Claire Beecroft

Claire Beecroft

I am an Information Specialist and University Teacher at the School of Health and Related Research (ScHARR) at the University of Sheffield.

Location Sheffield, UK

Activity

  • @ColinDavies While systematic reviews are commonly used as part of the evidence base for an HTA, original research such as a trial may also be commissioned if there is a lack of independent evidence- in the UK these trials are reported in the HTA Journal https://www.journalslibrary.nihr.ac.uk/hta/#/

    If the only trials available are those sponsored by...

  • I think the idea of developing a proposal and publishing it is designed to encourage transparency and accountability- if a proposal is sufficiently detailed, it can be used to evaluate the completed review and check if the proposed methods were used an applied correctly. But it is true that bias can still influence review questions and the proposal may not be...

  • Pharma companies are seldom keen to talk publicly about what a particular health system pays for their product/s. Pricing is not fixed by any means and there will be considerable variation between what different health systems pay for the same treatment.

  • Hi Oyekola- I agree- the use of the term U-Turn isn't very transparent, and could imply a flippant 'change of heart' rather than an object evaluation taking into account new evidence and/or a change in price.

  • Hi Sanjoy, Yes, I see what you mean. It's certainly true that a reduction in price can then lead to a reduction in the costs per QALY that would cause NICE to change its decision, but that doesn't make them unobjective. Pricing negotiations are always very secretive, as companies will negotiate with reimbursers on an individual basis, meaning the price will...

  • Hi Ton,
    When calculating Quality Adjusted Life Years it is likely that drugs will be downto be more cost effective for people who have more years of life left, as is obviously the case with young children. This poses an ethical dilemma for reimbursement decision-makers who may find themselves accused of placing more value on the lives of children than of...

  • Hi Amy- yes, a consideration of the wider impacts and potential cost savings in the longer term is important, and not just focussing on the cost per patient, which only tells part of the story.

  • Hi Carol- good point. Some drugs, referred to as 'orphan drugs' are usually of benefit to only small numbers or people, and are often very expensive but may offer significant improvements in length and/or quality of life. There is debate about the ethics of paying for these drugs, rather than others which might benefit more people, though possibly to a lesser...

  • Hi Sarit- good point. In news reporting, payers are often described as refusing to fund a treatment soley because of costs, but most health systems so try to incorporate a wider perspective on the value a new treatment brings.

  • Hi Excel. Yes, value is highly subjective- where one person may value being alive, in any condition, for as long as possible, another may place no value at all on being alive in a very poor health state.

  • Hi Amanda. Yes, sometimes there are areas where payers and sponsors agreed, and often this leads to a public blame-game where both payers and funders say the other is at fault.

  • Hi Tom. The Daily Mail are particularly keen on stories about patients being 'betrayed', as they put it. Emotional language is often used to construe decision-makers as bureaucrats and rationers.

  • Hi Carol. This is quite a typical article in that it focuses on an individual and the impact on them, rather than what the evidence tells us about the likely impact on CF patients more generally.

  • Thanks Andrea! The article seems to imply that the HTA takes much longer that it really does- most of the 14 years they quote is development, not evaluation!

  • Hi Anna. Case controls could be based on an outcome or an intervention, and can be either prospective, where we follow patients over time, or retrospective, where we track back over time. When looking at an outcome, we are more likely to undertake a retrospective study where we identify patients who experienced an outcome and then track back, comparing against...

  • Hi Jim. For Single Technology Appraisals (which look at just one, new technology, with a single indication), NICE has a 49 week timeline from development to publication, which is quite an interesting read: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/technology-appraisal-guidance/process/sta-timeline

  • Good point Scott- valuing social and ethical impacts remains a challenge but is an area where methodological progress needs to be made so that these factors can be more fully incorporated into decision making.

  • Hi Liz, you make some great points here about the terminology used to describe the effects of new drugs- ‘game changing’ is a well-used phrase in these kinds of news stories as it simultaneously conveys the idea that a health technology has dramatic impacts whilst not actually saying anything about what those impacts actually are!

  • So we could think of it as being a more precise result, rather than a more precise study, I guess?

  • Hi Laura, it depends on what you think would make a study ‘precise’, but here what we are trying convey is that in a meta-analysis, we put more ‘weight’ on studies with a narrower confidence interval (where the result we would get in the real world is very likely to be very similar to that achieved in the study), than those studies with a wide confidence...

