary, which considered the role of health economists in a post-truth world. Happily, for me, Peter’s ideas chimed with my own view that we ought to be taking our message to the man on the Clapham omnibus and supporting public debate. Perhaps our focus on (national) policymakers is too strong. If not explicit, this was a theme that could be seen throughout the meeting, whether it be around broader engagement with stakeholders, recognising local decision-making processes, or harnessing the value of storytelling through qualitative research. HESG members are STRETCHing the truth.


Meeting round-up: EuroQol Plenary Meeting 2017

The 34th Plenary Meeting of the EuroQol Group took place in Barcelona on 21st and 22nd September 2017. The local hosts of the meeting were Mike Herdman (UK-born but a Barcelona resident for many years), Juan Manuel Ramos-Goñi and Oliver Rivero-Arias. For the second year running, I chaired the Scientific Programme together with Anna Lugnér.

At its inception, the EuroQol Group was very much a northern European collaboration – the early versions of the EuroQol instrument (now known as the EQ-5D) were developed by researchers in the Netherlands, UK, Sweden, Finland and Norway – see here for an overview of the Group and its history. This year’s Plenary Meeting was attended by 111 participants (primarily academic researchers) representing 23 different countries spanning six continents.

As with previous Plenary Meetings, an HESG-style discussant format was followed – papers were pre-circulated to participants and presented by discussants rather than by authors. The parallel poster sessions also followed a discussant format, with approximately 10 minutes dedicated to the discussion of each poster. In total, 19 papers and 20 posters were presented. For the first time, the majority of the papers were lead-authored by women.

One of the themes of the meeting was a focus on the relationships and interactions between EQ-5D dimensions. A paper by Anna Selivanova compared health state values derived from discrete choice data both with and without interactions. Anna reported results demonstrating that interactions are important and that the interaction between mobility and self-care was the most salient. Another paper by Thor Gamst-Klaussen (represented at the meeting by co-author Jan Abel Olsen) explored the causal and effect nature of EQ-5D dimensions. The authors applied confirmatory tetrad analysis and confirmatory factor analysis to multi-country, cross-sectional data in order to test a conceptual framework depicting relationships among the five dimensions. The results suggest that the EQ-5D comprises both causal variables – mobility, pain/discomfort and anxiety/depression – and effect variables – self-care and usual activities.

An intriguing paper by John Hartman tested for differences in respondent characteristics, participation, response quality and EQ-5D-5L values depending on the device and connection used to access an online survey. The results showed systematic variability in participation and response quality, but the variability did not affect the resulting health state values. The findings could support extending the administration of valuation surveys to smaller devices (e.g. mobile phones) to obtain responses from younger, more ethnically diverse populations who have traditionally been found to be difficult to recruit.

Other topics covered in the programme included the views of UK decision makers on the role of well-being in resource allocation decisions, the development of a value set for the EQ-5D-Y (a version of the EQ-5D designed for use in children and adolescents), and the prevalence and impact of so-called ‘implausible’ health states.

The Plenary Meeting concluded with a guest presentation by Janel Hanmer of the University of Pittsburgh, followed by a reception at a restaurant on the Montjuïc hill overlooking the Barcelona harbour. The next EuroQol conference will be the Academy Meeting, which takes place in Budapest on 6-8 March 2018.


Meeting round-up: Fourth EuHEA PhD Student-Supervisor and Early Career Researcher Conference

The 4th catchily-titled EuHEA PhD Student-Supervisor and Early Career Researcher (ECR) conference took place from 6th–8th September 2017 in Lausanne, Switzerland. Students and ECRs can attend alone but are encouraged to bring their supervisors or other senior colleagues with them, who are then allocated as discussants.

With a format inspired by the UK HESG meeting, papers are pre-circulated and each given an hour session. The student or ECR first presents their paper for 25 minutes, followed by a 15-minute discussion from an allocated senior delegate. The floor is then opened to the audience for a further 20 minutes of discussion. This format enables students and ECRs to gain experience in both writing and presenting their work, in addition to receiving detailed feedback and suggestions for future directions.

45 papers were presented in total, and the overall standard of the work was exceptional. Four parallel sessions ran, roughly grouped into the themes of: economic evaluation of medical technologies; economics of health system financing, regulation and delivery; determinants of health behaviours and consequences; and patient and provider decision making and incentives. So there really was something for everyone. There were also short 10-minute presentation sessions. I really enjoyed these quick overviews and felt that I learnt more about people’s research from these than a traditional poster session.

The atmosphere is purposefully relaxed and friendly, and it was great to see students and ECRs contributing to the discussions just as much as their senior supervisors. The conference also seems to attract repeat attendance and so is beginning to form a supportive network of junior health economists who now meet annually. As one of the organisers of the first conference in Manchester, a personal highlight for me was seeing delegates who had originally attended as PhD students returning this time in the role of supervisor as their careers have progressed.

Ieva Sriubaite had the rather daunting but invaluable opportunity to have her paper “Go your own way? The importance of peers in the formation of physician practice styles” discussed by Prof Amitabh Chandra from Harvard, who also gave the plenary speech. Whilst the conference programme was packed, there were still plenty of opportunities to socialise, and a cultured trip to The Hermitage Foundation.

An initiative to come out of the previous conference is the formation of a EuHEA Early Career Committee, which will represent the interests of health economists at the start of their careers within EuHEA. I had the great honour of being elected to chair this committee, and we held our first committee meeting during the conference. Watch out for updates on our best idea to come from this meeting – a conference cruise.

For now, hold 5th–7th September 2018 in your diaries and book your flights to Sicily for the 5th conference. If that location doesn’t convince you to attend I don’t know what will.