Social Network Analysis of HTA Collaborations: the case of REBRATS

Tazio Vanni General Coordinator of Health Technology Assessment

Department of Science and Technology Secretariat of Science, Technology and Strategic Inputs

Brazilian Ministry of Health

Research team

• Luciana Leão

• Rodrigo Costa

• Flávia Elias

• Juliana Girardi

• Lucas Felipe

• Oney Araújo

• Elenilda Martins

Introduction

• Health Technology Assessment (HTA) is becoming increasingly multidisciplinary.

• Policy-makers and researchers are relying more on multi-institutional networks to develop strong, intellectually diverse teams that can answer complex research questions.

• National governments have promoted HTA networks in order: – to develop useful HTA studies – to support capacity building among health care workers

and policy-makers – to foster sustainable health systems

Saúde e CT&I: Inovação para o acesso

Social and Economic Development

Health System Science and Technology

System

Objective: To integrate health researchers and decision-makers in the promotion, development and diffusion of health technology assessment to support a sustainable Brazilian National Health System.

Working groups:

1. Research Prioritization and Promotion; 2. Methodological Development and Evaluation; 3. Professional Training and Continuous Education; 4. Information and Communication Management; 5. Technological Horizon Scanning; 6. Health Services Research.

Members: Currently 81 institutions, including research centres, hospitals, universities, federal, regional and municipal health agencies.

Coordination: Joint Committee lead by the Department of Science and Technology, Ministry of Health

Investment: ~US$ 10 millions

Studies: 435 studies

Introduction

• Social network analysis (SNA) can be used to evaluate collaborations between institutions and groups.

• SNA has the potential: – to identify hubs and authorities

– to improve information diffusion and consensus building

– to monitor and evaluate integration among institutions

– to inform expansion and restructuring plans

Objective

• No peer-reviewed publications investigating networks in HTA could be found in Medline and Embase.

• The overall objective of this study was to evaluate patterns of scientific collaboration in HTA networks, using REBRATS as a case study.

Methods

• REBRATS relies on a virtual repository (SISREBRATS), which is the largest repository of HTA studies in Portuguese.

• From the 396 studies included in SISREBRATS from 11/2009 to 09/2014, we extracted data for authors’ names, institutional affiliation and location (state in Brazil).

Methods

• We developed a programme in C++ to structure the data extracted in mixing matrices.

• Gephi open-source network analysis software for visualization and exploration of networks and complex systems.

• Network layout was defined using the Fruchterman-Reingold and Force Atlas 2 algorithms.

SNA metrics

• Nodes metrics included centrality and betweenness.

• Network statistics included density, connected components, diameter, average distance between nodes and clustering coefficient.

Methods

• Individuals were classified according to time since graduation, gender and education.

• Institutions were classified according to REBRATS membership, the region they were based and type of institution.

12

Number of Researchers: 1094 Number of communities: 101 Density: 0.008 Average centrality: 9.13

Top 10 authors Centrality Institution Top 10 authors Betweenness Institution

Francisco Acurcio 52 UFMG Flavia Elias 20.086 Fiocruz

Carisi Polanczky 50 IATS Denizar Vianna 71.312 UERJ

Edina Koga 41 UNIFESP Braulio Luna 16.848 UNIFESP

Jose Jardim 35 UNIFESP Carisi Polanczky 16.630 IATS

Tais Galvao 30 UFAM Francisco Acurcio 15.849 UFMG

Flavia Elias 29 FIOCRUZ Cid Manso 13.689 IMS UERJ

Braulio Luna 28 UNIFESP Claudia Coeli 12.056 UFRJ

Luis Rohde 28 UFRGS Marcus Tolentino 10.484 UFAM

Jorge Ribeiro 28 UFRGS Marisa Santos 10.399 INC RJ

Regis Andriolo 28 UEP Bernardo Tura 9.591 INC RJ

0%

5%

10%

15%

20%

25%

30%

2 - 12 13 - 22 23- 32 33 - 42 43 - 52

Time since first graduation

0%

10%

20%

30%

40%

50%

60%

Male Female

Gender

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

MSc/MA PHD Experts* Graduates

Educational Level

15

Number of institutions: 249 Number of REBRATS members: 78 Average nº collaborators (members): 16 Average nº collaborators (non-members): 7

Network statistics

Number of nodes

Average degree

Density

Average clustering coefficient

Number of connected components

249

9.373

0,037

0.767

1

Institution Centrality Institution Betweenness

FIOCRUZ 87 FIOCRUZ 0.2198

UFBA 63 USP 0.1427

USP 61 UFBA 0.1196

UFMG 52 UFRGS 0.1132

UFRGS 52 UFMG 0.1071

UERJ 49 UFSC 0.0900

HCPA 47 HCPA 0.0776

UFRJ 46 UERJ 0.0757

SVS_MS 42 UNICAMP 0.0556

UFSC 37 FM_USP 0.0433

Universities/Research Institutes

Government

Health Services

Discussion

• We have shown that SNA is instrumental to monitor and evaluate, as well as to inform the expansion and restructuring plans for HTA networks, and possibily other research networks.

• There are different dimensions of collaborations that should be further investigated.

• The creation, evolution and integration should be further explored.

Discussion

• More comprehensive datasets with other variables that can explain the structure and performance of these networks.

• Combination of datasets and methods should be employed to further our understanding of these networks.

• Development of impact assessment tools for research networks.

• Define guidelines for the creation and management of research networks.

Discussion

• There are still many questions for which the HTA community has not provided answers.

• The increase in life expectancy and the epidemiological transition coupled with the growth of the knowledge economy are increasing the preassure on the HTA community to develop new assessment tools.

• To met these challenges we have to consider what are the optimal research ecosystems.

Thank you

tazio.vanni@saude.gov.br