Pharmacoeconomics is the scientific discipline that evaluates the clinical and economic aspects of pharmaceutical products to provide health care decision makers, providers and patients with valuable information for optimal outcomes and the allocation of health care resources. Research themes in the NCPE have focused on economic evaluation of healthcare technologies, health technology assessment, health-related quality of life, comparative effectiveness and econometric methodology in high cost therapeutic areas e.g. oncology, rheumatology, hepatology, neurology and public health.
Novel approaches to cancer prevention, treatment and cost using pharmacoepidemiology and pharmacoeconomics.
HRB Interdisciplinary Capacity Enhancement Award
This 3 year project is being undertaken in collaboration with the Department of Pharmacology and Therapeutics, the National Centre for Pharmacoeconomics, the National Cancer Registry and the Department of Statistics, Trinity College Dublin.
Cancer is now one of the leading causes of death in Ireland. New anti-cancer agents are being developed to treat primary cancer and prevent recurrence of cancer. These treatments are becoming increasingly available. The opportunities to examine the use and associated costs in large populations are of great importance.
The research programme will consist of three inter-related work packages relating to cancer prevention, treatment and cost. All work packages are related to health services research with particular emphasis on treatments and adherence to treatments in cancer using pharmacoepidemiology and pharmacoeconomics.
Pharmacoepidemiology research will include observational studies of common medicines and their association with developing or preventing cancer and observational studies of medicines in those with cancer and outcomes.
Pharmacoeconomic research priorities will include
- Evaluation of the cost effectiveness of new health technologies (including chemoprevention programmes, diagnostics and chemotherapeutic agents)
- Estimation of the Value of Information (VOI) associated with the potential adoption of these new technologies. Treatment choices have to be made in the face of uncertainty about effectiveness, safety and economic implications. VOI provides a framework that can be used to explicitly estimate the expected benefit of future research to reduce this uncertainty
- Estimation of the likely net and gross budget impacts to the health service following the introduction of the new technology in Ireland
For more details:
C. O’Brien, E. Fogarty, C. Walsh, O. Dempsey, M. Barry, M.J. Kennedy & L. McCullagh. The cost of the inpatient management of febrile neutropenia in cancer patients – a micro-costing study in the Irish healthcare setting. European Journal of Cancer Care. Article first published online: 29 Jan 2014 | DOI: 10.1111/ecc.12182
A population study to elicit societal preferences for health related quality of life using the EQ-5D
HRB Health Research Award in Population Health
This 2-year project is being undertaken as collaboration between the NCPE, Trinity College Dublin and Professor Paul Kind, of the University of Leeds.
Health Technology Assessment (HTA) compares a treatment’s costs and benefits. These benefits are derived from a combination the length of life gained from a course of treatment, and the improvement in the patient’s quality of life over that time. This research project investigates the societal preferences between health states, using the EQ-5D methodology, which can be used to quantify levels of quality of life for these purposes. Studies of this nature have not been carried out previously in Ireland, and previous economic evaluations have been forced to use UK preferences.
A national survey is currently in field, which builds upon previous studies carried out elsewhere while incorporating a number of innovations, most importantly:
- investigating concurrently both the traditional “3 level” EQ-5D approach to the newer “5 level” EQ-5D methodology, and
- a comparison of whether participants with less than full health would in practice be willing to trade off remaining time for a return to full health, and the implications of this.
The final report will be completed in late 2015.
For more details:
Reddy BP, Adams R, Walsh C, Barry M, Kind P. Using the Analytic Hierarchy Process to derive health state utilities from ordinal preference data. Value in Health (revised manuscript under submission)
The ICORN National Outcomes Treatment Registry for Hepatitis C patients in Ireland
In January 2012, the protease inhibitors boceprevir and telaprevir were found to be cost-effective in the Irish setting. The Irish Hepatitis C Outcomes Research Network (ICORN) is a collaboration between the Irish Society of Gastroenterology (ISGE), the Infectious Disease Society of Ireland (IDSI), the National Centre for Pharmacoeconomics (NCPE) and the HSE/DoH. The goal of the collaboration is to optimise the quality of care of patients with hepatitis C (HCV) treated with direct-acting antiviral therapy. This includes the design and implementation of treatment protocols and the establishment of the ICORN Treatment Registry, also facilitating HCV clinical and laboratory research.
This is a multi-centred, observational, cohort research study. The aim of the ICORN Hepatitis C Treatment registry is to prospectively collect national clinical (effectiveness, safety and tolerability) and economic outcomes data from all HCV-infected patients (all genotypes) treated for hepatitis C, to populate a database, to analyse the results and produce reports and research papers.
The objectives of the research are:
a) To compare clinical trial outcome data with real world data
b) To assess the total costs associated with treating patients with triple therapy
c) To determine the safety and tolerability of triple therapy in the real world setting
This is the first prospective clinical and economic outcomes registry to be developed with multidisciplinary involvement from clinicians and healthcare providers in Ireland.
Evidence synthesis: Development and extension of Mixed Treatment Comparison (MTC) models.
Synthesizing evidence is a key component for economic modelling. MTCs are an extension of meta-analytical methods and allow the estimation of relative efficacy between treatments where direct evidence is insufficient or not available. Such estimates are a vital part of synthesizing evidence for economic evaluations.
Bayesian models have been developed for syntheses related to diseases such as rheumatoid arthritis, hepatitis C and multiple sclerosis. The focus of this research is extending these models to facilitate use of evidence other than randomized controlled trials (RCTs), e.g. observational studies. A hierarchical model allows the down weighting of particular trial designs, the adjustment for potential bias and estimates the consistency between evidence from different trial designs.
