Sarah Bates
I'm a PhD student at the University of Sheffield. I'm currently researching the inclusion of psychological factors in health economic modelling of obesity.
Location Sheffield, UK
Activity
-
Sarah Bates replied to Lynne Webber
Great summary!
-
Thanks for your comments - really interesting views!
-
Time of publication is an important factor and authors must justify the timeline used.
-
This is a great point and thank you for the example!
-
Great summary!
-
This is true. It is now a requirement in many countries that clinical trials are registered before recruiting any participants. This can help researches conducting systematic reviews; they are able to find what trials have been conducted, even if they weren't published, and request the results. However, this isn't the case for all countries or for all study...
-
Sarah Bates replied to Jim Smith
I'd also recommend that course and it pairs well with this one.
-
Sarah Bates replied to Jim Smith
This is a good point - we're not able to fund every medication due to the limited budget and so a decision is made on how best to spend that budget to benefit the most people. However it's easy to focus only on those who will be impacted when a high profile medication/treatment isn't funded.
-
Sarah Bates replied to Jim Smith
Great to hear - I'll pass your positive feedback on
-
Sarah Bates replied to Nelly Gilyazetdinova
Congratulations on the job and glad to hear you've understood more than you thought you had! By the end of the course you should have an even better understanding.
-
Really interesting to hear your experience. Although many examples given are medicine related, HTA is also conducted for public health interventions. Although it can be more challenging, public health interventions are often preventative (they can prevent or delay the onset of disease) and so it's really importance to consider the costs and benefits of these...
-
Sarah Bates replied to Cecilia DV
Thank you for highlighting this!
-
Sarah Bates made a comment
Thank you everyone for sharing and discussing these articles! Some really interesting reads. If anyone is joining late, please do continue to add to the discussion
-
Sarah Bates replied to Nicola James
@NicolaJames Thank you Nicola, I will pass this feedback on.
-
Sarah Bates replied to Qian Xin
Hi Cynthia, Welcome and don't worry about being late, you can take the course at your own pace. I think the two courses will be a great introduction to the topic before you start your masters course.
-
Sarah Bates replied to Nicola James
I'm really pleased you like the course; thank you so much for the positive feedback
-
Sarah Bates replied to Nicola James
Indeed, there does seem to be a similar impact for each of the statins. It would have been troublesome to calculate the effect of statins overall if there were large differences between the effects of each of the statins. However the meta-analysis included studies that compared a statin with a placebo and further research would be needed to make a stronger...
-
The simulation models are the most complex and so can include a lot of disease outcomes and patient characteristics. However this does require a lot of data and so isn't always the most appropriate option.
-
@NicolaJames Thank you Nicola
-
Sarah Bates replied to Anu Nagar
That's a good question. Andrew Dillon, NICE’s chief executive, stated "Our independent committees use a threshold for recommending treatments of between £20,000 and £30,000 per quality adjusted life year. We think it represents a reasonable compromise between ensuring everyone has fair and equitable access to the NHS and enabling access to new and innovative...
-
Thank you for the example!
-
This is true Ian, long-term data can be difficult to obtain due to the cost and challenges associated with gathering data on patients over many years
-
Great explanation!
-
You raise a good point - although it might seem unfair to only offer treatment to the group in which it is cost-effective, if we offer the treatment to all, it takes up resources that could be used on a cost-effective intervention.
-
Great points!
-
Sarah Bates replied to Darrell Robinson
Hi Darrell, we've checked with Professor Simon Dixon and he has said: "Economic evaluation assesses the cost-effectiveness of how the new technology is expected to be used in routine practice and this is usually based on evidence (a trial) that is a reasonable approximation to that. If practice changes after that, such that the care pathway changes...
-
Great question; I've not heard of this being used but there may be some people using it for cost-effectiveness analysis. Additional complexity can require a lot of resources in terms of data and computing power and so we often have to consider whether this complexity is going to significantly improve the cost-effectiveness analysis. If anyone knows more about...
-
You highlight a good point Ian. Often in the UK we focus on the healthcare costs but costs relating to factors such as employment and informal care may also be significantly impacted by a treatment
-
A report produced in 2012 showed that the average time from the start of the HTA process to publication of guidance is 1.73 years A more recent paper calculated that the average time between regulatory approval and HTA decision is 436 days although this was an analysis of decisions regarding only 12 disease areas.
References:
O'Neill, P., Devlin, N. and... -
Sarah Bates replied to Cristian Marsh
@JimSmith Thanks for highlighting!
-
You've made some really good points!
-
A great summary Pavel!
-
Great example!
-
Great point! Often there are specific inclusion criteria for patients within a clinical trial which may include no co-morbid conditions and so the results observed in the trial are not necessarily replicated in a patient population with more complex health conditions.
