Health Economics Research Centre (Herc), University Of Oxford

FORTHCOMING HERC SEMINAR
On Wednesday 1st May, Dr Padraig Dixon (Research Fellow, Bristol Medical School: Population Health Sciences) will be speaking on:
'The causal effect of adiposity on hospital costs: Mendelian Randomization analysis of over 300,000 individuals from the UK Biobank'
... The seminar will take place at 11.00am in Oxford. All welcome.
For more details, please see: http://bit.ly/2UUzNnT
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NEW PUBLICATION
How Economists Help Central Government Think: Survey Evidence from the UK Government Economic Service
Paul Anand, Laurence Roope & Andy Ross
... International Journal of Public Administration, 2019. DOI: 10.1080/01900692.2019.1575668
ABSTRACT
Economic thinking is widely used now across most areas of government activity, though there is not much research on what professional economists do. This paper, therefore, develops and reports on a survey of over 500 members of the UK Government Economic Service, which we use to shed light on the activities and thinking of practitioners. We find, inter alia, that professional economics can be seen as drawing on at least four distinct economic paradigms, that the uses of economics vary significantly between areas of government and that whilst significant use of research can be made, this is not necessarily a defining aspect of professional practice.
Link to paper: http://bit.ly/2JyCGJG
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NEW PUBLICATION
Is stratification testing for treatment of chronic obstructive pulmonary disease exacerbations cost-effective in primary care? An early cost-utility analysis
Abel L, Dakin HA, Roberts N, Ashdown HF, Butler CC, Hayward G, Van den Bruel A, Turner PJ, Yang Y
... Int J Technol Assess Health Care. 2019 Mar 4:1-10. doi: 10.1017/S0266462318003707
ABSTRACT
OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations usually require treatment with oral steroids or antibiotics, depending on the etiology of the exacerbation. Current management is based on clinician's assessment and judgement, which lacks diagnostic accuracy and results in overtreatment. A test to guide these decisions in primary care is in development. We developed an early decision model to evaluate the cost-effectiveness of this treatment stratification test in the primary care setting in the United Kingdom.
METHODS: A combined decision tree and Markov model was developed of COPD progression and the exacerbation care pathway. Sensitivity analysis was carried out to guide technology development and inform evidence generation requirements.
RESULTS: The base case test strategy cost GBP 423 (USD 542) less and resulted in a health gain of 0.15 quality-adjusted life-years per patient compared with not testing. Testing reduced antibiotic prescriptions by 30 percent, potentially lowering the risk of antimicrobial resistance developing. In sensitivity analysis, the result depended on the clinical effects of treating patients according to the test result, as opposed to treating according to clinical judgement alone, for which there is limited evidence. The results were less sensitive to the accuracy of the test.
CONCLUSIONS: Testing may be cost-saving in primary care, but this requires robust evidence on whether test-guided treatment is effective. High quality evidence on the clinical utility of testing is required for early modeling of diagnostic tests generally.
Link to PubMed: http://bit.ly/2FmLJIC #healtheconomics
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HERC PRESENTATIONS
HERC researcher Laurence Roope will present at the 2019 CSAE Conference at 4.30pm today on:
"Gravitational Allocation Problems"
... You can download this paper here: http://bit.ly/2Jn1XXf
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CONFERENCE NEWS
We can confirm that the summer 2020 HESG meeting that was originally going to be hosted by Cambridge will now be hosted by HERC in Oxford in late July.
More details on exact dates and practical arrangements to come soon.
... #healtheconomics
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NEW PUBLICATION
Comprehensive Geriatric Assessment in hospital and hospital-at-home settings: a mixed-methods study
Mike Gardner, Sasha Shepperd, Mary Godfrey, Petra Mäkelä, Apostolos Tsiachristas, Amina Singh-Mehta, Graham Ellis, Pradeep Khanna, Peter Langhorne, Stephen Makin, and David J Stott
...Continue Reading

NEW PUBLICATION
Making Information on CSR Scores Salient: A Randomized Field Experiment
Leonardo Becchetti, Francesco Salustri, Pasquale Scaramozzino
... Oxf Bull Econ Stat. doi:10.1111/obes.12301
ABSTRACT
We locate a giant ‘school report‐like’ scorecard poster with domain‐specific social and environmental responsibility scores of the ten leading world food companies, measured by the Oxfam ‘Behind the Brands’ world campaign, at the entrance of selected supermarkets. We test the impact of these scores on consumers’ choices by means of a randomized field experiment. Our findings show that the Oxfam ranking matters since the treatment has a positive and significant effect on the market share of the companies with the highest scores and a negative and significant effect on the companies placed at the lowest ranks. Invisibility matters too, with the largest non‐ranked companies selling in the store experiencing a slight fall in their market shares.
Link to paper: http://bit.ly/2TgGvXR
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NEW PUBLICATION
Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines
Koen B Pouwels, Susan Hopkins, Martin J Llewelyn, Ann Sarah Walker, Cliodna AM McNulty, Julie V Robotham
... BMJ 2019;364:l440
ABSTRACT
OBJECTIVE: To evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.
