Assessment of Technologies theme: areas of research interest and collaboration

The Assessment of Technologies theme is particularly interested in building collaboration in a number of specific research areas spanning applied work through to methodological investigation. These areas of research interest are outlined below along with the criteria applied in building collaborations.

Requests for collaboration are considered using the following criteria:

  • Does the proposed project offer scope to address one or more of our areas of particular research interest? (1-3 below)
  • Is the project in an area of particular significance to NHS Scotland and does it have the potential to deliver major benefit?
  • Does it have the potential to result in output rated as internationally excellent?
  • Does it provide an opportunity to build health economics capacity, either by providing training opportunities for existing staff or by allowing for new skills to be recruited?
  • Do we currently have or can we obtain the capacity to take on the management, supervision and investigator commitment required for the project?

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1. Technology management: Using economic analysis to inform decisions through the life-course of technologies

There are at least four stages in a technologies life-course: (a) idea, design and early testing, (b) adoption decision making, (c) implementation into practice and routine use, and (d) end of useful life of the technology and withdrawal.

Health economists working in the field of technology evaluation have tended to give almost exclusive emphasis to the technology adoption question (e.g., should a new drug be introduced into clinical practice?), with less consideration of the other aspects of technology management. The AT theme is particularly interested in collaborations that offer opportunities to explore (a), (c) and (d).

Tighter budget constraints in the NHS drive the need for monitoring the performance of technologies in routine use (life-course stages (c) and (d)) and so the AT theme welcomes collaborations in this area. Such projects would offer the opportunity to assess technologies in routine practice, possibly using observational data, and monitor costs and patient outcomes over time. Such on-going review of technology 'performance' by the AT theme can bring an economic perspective to service redesign or technology withdrawal decisions.

Related to the potential role for economic evaluation in the re-design of existing services, health economists are often brought into a research team to support the evaluation of a new technology that has already been through development and testing phases. The question then being addressed is does the technology (in its developed form) represent a cost-effective use of health care resources? The proposal here is to take advantage of the insights economics can offer at the technology design stage (stage (a)) to increase the potential for it to be cost-effective when introduced in clinical practice. Such work then allows the AT team to add value to early stage clinical research, especially given our significant experience and expertise in a number of clinical areas including ophthalmology (glaucoma, AMD, diabetic retinopathy), maternity care, urology (urinary incontinence, prostate cancer), and cardiovascular disease. We are interested in opportunities to build on this experience by collaborating closely with clinicians and using our existing economic models to help bring an economic perspective to the efficient design and redesign of technologies and services.

2. Improving the quality of economic modelling through validation work

Early evaluations of technologies, at the time of adoption decision making, tend to be based on economic modelling characterised by data limitations (for example, a lack of evidence relating to long-term costs and outcomes from use of the technology) and associated uncertainty in data inputs. We are particularly interested in collaborative opportunities that offer the prospect of model development, validation and updating in an iterative manner. For example, we are looking to engage on projects where there is scope to use routine data linkage infrastructure to validate the predicted impact of interventions based on initial decision modelling. Such work can then contribute to methodological refinement and improvement in the 'art' of economic modelling.

3. Broader measures of value within economic evaluation

While the quality-adjusted life year (QALY) outcome metric is the most commonly used in economic evaluations of health care interventions, it can be insensitive to important differences between interventions that are valued by patients. This is of particular importance in the context of decision making in the NHS, where greater emphasis is being placed on delivering patient-centred care. HERU has a longstanding and on-going interest in this broad topic – the AT theme is no exception. Researchers in the theme, therefore, welcome collaborations on projects offering opportunities to develop broader outcome metrics, using either a modified cost-utility or a cost-benefit analysis framework.