-
This is a really good point Nicola - treatments can be more effective in some patients than others. To try to identify this, economic evaluation may include subgroup analysis to determine whether treatment might be more effective and cost-effective for some that others (e.g. different ages or condition severity). However even within these groups, patients may...
-
Thank you for sharing this; I agree that different people will have different views depending on their priorities.
-
Sarah Bates replied to Cristian Marsh
Thank you for highlighting that NICE give additional consideration to end of life treatments; this is a good example of how the cost-effectiveness is considered alongside other factors.
-
Qualitative methods can definitely inform researchers! And acceptability is really important - for example an intervention to help people stop smoking could be really effective but if people don't or can't attend, then it won't be effective at all.
-
Very good summary!
-
Thanks Thomas! I've attended one of these myself as a member of the public and it's interesting to see the discussions that take place.
-
Good point, the number of patients that would receive the treatment may also be considered
-
Sarah Bates replied to Thomas Dunn
It's very true that we can all have different views about what value means to us
-
Having worked in the area of public health myself, I agree that it can be more challenging; interventions themselves can be heterogeneous in terms of content, intensity and duration which can impact our ability to make conclusions.
-
Sarah Bates replied to Anu Nagar
Good points; the number and quality of studies can have a big impact on outcomes
-
Sarah Bates replied to Denis Duignan
Really interesting points!
-
Sarah Bates replied to Anu Nagar
You can follow the course at your own pace so feel free to move on to the next steps!
-
In the case of a new technology, evidence would usually have to be generated by conducting research; there will be some information about clinical trials in week 2.
-
Great point - although it would be nice to fund all treatments that provide an incremental benefit; this is not possible with budgetary constraints
-
Sarah Bates replied to Liz S
You make an interesting point about the potential trade offs that people would make between quality of life and length of life
-
There's not necessarily a clear answer to this question as this can vary depending on the extent of the evidence available
-
Sarah Bates replied to Nicola James
Glad to hear you've found it interesting and thank you for your contributions so far!
-
This is a good question! It would depend on the magnitude of the costs and benefits; there will be more information about the decision making process later in this course.
-
Sarah Bates replied to Dakota Drouillard
Thank you for sharing Dakota, this is an interesting example of a case where a treatment has been made available in some areas of the UK but not others
-
Sarah Bates replied to Edward Rigby
This a a good summary and you've highlighted how the issue of funding is seen from different perspectives. Although funding of all treatments cannot be achieved due to the budget of the NHS, it can be hard for patients and their families to accept that potential treatments for a condition directly impacting themselves are not funded
-
Sarah Bates replied to Agata O
Thank you for sharing; this is an interesting article and a good example of HTA in the news
-
Sarah Bates made a comment
Hi everyone and welcome to the course! I'm the mentor and I'll be checking the course comments regularly to answer any questions you might have. I look forward to hearing a bit about yourselves and motivations for taking the course.
-
Sarah Bates replied to Fernando Keresztes Bigatto
These are really good points! I will pass these on to the course leaders
-
Sarah Bates made a comment
There some really interesting example given here! Thank you all for sharing these links and your summary of these.
-
@FernandoKeresztesBigatto I don't know about AI specifically but models are becoming more complex. However these require more data which can be difficult to collect
-
Really interesting!
-
Sarah Bates replied to Nessa Walsh
Good summary!
-
@WilliamMajrowski Thank you, That's a great example. Sometimes qualitative studies conducted with patients and/or health care practitioners (and reviews of these) can help understand why the stroke units are better than usual care
-
This is a good point, and some do argue that the end-of-life criteria is somewhat unfair for the reasons you have mentioned
-
@BenedictDavies Yes in this example life years is used
-
Sarah Bates replied to Menno A
@ElizabethBenneth good question; this is in part so these can be covered in detail but also these are the activities that tend to be done by external organisations included universities. The final three steps are usually conducted by NICE or an equivalent organisation in other countries.
-
Thank you for providing this example Roshani! It's a great summary of how systematic reviews of qualitative research can add to our understanding of patient experiences especially in an area such as pain which can have a large impact on a patients life.
-
This a good point about the number and quality of studies available. This is why usually systematic review will give a rating of the quality of the studies and it is very transparent how many studies have been used and how the quality varies. This means that the reader can make an informed decision about the results.
-
Sarah Bates replied to Benedict Davies
The LIPID trial has the large weighting because of the sample size so this study represents more of the overall sample than some of the small studies. The 95% confidence intervals is close to 1 and to the line of no effect but still indicates a statistically significant reduction in risk. It means that if the experiment were conducted 100 times, we would...
-
great points!