A direct application of this MTC model is the combining of registry data (from the ICORN study for hepatitis C) with existing RCT evidence.
For more details:
Schmitz S, Adams R, Walsh C. The use of continuous data versus binary data in MTC models: A case study in rheumatoid arthritis. BMC Medical Research Methodology 2012; 12:167.
Schmitz S, Adams R, Walsh C.Incorporating data from various trial designs into a mixed treatment comparison model. Statistics in Medicine. Article first published online: 25 FEB 2013. DOI:10.1002/sim.5764
Multiple Criteria Decision Analysis
Health technology assessments aim to aid informed decision making by assessing different aspects of new interventions and technologies. While efficacy, cost and budget impact play a dominant role, other aspects such as the quality of evidence, particular social or ethical circumstances or the feasibility of introducing the intervention may also impact on the decision. One is therefore facing a multi-dimensional decision problem. Currently decisions are taken on a case by case method, which allows for individual circumstances of each decision. However, a partially structured approach has the potential to improve consistent and transparent decision making.
Multiple Criteria Decision Analysis (MCDA) is a methodology to systematically include multiple criteria in a decision making framework. By using such a method, the decision making process is more transparent, consistent and coherent. This research is comprised of two stages; a descriptive approach and a prescriptive approach. The descriptive approach will examine current criteria and place weights on these criteria based on previous decisions. The prescriptive approach will use a formal process to identify relevant criteria.
The Cost-Effectiveness of Disease-Modifying therapies in Multiple Sclerosis in Ireland.
Multiple sclerosis (MS) is the most common disabling neurological disease of young adults, with a prevalence in Ireland of between 180 and 290/100,000. Over 7000 people in the Republic of Ireland are estimated to be affected by this disease. MS is associated with significant economic and Health-Related Quality-of-Life burden. The number of available disease-modifying therapies (DMTs) for MS is increasing and consequently robust methods for assessing the cost-effectiveness of these new DMTs are a priority for clinicians and health-policy decision-makers alike. This study evaluated the economic impact of MS in an Irish cohort and assessed the cost-effectiveness of DMT from the perspective of the Irish healthcare payer.
For more details:
Direct and indirect economic consequences of multiple sclerosis in Ireland. Fogarty, E; Walsh, C; McGuigan, C; Tubridy, N; Barry, M. Applied Health Economics and Health Policy 2014;12(6):635-645
Relating Health-related Quality of Life to Disability Progression in Multiple Sclerosis using the Five-level EQ-5D. Fogarty E, Walsh C, Adams R, McGuigan C, Barry M, Tubridy N. Multiple Sclerosis 2013;19(9):1190-1196
Comparing the efficacy of first and second generation disease-modifying therapies for relapsing-remitting multiple sclerosis: A network meta-analysis. Fogarty E., Schmitz S., Walsh C., Barry M. Value in Health 2013 16:7(A618-)
A qualitative assessment of the attitudes/perspectives of Patients, Prescribers and Pharmacists to Generic Medicines.
Escalating pharmaceutical costs have become a global challenge. Generic medicines provide an opportunity for savings in medicines expenditure due to their cheaper price. Consequently, generic substitution policies aimed at promoting the utilisation of generic medicines have been introduced in many developed countries. Current legislation in Ireland does not permit generic substitution to take place. However, the Health (Pricing and Supply of Medical Goods) Bill, 2012 will allow the introduction of a reference pricing system with generic substitution of interchangeable medicinal products, and is expected to pass into law in 2013.
Implementing a generic substitution policy in Ireland will not be without challenges. These include the existing low rate of generic prescribing in Ireland at just 19% by volume, prescribers’ concerns about efficacy and the supply of generic drugs and the current pricing mechanism for generic products. In fact, low perceived efficacy and safety is reported by the WHO, as a common reason for generic medicines’ underuse.
The rationale for this study is based on the fact that the attitudes of patients, pharmacists and prescribers to generic medicines have not been explored in detail in Ireland heretofore. One survey undertaken almost 20 years ago was limited to the documentation of prescribers’ attitudes to generic medicines.
The aim of this study therefore is to assess patients’, pharmacists’ and prescribers’ attitudes to generic medicines before and after the introduction of the reference pricing system, which is expected to be implemented in 2013.
Incorporation of Patient Preferences in HTA
Internationally, HTA agencies have given increased consideration to greater patient-focused HTAs by incorporating the patients’ values, needs, preferences and lived experiences and by doing so have involved a broader range of stakeholders in conducting HTAs.
Patients have experiential knowledge about living with an illness or condition and can provide valuable perspectives about the intended or unintended consequences of current or future health technologies. Incorporation of patient preferences in HTA through a process of consultation broadens the evidentiary base of health technology and supports more robust, comprehensive HTA. Further, democratic (informed, transparent, legitimate decisions), instrumental (better quality decisions) and developmental (increase public understanding of HTA and health technology, increase capacity to contribute) HTA goals are achieved.
The NCPE will seek funding to gather patient preferences using techniques such as TTO and DCE in a specific disease area. We will then incorporate these preferences in a model to assess the impact on decision. Research exploring the effectiveness of public and patient engagement in HTA is scarce and uncertainty persists regarding the most valid way to integrate public and patient input alongside other forms of evidence. This research will focus on the incorporation of patient preferences in HTA, identifying a model for patient engagement at a local level, and contributing to international research.