Professor Charles Normand
Position: Edward Kennedy Professor of Health Policy and Management
Professor Charles Normand is Edward Kennedy Professor of Health Policy and Management at Trinity College Dublin. He is vice-Chairman of the Board of St James’s Hospital and is Chair of the WHO European Observatory on Health Systems and Policy. He trained as an economist, and has worked for 25 years on the economics of health and health care. He has a particular interest in understanding the ways in which ageing impacts on use of health and social care, and on financing of services for older people. His research is mainly on health care finance, economic evaluation in cancer prevention and treatment, equity and access to services, management of chronic diseases, screening policies and end of life care. He is a co-author of a leading textbook on health economics and the WHO guidebook on social health insurance. He is co-principal investigator on the Irish Longitudinal Study on Ageing (TILDA).
Centre for Health Policy and Management
3-4 Foster Place
Enhancing the Evidence Base for Cost-Effectiveness Analysis in Ireland: Building Improvements from the Intervention-Specific to System-Wide Levels
Dr James O’Mahony is leading this Health Research Board Emerging Investigator Award (EIA) which contains three principal components. The first addresses the theoretical and empirical basis for the cost-effectiveness threshold used to determine if an intervention represents good value for money. The second examines common methodological problems in cost-effectiveness analyses of cancer screening and proposes a simple simulation modelling framework for use as a teaching and method research tool to help avoid such problems. The final component uses microsimulation modelling to simulate the cost-effectiveness of novel triage techniques for women tested as positive for the human papillomavirus (HPV) at primary screening and to investigate the potential of HPV self-sampling for the prevention of cervical cancer in women who do not typically participate in cervical screening. Dr O’Mahony is accompanied on the EIA programme by doctoral candidate Ms Yi-Shu Lin. James and Yi-Shu work conjunction with the CERVIVA multi-disciplinary research consortium, which investigates the diagnosis and prevention of HPV-associated cancers. Other research partners on the programme include participants based at the Royal College of Surgeons in Ireland and the Erasmus Medical Centre, Rotterdam. Last updated 2019
CERVIVA-Vax: Monitoring the impact of HPV vaccination in Ireland
Infection with Human Papillomavirus (HPV) can lead to development of cervical cancer. For this reason HPV now plays an important role in cervical cancer prevention. For example, HPV vaccination programmes are established in several countries worldwide, including Ireland, where a national school based HPV vaccination programme began in 2010.
The vaccine does not protect against all HPV as it only targets the main HPV types. So it is important that all women, aged 25- 60, continue to have regular cervical smear tests through the CervicalCheck programme. Very soon the first set of women who have received the vaccine through the school programme, will be eligible to attend for their first CervicalCheck smear. It is important that we monitor the impact of vaccination in those that have received the vaccine to identify if it reduces the prevalence of HPV and cytological abnormalities. It is also important that we look at how the current tests we use for cervical screening in unvaccinated women perform in women who have received the vaccine. Furthermore, it is vital to understand if whether a woman is vaccinated (or not) affects whether she attends for screening.
In CERVIVA-Vax, we will (1) investigate the number and type of HPV infections detected in women who have received the HPV vaccine and attend cervical screening; (2) explore how current screening tests perform in women who are vaccinated; (3) observe screening uptake in vaccinated women compared to unvaccinated women.
Changes in screening uptake, HPV infections and detection of cervical abnormalities may have an adverse effect on how well screening works for individual women and the population. By investigating the early impact of HPV vaccination on screening in Ireland, CERVIVA-Vax will be able to inform CervicalCheck, and international screening programmes, of the best cervical screening approach for both vaccinated and unvaccinated women. Last updated 2019
Optimal screening and management strategies for cervical cancer
The overall goal of health economics is to maximise the health gain achieved by health services within available funding. The application to health economics to cervical screening has the particular goal of finding which screening tests will prevent the most disease at an acceptable cost to the health system. The cost-effectiveness of cervical screening depends in part on the interval between screens. If the interval is very short, such as one or two years then screening may impose high costs with little or no benefit over longer screening intervals. Cervical screening at intervals of three to five years as employed in Ireland is thought to be highly cost-effective. Recent developments in screening technology mean that more advanced tests are now available to detect early stages of cervical disease. These new tests include tests for the DNA and RNA of the human papillomavirus. The health economics research in CERVIVA II is to find which new testing technologies will further enhance the cost-effectiveness of Irish cervical screening services. This involves considering the trade-offs of the likely benefits of new tests that are better able to detect disease against the possible costs of false positives and the costs of the testing technologies themselves. Last updated 2015