Meeting round-up: 7th annual Vancouver Health Economics Methodology (VanHEM) meeting

The 7th annual Vancouver Health Economics Methodology (VanHEM) meeting took place on June 16 in Vancouver, Canada. This one-day conference brings together health economists from across the Pacific Northwest, including Vancouver, Washington State, and Calgary. This has always been more than a Vancouver meeting, which led Anirban Basu from Washington State to suggest changing the name of the meeting to the Cascadia Health Economics Workshop (CHEW) – a definite improvement.

This year’s event began a day early, with Richard Grieve from the London School of Hygiene and Tropical Medicine, Stephen O’Neill from NUI Galway, and Jasjeet Sekhon from the University of California Berkeley, delivering a workshop titled Methods for Addressing Confounding in Comparative Effectiveness and Cost-effectiveness Studies. This provided both theoretical and practical examples of propensity score matching, genetic matching, difference-in-difference estimation and the synthetic control method. I was fortunate enough to be one of the 16 attendees (it was oversubscribed) to participate after being unable to attend when the course was offered at the Society for Medical Decision Making conference this past October. The course was an excellent introduction to these methodologies, including both theoretical and empirical examples of their use. I was particularly interested to have R and Stata code provided, to work through real-world examples. Being able to see the data and code and explore different analyses provided an incredibly rich learning experience.

The following morning, Prof Grieve delivered the plenary address to the more than 80 attendees. This talk discussed the potential for causal inference and large-scale data to influence policy, and outlined how observational data can complement evidence from randomized controlled trials (the slides are available here [PDF]). Since the expertise of our health economics community centres on other methods, primarily economic evaluation and stated preference methods, Prof Grieve’s plenary catalyzed a lot of discussion, which continued throughout the day. After the plenary, there were eight papers discussed over four parallel sessions, in addition to ten posters presented over lunch. This included an interesting paper by Nathaniel Hendrix from Washington state on a mapping algorithm between a generic and condition-specific quality-of-life measure for epilepsy, and two papers using discrete choice methodology. One by Tracey-Lea Laba evaluated cost sharing for long-acting beta-agonists in Australia, and another by Dean Regier, Verity Watson and Jonathon Sicsic explored choice certainty and choice consistency in DCEs using Kahneman’s dual processing theory.

Having been to three HESG meetings, there are lots of similarities with the format of VanHEM. For instance, papers are discussed for 20 minutes by another attendee, and the author has 5-minutes for clarification. What is different is that before a wider discussion, members of the audience break into small groups for 5 minutes. In my experience, this addition has been very effective at increasing participation during the final 25 minutes of the session, which is an open discussion amongst all attendees. It also gave attendees the opportunity to swap tips on where to find the best deals on plaid shirts.

I was fortunate enough to have my paper accepted and discussed by Prof Larry Lynd from the UBC Faculty of Pharmaceutical Science. Prof Lynd provided a number of excellent suggestions. Of particular note was a much simpler and more intuitive description of the marginal rate of substitution.

VanHEM also afforded an opportunity for discussion and reflection within the local health economics community. Recently, the Canadian Institutes for Health Research launched the Strategy for Patient-Oriented Research (SPOR). In BC, this involves an $80 million investment to “foster evidence-informed health care by bringing innovative approaches to the point of care, so as to ensure greater quality, accountability, and access of care”. One innovative approach is the creation of a new health economics methods cluster in the province, which is co-led by David Whitehurst (Simon Fraser University) and Nick Bansback (University of British Columbia). It receives SPOR funds to help support the health economics community as a whole, and specific research projects that focus on novel methods. At VanHEM, one hour was dedicated to determining how the cluster could help support the community that sees many health economists located at different sites throughout the region. Participants suggested having a number of dedicated academic half-days throughout the year that aim to provide an opportunity for members of the community to see each other face-to-face and engage in activities that support professional development. The theme of great titles continued with the suggestion of a “HEck-a-thon”.

Overall, this year’s VanHEM meeting was a great success. The addition of a pre-meeting workshop provided an excellent opportunity for our community to gain practical experience in causal methods, and we continue to see increased numbers of participants from outside our local region. I’m looking forward to doing this again in 2018, and I would encourage anyone visiting our region to be in touch!

Credits

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Meeting round-up: 16th Annual International Conference on Health Economics, Management & Policy

The 16th Annual International Conference on Health Economics, Management & Policy took place this June, as it does every year, in Athens, Greece. The conference is run by the Athens Institute for Education and Research, which was established in 1995 and covers a wide range of academic disciplines, including health economics.

The conference was held in the centre of Athens in parallel with a variety of conferences for other disciplines. In fact, the 3rd International Conference on Public Health happened to be in the same room and had many of the same sessions as this meeting. As a result, there was less health economics than I had expected but this was not a problem and I think made for more interesting discussion as the two disciplines gave a range of different comments.