  • Thanks for your comment Rajeev. The opportunity cost must indeed be considered when allocating resources- when one group of patients are granted access to a new, innovative drug, another group may lose access to a treatment in order to fund the innovative drug. It’s easy to categorise these decisions as 'fair' or 'unfair', and to see patients as either...

  • Thanks for your post Ellie. It is often the case that news articles will focus on the case of an individual patient. This does a good job of bringing the story to life and making it engaging to lay readers, but obviously also brings an emotive aspect to the reporting- especially in the case of drugs for childhood diseases.

  • Hi Glenn- yes it is often the case that NICE is described in overtly disparaging terms, the word 'rationing' being used frequently to describe its role. Similarly there is often a lack of specific information on the effects of a drug/treatment- 'game changing' is a highly subjective term!

  • Good point Tamás ! There is undoubtedly a political angle to these decisions and politicians are not above using drug funding as a tool to win votes!

  • Hi Johnny, you can share this video via the youtube version at: https://youtu.be/5WmeesznKkg

  • Some good points being made here, especially around opportunity cost- one of the aspects of healthcare decision making that gets the least attention in the press. When we choose to approve a treatment for one group of patients, but not for another, we take into account not only costs and effects, but also the impact on the patients in other areas of the...

  • Thanks for posting this link Rosemary- and a good point that while NICE makes decisions about a wide range of treatments, the ones for cancer and/or serious conditions in children, tend to dominate in the press.

  • Hi Stephanie,

    Yes, we all value our health in different ways- for one with cancer person, staying alive the longest possible time will always be their priority, for another person, quality of life would be more important than length of life, so they might value the same cancer drug very differently.

  • Hi @YvesMielZuniga
    In private healthcare systems, such as the United States, higher costs for drugs are more widely accepted and reimbursed as the system is insurance- and patients will receive whatever treatments their insurance covers . In the UK we have a nationalised healthcare system with a fixed budget, so we must make judgements on what is affordable,...

  • Hi Amanda,

    Within HTA, we are always looking at the quality of a treatment (such as its benefit to patients relative to existing treatments) in relation to cost. Depending on the healthcare system, there may be a difference between what might be considered a 'reasonable cost' and what is affordable.

  • Hi Petra,
    Yes its true that many news reports focus on the patient perspective (which is likely to be similar to the readers perspective) so some news stories only really serve to reinforce the viewpoint that all drugs should be funded as a value should not be place on life. More balanced reporting will offer both the patient perspective and some relevant...

  • Hi Daisuke,

    As you note, the emphasis is often on costs and the message given by media outlets is 'drug rejected due to being too expensive'. This tends to give the impression that these decisions are made quite simply, based purely on the cost of a drug, rather that the more complex range of evidence about QoL, life expectancy, and quality of the research...

  • Good point about QoL Yves. While we may all have our own ideas about what QoL means, within health economics and HTA, QoL is something that is objectively measured and quantified, but that isn't always made clear in media reporting.

  • Hi Sam, some systematic reviews, such as those done by the Cochrane Collaboration, require reviewers to try and source unpublished data, but of course, this is not always made available, and so the reviews results may indeed be skewed by the tendency to publish positive results over negative or inconclusive ones.

  • Good point Rachel- there is increasing use of a wide range of study designs to enable researchers to conduct systematic reviews where no RCTs exist, but critics argue that these reviews are of little value if the evidence used in them is susceptible to bias. Is it right to do a review of the best available evidence, even if that evidence is flawed?

  • Yes, in some cases a translation will be sourced, though sometimes there will be a member of staff who is able to do this. We don't use automated translation services. As for contact with authors, yes, it is sometimes necessary to contact authors to clarify issues or request access to data, and we even sometimes encourage our dissertation students to contact...

  • Thanks Zizi- opportunity cost is something that is very much under- reported and under-explained in mainstream media so I fully agree with your comments. This article also creates the impression that NICE can be swayed simply by public pressure, which cannot be the case.

  • Thanks Uta- good to see posts about media within the pharma industry. As you note, there are still some biases in the reporting, but at least in this case there is some sense of balance- the new decision is not solely described as being based on a price-cut but on new evidence emerging to support the effectiveness of the therapy. This is most often the reason...