DESIGN: Cross sectional study.
SETTING: General practices contributing to The Health Improvement Network database, 2013-15.
PARTICIPANTS: 931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis.
MAIN OUTCOME MEASURES: The main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication.
RESULTS: The most common reasons for antibiotics being prescribed were acute cough and bronchitis (386 972, 41.6% of the included consultations), acute sore throat (239 231, 25.7%), acute otitis media (83 054, 8.9%), and acute sinusitis (76 683, 8.2%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines.
CONCLUSION: For most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines.
Link to paper: http://bit.ly/2EhDwES
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NEW PUBLICATION
The Vote with the Wallet Game: Responsible Consumerism as a Multiplayer Prisoner’s Dilemma
Leonardo Becchetti and Francesco Salustri
... Sustainability 2019, 11(4), 1109; https://doi.org/10.3390/su11041109
ABSTRACT
Socially responsible consumers and investors are increasingly using their consumption and saving choices as a ‘vote with the wallet’ to award companies that are at vanguard in reconciling the creation of economic value with social and environmental sustainability. In our paper, we model the vote with the wallet as a multiplayer prisoner’s dilemma, outline equilibria and possible solutions to the related coordination failure problem in evolutionary games, apply our analysis to domains in which the vote with the wallet is empirically more relevant, and provide policy suggestions.
Link to paper: http://bit.ly/2T2XY6I
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NEW PUBLICATION
Is Doctor Referral to a Low‐Energy Total Diet Replacement Program Cost‐Effective for the Routine Treatment of Obesity?
Kent S, Aveyard P, Astbury N, Mihaylova B and Jebb SA
... Obesity, 27: 391-398. doi:10.1002/oby.22407
ABSTRACT
OBJECTIVE: The study objective was to estimate the cost‐effectiveness of a commercially provided low‐energy total diet replacement (TDR) program compared with nurse‐led behavioral support.
METHODS: A multistate life table model and the weight reduction observed in a randomized controlled trial were used to evaluate the quality‐adjusted life‐years and direct health care costs (in United Kingdom 2017 prices) over a lifetime with TDR versus nurse‐led support in adults who had obesity, assuming that (i) weight returns to baseline over 5 years and (ii) a 1‐kg weight loss is maintained after 5 years following TDR.
RESULTS: The per‐person costs of the TDR and nurse‐led programs were £796 and £34, respectively. The incremental cost‐effectiveness ratio of TDR was £12,955 (95% CI: £8,082‐£17,827) assuming that all weight lost is regained and £3,203 (£2,580‐£3,825) assuming that a 1‐kg weight loss is maintained after 5 years. TDR was estimated to be more cost‐effective (i.e., lower incremental cost‐effectiveness ratios) in older adults and those with a higher BMI, with little difference by gender.
CONCLUSIONS: At current retail prices and with plausible long‐term weight regain trajectories, TDR is projected to be cost‐effective in adults with obesity and could be considered as an option to treat obesity in routine health care settings.
Link to paper: http://bit.ly/2GZAkAJ
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HERC NEWSLETTER - ISSUE #26 - OUT NOW
In this issue:
• Body mass index and the use and costs of primary care services... • Economic modelling and financing of personalised medicine • Increasing efficiency in the English diabetic retinopathy screening programme • Comparing methods for analysing partial factorial trials
In addition our spotlight feature focuses on HERC DPhil student Patrick Fahr.
Click here to read the newsletter: http://bit.ly/2EjUrrL
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HERC NEWSLETTER - ISSUE #26 - OUT NOW
In this issue:
• Body mass index and the use and costs of primary care services... • Economic modelling and financing of personalised medicine • Increasing efficiency in the English diabetic retinopathy screening programme • Comparing methods for analysing partial factorial trials
In addition our spotlight feature focuses on HERC DPhil student Patrick Fahr.
Click here to read the newsletter: http://bit.ly/2EjUrrL
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HERC VACANCY
We are currently recruiting a Researcher in Health Economics. We are looking for a suitably experienced candidate to support a number of the Unit’s research projects, involving the exploration of data from large observational studies and NHS databases. You will oversee the day-to-day running of the projects, prepare data analysis and application of modelled based economic evaluation, and report findings by publishing them in scientific journals and presenting the...m at international conferences.
The closing date for applications is 12.00 noon on 22 February 2019.
For more information, please visit: http://bit.ly/2sIGcG5
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NEW PUBLICATION
Health‐related quality of life in people with type 2 diabetes participating in the LEADER trial
Michael A. Nauck, John B. Buse, Johannes F. E. Mann, Stuart Pocock, Heidrun Bosch‐Traberg, Helle Frimer‐Larsen, Qing Ye, Alastair Gray, LEADER Publication Committee for the LEADER Trial Investigators
... Diabetes Obes Metab. 2019 Mar;21(3):525-532
ABSTRACT
AIMS: To assess health‐related quality of life (HRQoL) in people with type 2 diabetes (T2D) participating in the LEADER cardiovascular outcomes trial using the five‐dimension European Quality of Life questionnaire (EQ‐5D).
