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Pharmacoeconomics

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.

Research projects

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.
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

Pharmaeconomics ImageA 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 in collaboration with the National Centre for Pharmacoeconomics, the Department of Statistics, Trinity College Dublin and Professor Paul Kind, University of York.
Health state valuation is fundamental to health technology assessments (HTA) and should be an important component of the research strategy of countries involved performing HTA.  For many health jurisdictions, including Ireland where EQ-5D is recommended, corresponding social preference weights are lacking. This has led to the use of value sets imported from other countries, very often the UK value set.  The primary aim of this project is to establish valuations for EQ-5D from a representative sample of the Irish population. The project aims to use both established and novel methods to value health states. 
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 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.

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 a National BCG vaccination programme in Ireland
Commissioned by the National Immunisation Advisory Committee
The current practice in Ireland is the vaccination of all neonates with the BCG vaccine.  A 2010 report by the Health Protection Surveillance Centre on the Guidelines for Prevention and Control of Tuberculosis in Ireland highlighted the criteria for discontinuation of the universal BCG vaccination programme.  This research will examine the cost-effectiveness of the current national neonatal BCG vaccination programme in Ireland. 

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 is a priority for clinicians and health-policy decision-makers alike.  This study will evaluate the economic impact of MS in an Irish cohort and assess the cost-effectiveness of DMT from the perspective of the Irish healthcare payer.

The Cost-effectiveness of Treatments for HCV in Ireland;  A Multi-technology Assessment
Chronic Hepatitis C (HCV) is a major public health problem in Ireland. Between 2004 when HCV became a notifiable illness in Ireland and 2009, 8090 cases were notified to the Health Protection Surveillance Centre. HCV is a leading cause of liver transplantation in Ireland and world-wide, chronic Hepatitis C is a leading cause of morbidity and cancer-related death. Standard of Care treatment for HCV for the past 10 years has been a combination of weekly subcutaneous pegylated interferon with twice daily oral ribavirin. Recent randomised controls trials looking at the addition of telaprevir or boceprevir to standard of care HCV treatment in HCV genotype 1 patients have shown very favourable results. The SVR rates achieved in treatment naive patients are roughly double that seen with standard of care. These therapies herald a major step forward in the treatment of HCV.  However they have significant cost and budget-impact implications for the Irish healthcare system, relating to direct costs of the new medicines, in addition to the cost of supportive treatments such as synthetic erythropoietin. Establishing the cost-effectiveness of new technologies involves the process of health technology assessment (HTA) centred on economic models.  Key inputs for robust models involving cost-effectiveness or cost utility analysis include clinical efficacy parameters, defined cost data and quality of life utility data.  While the National HCV database collects data on liver-related and medical outcomes of state-infected patients, no study to date has been undertaken to establish health related quality of life utilities or the cost of HCV care for state-infected and non-state infected patients with HCV in Ireland or to examine the cost-effectiveness of strategies to treat it.  This study will endeavour to establish the costs, utilities and transition probabilities of differing HCV healthstates in an Irish population and use them to perform a multi-technology  assessment evaluating the cost-effectiveness of HCV treatment strategies in Ireland.

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Last updated 21 September 2016 oneillm1@tcd.ie (Email).