bayesian economic evaluation: a multidisciplinary future george sarna 17 december 2002
TRANSCRIPT
Bayesian Economic Evaluation: Bayesian Economic Evaluation: A Multidisciplinary FutureA Multidisciplinary Future
George Sarna
17 December 2002
Summary
MRC - mission/principles Scientific challenges Links with other organisations MRC support - health economics/statistics What we have tried and what has failed What should we be doing to develop this
field?
MRC Background
Set up in 1914 1 of 6 Research Councils Funded by Government (£350m pa)
Research - Investigator initiated Support high quality research with aim of maintaining
& improving human health Train skilled people Advance & disseminate knowledge & technology to
meet national needs for health, quality of life & economic competitiveness
Principles
Will support good work in all sectors of medical research
Excellence is keyProposals from all areas compete for funding
availableDo not as a rule earmark funds for particular
topics though good proposals in strategic areas may receive priority
Science & Policy Data integration New diagnostics Translation Multidisciplinary working Forging Partnerships Training and retaining
researchers Engaging the public
Post-genome Health of the Public
Individual
UnderstandingHealth & Disease
Cell
Organ
Animal
Genome
Environment
Population
Families
Challenges Ahead
Biomedical Research
“continuum”
prevention diagnosis treatment
Short versus long term funding
Short term versus long term gross research spend (2000/01) - £m
0
50
100
150
200
250
300
BHF Wellcome Trust BBSRC CRC Other AMRC MRC
Re
sea
rch
sp
en
d (
£m)
Long term
Short term
Health Services and Public Health
Spend £m
0
5
10
15
20
25
30
35
40
45
50
95/96 96/97 97/98 98/99 99/00 00/01
year
Spend £m
MRC Spend on People & Population Studies
Trial Numbers
0
20
40
60
80
100
120
140
1931-1940 1941-1950 1951-1960 1961-1970 1971-1980 1981-1990 1991-2000
Decade
Nu
mb
ers
Trial Numbers Value of New Awards £m
0
2
4
6
8
10
12
14
16
18
20
97/98 98/99 99/00 00/01
Decade
Va
lue
£m
Value of New Awards £m
MRC & Clinical Trials
MRC Support
Clinical Trials - 120 ongoing trialsJustification for inclusion/exclusion of health
economics in applications; planned analysesBurden of disease, present and future resource
implications for NHS/economy
MRC Biostatistics Unit (Cambridge)
MRC Health Services Research Collaboration (Bristol)
MRC Clinical Trials Unit (London)
Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002)
MRC/DH funded study - Alan Scott Clinical analysis + cost effectiveness study 6800 deaths in England + Wales in 2000; 2.1 %
of all deaths in men older than 65
Screening study - ultrasound scansRCT of 67800 men aged 65-74 (1997-1999)Randomised to receive scan or notPrimary outcome was mortality related to abdominal
aortic aneurysm
Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002)
Clinical analysis Deaths - 65 (intervention) cf 113 (control) Risk reduction - 53%
Costs Additional cost of screening - £2.2m Cost per life year gained - £28k (4 year follow-up)
and ?? £8k (over 10 years) Both within perceived NHS threshold
Policy/Practice???
What we have tried/failed
Capacity building HSR/Public Health Fellowships MSc courses - medical statistics
Failed Health economics: discipline hopping scheme
Strategic factors
Issue: cost-effectiveness - prioritisation
Career Path and Eligibility for Funding Schemes
NON-CLINICAL CLINICALPhD training ______ Research Studentship ________ Clinical Training Fellowship
Postdoctoral ______ Research Assistant on Grant ___ Research Assistant on GrantPeriod ______ Research Fellowship
______ Career Development Award ____ Clinician Scientist Fellowship______ Senior Fellowship ____________ Senior Fellowship
University/Clinical Appointment * Career Establishment Grant OR
* Co-ordinated Grants SchemeMRC Senior Fellow - Centre Grant(Clinical or Non- - Co-operative GrantClinical) - Development Grant
* Innovation Grant Strategic Project Grant Programme Grant MRC Readership/Professorship
Funders’ perspective - What next?
Emerging issues?
What is urgent?
What (else) is needed in terms of infrastructure/resources - ?UK wide
Feedback to funders - advice to applicants
Strategic factors
Issue: cost-effectiveness - prioritisation
Web Page: www.mrc.ac.uk
Email: george.sarna@ headoffice.mrc.ac.uk
Telephone 020 7636 5422
The Medical Research Council
Health Services Research (HSR)
The investigation of the health needs of the community and the efficiency and effectiveness of the provision of
services to meet those needs
Trials
Importance of the Question Burden of ill health - NHS, Community, Family? The right question: clinical, timely, feasible? Prior knowledge & evidence - systematic reviews? Impact? Generalisable? Particularisable?
Design Will the design answer the question? Feasible? Pilot / preliminary data? Staging? Outcome measures? Effect sizes? Sampling size and strategy Bias? Randomisation - 3rd party?
Council Board, Panel and Group Structure
Council
Strategy Development Group
Molecular and CellularMedicine Board
Physiological Medicine and Infections Board
Awards AdvisoryGroup
Neurosciences and Mental Health Board
Health Services and Public Health Board
MRC Advisory Board
Cross-BoardGroup
InnovationGrantPanel
CareerEstablishment
GrantsPanel
Investigator Initiated FundingSchemes for Research
.Programme Grants To support both focussed and more broadly based long term programmes of
research.
Co-operative Group Grants To establish or bring together critical research mass, in ways which add value to
individual research projects and improve the productivity of research environments.
Development Grants – for Co-operative Groups To help get to the point where they can make competitive applications for
funding under the Co-operative Group Grants scheme.
Career Establishment Grants To provide 5yrssupport for scientists recently appointed to University academic
posts to help them to establish themselves as independent research workers capable of winning support in open competition.
.Strategic Grants To support work which makes a specific contribution to MRC’s strategy
Understanding and Treating Brain Diseasee.g. bipolar disorder
Individual
Cell
Brain
Genome Environment
Population
Families
cognitive behavioural therapy
coupletherapy
e.g. depression
e.g. risk behaviour
e.g. Huntington’s
L-Dopa,stem cells
e.g. Parkinson’s publichealth
antipsychoticse.g. schizophrenia
gene therapy parenting
e.g. antisocial behaviour
Finance
Intramural versus extramural gross research spend (2000/01) - £m
0
50
100
150
200
250
300
350
BHF Wellcome Trust BBSRC MRC CRC
Re
sea
rch
sp
en
d (
£m)
Intramural
Extramural
MRC Corporate Policies & Influences The following represent important elements in the way the MRC
has pursued its mission and national responsibilities to date: Investing in the best science, across the whole field relevant
to human health; Responding to, and balancing the needs of, all stakeholders; Meeting national (health and policy) needs; providing long-
term support and critical mass; Building capacity (through people and in fields of research,
eg Health Services Research); Funding national infrastructures (eg Mary Lyon, Biobank)
and national facilities (eg HGMP) in response to investigator demand.