Rita Faria’s journal round-up for 29th July 2019

Every Monday our authors provide a round-up of some of the most recently published peer reviewed articles from the field. We don’t cover everything, or even what’s most important – just a few papers that have interested the author. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.

All-male panels and gender diversity of issue panels and plenary sessions at ISPOR Europe. PharmacoEconomics – Open [PubMed] Published 22nd July 2019

All male panels and other diversity considerations for ISPOR. PharmacoEconomics – Open [PubMed] Published 22nd July 2019

How is gender balance at ISPOR Europe conferences? This fascinating paper by Jacoline Bouvy and Michelle Mujoomdar kick-started a debate among the #HealthEconomics Twitterati by showing that the gender distribution is far from balanced.

Jacoline and Michelle found that, between 2016-18, 30% of the 346 speakers at issue panels and plenary sessions were women. Of the 85 panels and sessions, 29% were manels and 64% were mainly composed by men, whereas 2% were all-women panels (‘famels’?).

The ISPOR president Nancy Devlin had a positive and constructive response. For example, I was very pleased to know that ISPOR is taking the issue seriously and no longer has all-male plenary sessions. Issue panels, however, are proposed by members. The numbers show that the gender imbalance in the panels that do get accepted reflects the imbalance of the panels that are proposed.

These two papers raise quite a lot of questions. Why are fewer women participating in abstracts for issue panels? Does the gender distribution in abstracts reflect the distribution in membership, conference attendance, and submission of other types of abstracts? And how does it compare with other conferences in health economics and in other disciplines? Could we learn from other disciplines for effective action? If there is a gender imbalance in conference attendance, providing childcare may help (see here for a discussion). If women tend to submit more abstracts for posters rather than for organised sessions, more networking opportunities both online and at conferences could be an effective action.

I haven’t studied this phenomenon, so I really don’t know. I’d like to suggest that ISPOR starts collecting data systematically and implements initiatives in a way that is amenable to evaluation. After all, doing an evaluation is the health economist way!

Seamless interactive language interfacing between R and Stata. The Stata Journal [RePEc] Published 14th March 2019

Are you a Stata-user, but every so often you’d like to use a function only available in R? This brilliant package is for you!

E.F. Haghish created the rcall package to use R from Stata. It can be used to call R from Stata, or call R for a specific function. With the console mode, we call R to perform an action. The interactive mode allows us to call R from a Stata do-file. The vanilla mode evokes a new R session. The sync mode automatically synchronises objects between R and Stata. Additionally, rcall can transfer various types of data, such as locals, globals, datasets, etc. between Stata and R. Lastly, you can write ado-commands to embed R functions in Stata programs.

This package opens up loads of possibilities. Obviously, it does require that Stata users also know R. But it does make it easy to use R from the comfort of Stata. Looking forward to trying it out more!

Development of the summary of findings table for network meta-analysis. Journal of Clinical Epidemiology [PubMed] Published 2nd May 2019

Whilst the previous paper expands your analytical toolbox, this paper helps you present the results in the context of network meta-analysis. Juan José Yepes-Nuñez and colleagues propose a new summary of findings table to present the results of network meta-analysis. This new table reports all the relevant findings in a way that works for readers.

This study is remarkable because they actually tested the new table with 32 users in four rounds of test and revision. The limitation is that the users were mostly methodologists, although I imagine that recruitment of other users such as clinicians may have been difficult. The new format comprises three sections. The upper section details the PICO (Population; Intervention; Comparison; Outcome) and shows the diagram of the evidence network. The middle section summarises the results in terms of the comparisons, number of studies, participants, relative effect, absolute outcomes and absolute difference, certainty of evidence, rankings, and interpretation of the findings. The lower section defines the terminology and provides some details on the calculations.

It was interesting to read that users felt confused and overwhelmed if the results for all comparisons were shown. Therefore, the table shows the results for one main comparator vs other interventions. The issue is that, as the authors discuss, one comparator needs to be chosen as the main comparator, which is not ideal. Nonetheless, I agree that this is a compromise worth making to achieve a table that works!

I really enjoyed reading about the process to get to this table. I’m wondering if it would be useful to conduct a similar exercise to standardise the presentation of cost-effectiveness results. It would be great to know your thoughts!

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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!