MATERIALS AND METHODS: The EQ‐5D was administered every 12 months in a subset of patients from Canada, Denmark, Germany, Ireland, Italy, Netherlands, Spain, Sweden, the United Kingdom and the United States. We compared changes in utility index scores and visual analogue scale (VAS) scores from baseline to 36 months in participants treated with liraglutide and placebo. We also assessed which complications had the greatest impact on quality of life.
RESULTS: At 36 months, less deterioration in EQ‐5D utility index score was seen in the liraglutide group (−0.058) than in the placebo group (−0.082; estimated treatment difference [ETD] 0.023, 95% confidence interval [CI] 0.004;0.043; P = 0.020). A smaller decrease in EQ‐5D VAS score was also demonstrated in the liraglutide group (−3.51) vs. the placebo group (−5.45; ETD 1.94, 95% CI 0.32;3.57; P = 0.019). The benefits of liraglutide treatment compared with placebo were driven primarily by shifts in the domains of mobility and self‐care. The most influential events contributing to poorer HRQoL were stroke, heart failure, malignant neoplasm and confirmed hypoglycaemia.
CONCLUSIONS: Liraglutide demonstrated a modest but significant benefit in patient‐reported health status using the EQ‐5D, compared with placebo. This benefit may be of clinical relevance and requires further study.
Link to paper: http://bit.ly/2UUTjQN
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NEW HERC PUBLICATION
Simulating the impact of targeting lower systolic blood pressure and LDL-cholesterol levels on type 2 diabetes complication rates
Mostafa SA, Coleman RL, Agbaje OF, Gray AM, Holman RR, Bethel MA
... J Diabetes Complications. 2019 Jan;33(1):69-74
ABSTRACT
AIMS: There are few data available on the incremental benefits of risk factor modification in type 2 diabetes mellitus (T2DM). We simulated the potential benefits of achieving lower systolic blood pressure (SBP) and LDL-cholesterol targets.
METHODS: We used the UKPDS Outcomes Model v2.0 to estimate 10-year event rates for complications using baseline data from 5717 participants with T2DM in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin Study. All risk factor values were held constant over 10 years. In separate analyses, different levels of SBP between 160 and 120 mm Hg and LDL-cholesterol between 5.0 and 1.0 mmol/l were imposed on the cohort. Cumulative relative risk reductions (CRRR) at each 10 mm Hg and 1.0 mmol/l decrements respectively were compared using Kruskal-Wallis tests.
RESULTS: CRRRs for each 10 mm Hg SBP decrement from 160 mm Hg were 2.2%, 4.5%, 7.0% and 10.0% for myocardial infarction (MI); 12.5%, 24.8%, 35.6% and 44.9% for stroke; 5.4%, 10.9%, 16.2% and 20.9% for blindness; 7.4%, 14.7%, 21.6% and 27.4% for amputation, respectively. CRRRs for each 1.0 mmol/l LDL-cholesterol decrement from 5.0 mmol/l were 16.9%, 30.8%, 41.2% & 51.0% for MI; 9.2%, 19.7%, 29.6% & 38.8% for stroke (p < 0.001 in all cases).
CONCLUSIONS: These simulated outcomes illustrate the potential benefits of targeting progressively lower SBP and LDL-cholesterol values.
Link to paper: http://bit.ly/2DZtzgc
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HERC VACANCY
We are currently recruiting a Researcher in Health Economics. We are looking for a suitably experienced candidate to support a number of the Unit’s research projects, involving the exploration of data from large observational studies and NHS databases. You will oversee the day-to-day running of the projects, prepare data analysis and application of modelled based economic evaluation, and report findings by publishing them in scientific journals and presenting the...m at international conferences.
The closing date for applications is 12.00 noon on 22 February 2019.
For more information, please visit: http://bit.ly/2sIGcG5
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HERC EXTERNAL PRESENTATION
Professor Philip Clarke will be presenting at the University of York on Thursday 7th February on:
"The origins of health economic evaluation: What can we learn from history?"
... For more information: http://bit.ly/2MQNcdb
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NEW HERC PUBLICATION
Challenges for Optimizing Real-World Evidence in Alzheimer's Disease: The ROADMAP Project
Gallacher J, de Reydet de Vulpillieres F, et al. [includes Gray A]
... J Alzheimers Dis. 2019;67(2):495-501.
ABSTRACT
ROADMAP is a public-private advisory partnership to evaluate the usability of multiple data sources, including real-world evidence, in the decision-making process for new treatments in Alzheimer's disease, and to advance key concepts in disease and pharmacoeconomic modeling. ROADMAP identified key disease and patient outcomes for stakeholders to make informed funding and treatment decisions, provided advice on data integration methods and standards, and developed conceptual cost-effectiveness and disease models designed in part to assess whether early treatment provides long-term benefit.
Link to paper: http://bit.ly/2D5oHoq
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