  • Hi Hannah, thanks for this. Very interesting to look at how the media within the industry report these stories. I subscribe to PharmaTimes so I see these stories regularly, and yes there is still some bias in the reporting even though both the writers and the readers are likely to have a high level of inside knowledge on the subject! There is a often a...

  • Some interesting comments here, especially around what constitutes 'news' within the modern media and how much detail the public want the public "want" to be provided with. It is certainly debatable as to how palatable the realities behind NICE's decisions would be to the public, but I still think a lot of people would be interested to hear about the "losers"...

  • It certainly seems that the article is suggesting that the 'u-turn' is on NICE's part, rather than the producers of the drug. The term 'u-turn' is possible a somewhat misleading once, designed as you note to indicate a 'wrong' decision has been 'righted' rather than a wider change in various factors that influenced the original decision.

  • It certainly would be interesting to see how NICE might re-word an article to better represent their perspective on decisions, but I think the freedom of the press might prevent that ever happening :)

  • Great points here Ian, especially about the potential unexpected consequences of a new therapy being made available. The wider, long-term benefits of a new therapy may help to offset the short-term costs, but identifying and measuring them is difficult. Nevertheless, these kinds of issues are the sort of thing that keep statisticians, economists and modellers...

  • Fantastic debate here, and thanks to those who have shared links and resources on this contentious subject!

  • Indeed Jana, RCTs cannot always give us a realistic picture, particularly of the likely levels of compliance with a therapy in the real world.

  • Many of you have noted that clinical trials may be limited in their wider applicability and are not able to pick up rarer adverse events. Some of you have also commented on the strict inclusion and exclusion criteria that are often applied to trials in order to eliminate major biases and confoudning factors- these criteria can end up producing a result that...

  • Thanks Jonathan! Your comment about the somewhat partial view that a report of and RCT gives is a good one- what isn't reported may be as important and revealing as what does make it into print. With increasing availability of resources to enable open-access publishing of data sets, things will hopefully improve in this regard, and reviewers will have access...

  • Thanks for your post Rui. There is much research ongoing into how real-world evidence can be accurately collated and incorporated into systematic reviews. As you note, the carefully controlled environment of the RCT does not necessarily replicate the experience of patients in the real world, so finding ways of capturing a more realistic picture are vital.

  • One theme that's clearly coming through in your comments is the potential for bias and limitations in the evidence base which a systematic review is based on. When appraising systematic reviews, a key criterion is how extensive the literature search has been, and what has been done to limit bias in the retrieval of studies. While some published reviews, even...

  • Good points here Helen- and as you note, when an individual's life is directly affected, it is little consolation to know that a rigorous analysis has been conducted. While some may accept that a treatment isn't cost-effective, its entirely understandable that for many people it is unacceptable that the costs of life-extending drugs can influence their...

  • We'll be looking in more detail at how cost-effectiveness is evaluated in week 4, so hopefully you'll find that interesting :)

  • I think its more the pharma industry that are disputing his arguments, especially about the cancer drug fund. I think there was a newspaper article where Paul Catchpole of the ABPI was taking issue with some of the issues Prof Claxton has raised.

  • Sorry I got his name wrong- its Claxton not Klaxton. If you search 'Karl Claxton Cancer Drugs' that should work!

  • Some excellent points being raised here! Many of you have noted the difficulty in making this decision and the ethical minefield involved. When considering funding a drug for all patients, regardless of how effective it might be for some patients due to age, ethnicity, gender etc, it can be useful to remember that when therapies are approved, the funding for...

  • Good point Natasha- one way of thinking about how we decide which patients we will fund a treatment for is to recognise the 'opportunity cost'- which in health economics means the benefits to other patients that will have to be foregone in order to make a new treatment available. So in this instance, we could investigate what treatments would have to be...

  • Yes! A key hope of 'value based pricing' was that it would encourage true innovation, rather than smaller step changes in outcomes for patients.

  • Really interesting comments Harry- you are correct that there has been a shift in the relative costs of drug development, and how these costs are borne/shared. Cancer drugs are often the most emotive, but as you say, the newer drugs are often quite specialised, focused on treating specific variants of cancer in specific populations, rather than being widely...