The sessions followed a format whereby each discussant had 15 minutes to present a short summary of their own paper. There were between 2 and 5 presentations per session and these were delivered back to back. Only after all presentations in a session were concluded was the floor opened up for questions, comments or discussion. Papers had been grouped to have similar themes and so, in many cases, this worked well in widening the discussion to more general research areas. Each session was chaired by a senior researcher, and chairs were under strict instructions not to participate in the discussion of their session. There were no plenary talks, other than a very friendly welcome and introduction by the president of the Institute at the beginning of the first day.

Participants had a wide range of research backgrounds, so presentations which were targeted at a more general audience were better received. Personally, I found the discussion in my session really useful, partly because there were a number of public health experts in the room. I presented a paper on the topic of childhood obesity, which is always of interest to people with a range of different backgrounds. Others may not have benefitted from this quality of discussion because of their more specific research areas. This is something I think it would be important to consider before presenting at this conference. I found myself tweaking the delivery of my presentation after realising the variety of backgrounds and research interests in the audience.

The conference was followed by two days of ‘educational’ trips in the areas surrounding Athens. For these trips, participants at the Health Economics, Management and Policy conference were joined by attendees of conferences from other academic disciplines which were taking place in parallel, allowing participants to network beyond their own research areas. Unfortunately, I was unable to participate in these trips but Athens is a beautiful place and I expect that the trips were very informative and a lot of fun.

This was a very international conference and makes for a great opportunity to network with researchers from all over the world. All papers and discussions were given in English. The conference would be great for PhD students or researchers who have relatively little experience presenting their research, due to the friendly atmosphere and informal discussion.

Credits

Meeting round-up: 18th European Health Economics Workshop (EHEW)

I attended the European Health Economics Workshop (EHEW) in Oslo. The workshop has been running for almost 20 years and it shows. Most participants have attended many editions of EHEW, which has and continues to shape the field of health economics theory. This is “the theory workshop”. The atmosphere is one of great friendship and constructive feedback, based on long-term collaborations that set the tone of the workshop. I am definitely not a theorist but found a very welcoming group of people, interested in fostering collaboration between theory, experiments, and empirical work.

EHEW is also a perfect example of the law of small numbers. The smaller the workshop, the more useful the feedback. The smaller the workshop, the larger the potential for fruitful research co-authorship.

Over two days, we went through 15 papers, building up to a total of not more than 30 participants, all of whom had an active role. The author presents in 25 minutes, followed by 10 minutes from the discussant and floor debate, a format that has become the golden rule.

We started off the proper way, with a wine reception at our headquarters hotel in downtown Oslo. I have to say, the organizers – Tor Iversen, Oddvar Kaarboe and Jan Erik Askildsen – did a terrific job. We all know what people remember from a workshop or conference: food and venue. It will be hard to beat EHEW Oslo (although we are possibly headed to Paris next year). We spent Friday and Saturday in an old stable, transformed into a delightful meeting room (see below). The catering was also on point, but what really stood out were the dinners. I think we can all agree that the dinner on Friday night was the best conference meal of all time; a 4-course dinner with paired wine at Restaurant Eik (I leave this here in case you ever go to Oslo – trust me, you want to go there.)

What about scientific content, you might ask? Jonathan Kolstad set the tone with an opening keynote lecture on the role of IT in physician response to pay for performance. The lecture combined theory with empirics, and I was rapidly drawn into a data-envy generating process. Tremendous physician and patient level data from the largest provider in Hawaii. Can you imagine the hardships of field work?

As for the presentations, we covered a broad range of topics. Luigi Siciliani, Helmuth Cremer and Francesca Barigozzi teamed up for a session on long-term care. Their theoretical approaches ranged from a standard IO two-sided market approach to strategic bequests and informal caregiving within the family. We had sessions on the regulation of drugs and unhealthy food, hospital, pharmaceutical and insurance markets, and on GP and health behavior. The paper by Marcos Vera-Hernandez (Identifying complementarities across tasks using two-part contracts. An application to family doctors) was a fantastic example of how to combine theory and empirical analysis. Johannes Schunemann gave a thought-provoking talk on The marriage gap: optimal aging and death in partnerships. I don’t quite agree with the assumptions and conclusions of the study, but then again I think that’s why I’m not a theorist… The main problem, in this case, is that there is nothing about the model that is specific to the variables being studied. We also covered the hot topic of antibiotic prescribing, with a model for prescription under uncertainty about resistance that got us all guesstimating our risk aversion.

The discussions within the workshop highlighted the potential benefits from having cross-field feedback. Empirically-minded researchers provided very useful feedback for theory articles, and vice-versa (for the few exceptions to the theory rule). In retrospect, I am convinced this arises from getting less caught up in technicalities of the theoretical model or the econometric specification, and placing a stronger emphasis on the basic assumptions of the models and the corresponding story.

All in all, we had a terrific time in Oslo. I was impressed by the level of collegiality amongst long-term participants, as well as their welcoming attitude towards newbies like myself. We worked hard and partied hard – even brought back dancing to EHEW – and I look forward to meeting up with the theorists in the near future. Lise, it’s on you!