-
Sarah Bates made a comment
Welcome to the final week of this course! There's been some great comments and discussion so far, if you have any questions about any of the material on the course, please just comment and I'll do my best to answer them!
-
The part in the step is the executive summary of the HTA and so it is particularly important than this is clear as it's often the first thing read. HTAs are commonly carried out by independent agencies or university departments at the request of those who hold healthcare budgets (e.g. NICE in the UK) and they will then use the HTA to make a decision so there...
-
Sarah Bates replied to Laura Walsh
Normally one model is used but in an HTA assessment however a justification will be included for the choice of model and a clear description of any evidence used in the modelling process which helps to keep the process transparent and avoid bias
-
This is a good point and an HTA will usually consider costs and savings over the lifetime of a patient rather than just the near future. In step 4.5 there is some information about modelling which might help to answer your question too.
-
This is an interesting question; as far as I'm aware, the threshold isn't any different in this case but if a condition is a common cause of death, there is usually more research funded and this leads to more treatments for that condition reaching the HTA process
-
Sarah Bates replied to Phillip Morgan
Well spotted Phillip, I'll pass this feedback on
-
Sarah Bates replied to Fikadu Batu
Welcome! I think you'll find that this course pairs well the the Measuring and Valuing health course
-
Sarah Bates replied to Phillip Morgan
Hi Phillip, I'm afraid I don't know much about patents and the impact on cost. However I can say HTA is only one of the factors considered when making recommendations and there are exceptions in which NICE will consider accepting a higher price. There is more about this in step 4.9.
-
You're right. Life years was used to measure benefits in this example, QALYs are another method and these are discussed in the next step
-
In this case the comparator would simply be no treatment. An HTA of this type would usually make use evidence from clinical trials that have used a placebo as a comparator (looks like the medication but with no active ingredient)
-
Good points here. I also think qualitative reviews are important as, like you've said, they provide an opportunity to gather information that wouldn't necessarily be collected otherwise. My work is in weight loss maintenance and qualitative research can provide more information about why participants did or did not attend sessions, what was most helpful and...
-
The conclusions from a systematic review of studies with smaller sample sizes may be viewed with more caution, however this is something the authors will usually comment on as part of the discussion.
-
Excellent points!
-
Sarah Bates replied to Hege Larsen
This is a good question, expert advice from health professionals and patients representatives is also considered by the NICE committee
-
Hi William, there has been recognition of the challenges facing research and HTA of rare disease treatments specifically. Recently a working group of individuals with expertise in this area was formed to clearly identify these challenges and so there is ongoing work in this area. Thank you for highlighting this.
-
Hi Phillip, Good question! HTA is also carried out on non-pharmacological treatments such as surgery or behavioural interventions. In these cases, it might be necessary and/or appropriate to look at other sources of evidence rather than just RCTs, such as observational studies. However the process described in step 1.8 would still be followed.
-
Sarah Bates replied to Vicki Gardiner
@PhillipMorgan Thank you for the extra information!
-
Sarah Bates replied to Hege Larsen
Great summary of the article! I think you make a good point about the need for more public awareness about the process
-
Sarah Bates replied to Hege Larsen
Great comment!
-
Sarah Bates made a comment
Welcome to week three!! For those who have joined us a bit late, I'll still be looking at comments for the previous two weeks so add a comment if you have any questions!
-
Hi William, Thanks for your comment. I don't know too much about human rights theory so it's interesting to hear your perspective. HTA is used to inform decisions made regarding funding when there is a budget to try to maximise the benefits that can be achieved for patients. More information will be given later in the course about the exact process which might...
-
Great point Rita!
-
Sarah Bates replied to Jormis Kraja
Welcome Jormis!
-
You're right Glenn, these types of ethical issues are considered in an HTA
-
Sarah Bates replied to Grace WAYi-WAYI
Hi Grace, welcome to the course and sorry to hear you've been ill! The course timeline is flexible so you can still start from the beginning today and work through at your own pace. Although we're in the second week of the course, I'll still be looking at comments and will respond to questions on the week one steps. However I'll be unable to respond to queries...
-
Great question Fernando, I have attended a NICE committee meeting as a member of the public and there was a part of the meeting where the public were asked to leave. This is the information on the NICE website: "Information classed as confidential includes confidential academic or policy work, patients’ and lay experts’ personal testimonies (if this is what...
-
That's a great question and I think you've highlighted an ongoing challenge!
-
Great points!
-
Great comment! New treatments can result in new pathways especially, as you've said, when treatments have side effects that create the need for further considerations/treatments/monitoring. This all needs to be considered in an HTA and this is why it's so important to include health care professional with expertise to contribute to a full understanding of the...
-
Thanks for providing another real-world example!
-
Sarah Bates made a comment
Welcome to week 2 everyone! Looking forward to some more great discussions