  • Thanks for your comments everyone! Its clear that while we all know what we personally value, coming to a conclusion about what is valuable within a healthcare system is difficult to define. In the UK we have attempted to take a more broad approach to value in healthcare, by investigating how 'value-based pricing' might help us make better decisions. However,...

  • Good definition Natasha! This is in essence is what health technology assessment is all about-ensuring that the NHS gets results that are commensurate with the price paid for drug. Sadly with some cancer drugs the benefits gained are not in proportion to the price.

  • Hi Bruno, glad you enjoyed Measuring and Valuing Health- a good course for anyone who wants to understand what a QALY is! Indeed, for most people the methods used to calculate cost-effectiveness are a mystery, and can easily be misconstrued.

  • Thanks for your post- a very interesting one as the story you have chosen has recently re-emerged due to NICE and Roche finally reaching a deal to fund Kadcyla- perhaps the public pressure on both parties was a factor in bringing about a happy resolution to the decision on this drug?

  • Thanks Christina for your very insightful comment :)
    Indeed the use of language is highly significant in much reporting about NICE decisions, and much of it, while not false as such, is misleading. 'Superior overall survival' sounds great, but often means patients living just a few more weeks, with an additional cost of tens or even hundreds of thousands. Its...

  • Glad to see so many of you responding to this discussion. Already you've discovered a wide range of news stories with a variety of approaches in reporting decisions. As we can see some media tell a fuller story than others, with some forms, especially tabloid newspapers, tending more towards the 'story' of the affected patients, rather than the...

  • Its a long shot but I'd want to know if there was any clue to the socio-economic background of the person. Being from a less affluent background (which might be given away by clothing or belongings found on or near the body) might give clues about their likely appearance as well- being poor can lead to all kinds of other issues- especially relating to your...

  • The first series of Danish/Swedish crime drama the Bridge had a strong forensic element to it. A body is found in the middle of the bridge that joins Denmark and Sweden, and the body has been severed in the middle on the exact mid-point of the bridge. The pathologist is able to quickly identify that the body is not one, but two, with top half being from one...

  • Good point Peter!

  • Thanks for these lovely comments- I'm delighted you all found the course enjoyable and engaging!

  • My sentiments exactly Jason- to be clinically relevant and applicable, review questions need to be precise, and that means it is unlikely that 200 or more studies would match the review question.

  • Great points all round here! Yes, it can seem a waste of resources to spend time reviewing an inadequate evidence base and then draw no solid conclusions, but it can be very helpful to researchers to have this information on where the gaps in the evidence base are, so that they can design and conduct research that is actually needed, and can demonstrate that...

  • Fantastic point well put Andrea. As a fellow IS it is sometimes positively frightening to see how badly a search has been conducted- which has implications for the whole of the subsequent methodology!

  • Good point Tracy. Practice varies internationally in terms of how, or even if, patients are engaged with decisions, but I would agree that their perspective on the value of health technologies to them should always be considered.

  • Great point well made Bryony!

  • I like your brevity Gopaldas! Quite concise and accurate!

  • Hi Katherine,

    Thanks for your post! Like others, you identify that value is quite complex in healthcare, certainly not merely a matter of cost. The difficulty is measuring the wider impacts of health technologies that can influence its 'value', especially societal values. As patients, what we value can change over time. For instance, if you are not affected...

  • Hi Ray,

    It sounds like you have good understanding of the concept of value based pricing already, and I hope the course will help you to see how HTA can fit within the overall assessment of the value of the new health technology or drug. It certainly a fascinating area and I hope you enjoy exploring it with us,

    Best wishes,

    Claire

  • Hi Cecile,

    Glad to see you manage to find this and get registered! I really hope you enjoy the program and that it helps you achieve your learning goals for your work role,

    With best wishes,

    Claire

  • Hi Amit,

    Welcome to the course! Your experience with systematic review and will be very useful, and the course is structured in such a way that it demonstrates how these kinds of reviews fit within the overall HTA process so you should find it really helpful!

    Good luck!

    Claire

  • Hi Ginette,

    Welcome to the course- I hope it gives you a taste of what our Masters programs offer, and if you want more information, the course homepage for the MSc in International Health Technology Assessment is at: tinyurl.com/mscihta

    My contact details are this page so feel free to get in touch if you have any questions!

    Best wishes,

    Claire