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University of Exeter Medical School,
South Cloisters,
St Luke's Campus,
Exeter EX1 2LU


Health Economics - Current areas of research


Members of the Health Economics Group have interests in econometrics, preference elicitation, methods for economic evaluation, including economic modelling methods, applied research in health and social care, health outcomes (health valuation) research, decision-making and priority-setting, and in areas of neurodegenerative diseases, infectious diseases, mental health, and drug/alcohol abuse. New members to the group will be encouraged to develop their own research interests in these and other/related areas.

The Health Economics Group also supports the work of the South-West Research Design Service (SW-RDS), led by Professor Gordon Taylor. The Group has successfully hosted MSc students seeking placements.

This is a pilot study of a cluster randomised trial of the provision of alcohol handgel to postpartum mothers to prevent neonatal infective morbidity in the home. This project is being carried out in Uganda and funded by MRC/Wellcome Trust/DFID in collaboration with the University of Liverpool (funding ~£150,000).

(In collaboration with Psychology and Sports Science, University of Exeter)
Integrating Behavioural Activation and Physical Activity promotion (BAcPAc): A pilot randomised controlled trial with depressed patients.

This project has for objective to identify the most important features of IPTp and syndromic management of curable STIs/RTIs that can be modified so as to increase their acceptability among pregnant women, healthcare providers, and policymakers. In collaboration with the the London School of Hygiene and Tropical Medicine and with the National Institute of Medical Research in Tanzania, funding for Exeter, ~$150,000.

(In collaboration with Psychology Department & Mood Disorders Group, University of Exeter)
Multicentre Randomised Controlled Trial of Collaborative Care for Depression. Funded by MRC, circa. £1.7million.

Rehabilitation Enablement in Chronic Heart Failure

(In collaboration with University of Bournemouth, and others)
Multi-centre RCT of group-based cognitive behavioural therapy for people with multiple sclerosis. Funded by the Multiple Sclerosis Society, circa. £265,000.

What outcomes of NHS care should be measured for children with neurodisability?

(In collaboration with Primary Care Research Group, and others)

An economic evaluation alongside a controlled trial of community mentoring (Devon Ageing & Quality of Life Study). Funded by Devon County Council, £160,649.

A cluster randomised controlled trial investigating the cost effectiveness of a self-management course to manage persistent pain.

(In collaboration with Queen Mary University of London & University of Warwick)

An RCT evaluating the use of self-management care to manage persistent pain. Chronic musculoskeletal pain is a common condition that often responds poorly to treatment. Self-management courses have been advocated as a non-drug pain management technique, although evidence for their effectiveness is equivocal. Anne Spencer is managing the Health Economics component of a trial that looks at the effectiveness of a self-management course based on evidence for effectiveness for specific course components and characteristics.

(In collaboration with PCMD Clinical Neurology Research Group, and others)

Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID). Funded by MRC circa. £2million.

ENCEPH UK - Understanding and improving the outcomes of Encephalitis.

This is a NIHR Programme Grant for applied research that consists of a series of inter-related studies; a retrospective study looking back at previous patients, a prospective study investigating new patients and an Intervention study to change practise; The over-arching aim is to better understand and improve the outcomes of encephalitis for the benefit of patients. Dr. Antonieta Medina-Lara leads the cost-effectiveness analysis and the quality of life studies in both adults and children. In collaboration with the University of Liverpool, funding £2 million.

(In collaboration with Primary Care Research Group, and others)
The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: a cluster randomised controlled trial comparing nurse-led and GP-led management systems. Funded by NIHR Clinical Trials, circa. £2.2 million. 

(In collaboration with PCMD Child/Mental Health Research Groups, and others).

The Clinical and Cost Effectiveness of Exercise Referral Schemes: A Systematic Review & Economic Evaluation. Funded by the NIHR HTA Programme, £159,652

Investigating the Health Outcomes & Costs Associated with Multiple Sclerosis. Development of a mapping algorithm from trails that contain only MS disease specific measures - Annie Hawton and Colin Green. IHSR PhD studentship.

Obesity prevention in children, NIHR funded trial and economic evaluation (£1.35m).

(In collaboration with University of East Anglia, Caledonian University Glasgow and Durham University)
Discrete choice experiments (DCEs) allow a number of characteristics to be traded off against one another and are becoming increasingly popular in health economics. There are two main variants of DCEs that take as a starting point more traditional value elicitation techniques used to estimate a QALY. The DCETTO includes a time attribute and is based on the Time Trade Off (TTO) technique and the DCESG includes risk and is based on the Standard Gamble (SG) technique. Anne Spencer is investigating how the DCE approach has helped address some methodological problems faced by more traditional techniques and has raised new challenges.
Associated publications:

  • Discrete choice experiments: A review of the methodological challenges of applying DCEs to value generic Quality of Life measures. Anne Spencer organised and chaired a session at iHEA Australia, July 2013.
  • “A framework for estimating health state utility values within a discrete choice experiment: Modelling risky choices”, Robinson A, Spencer A, Moffatt P. forthcoming Medical Decision Making, 2014.
  • Exploring differences between generic health states values derived using time trade off methods and choice based methods. Prades JLP, Robinson A, Spencer A and Covey J, IHEA Dublin, 2014

(Elizabeth Goodwin, Colin Green and Annie Hawton)

MS Society Junior Fellowship Grant which will aim to Extend the evidence on quality adjusted life years (QALYs) in MS-related research/policy, and on the framework for cost-effectiveness analyses in the context of MS. Elizabeth Goodwin, Colin Green and Annie HawtonObjectives include developing QALY weights for MS health states based on the preferences of people with MS; estimating QALY weights for MS-related fatigue states; and providing evidence on the wider societal impact of MS.

(In collaboration with PCMD Clinical Neurology Research Group, and others)

Clinical trial methods (including economic evaluation/modelling) in for Applied Health Research, funding circa. £2million. This project includes a strong component of methodological research on modelling methods for cost-effectiveness analyses of treatments for Alzheimer’s disease and Parkinson’s disease.

(In collaboration with PCMD Child Health Research Group, and others)
Exploratory RCT on school-based intervention to prevent and reduce obesity in primary school children. Funded by NIHR Research for Patient Benefit Programme, £198,025.

Development of a new preference based measure for Multiple Sclerosis which can be used in economic evaluations - Liz Goodwin and Colin Green. Funded PhD studentship by the UK Multiple Sclerosis Society.

(In collaboration with Bath University)

A randomised controlled trial of a community based physical activity intervention for retired older people. The primary aim of the REACT study is to assess the effectiveness and cost-effectiveness of a community-based physical activity intervention for reducing the progression of mobility-related functional limitations in older people who are at high risk of transition from independence to mobility related disability.

(In collaboration with Primary Care Research Group, and others)
Cardiac rehabilitation Programme Development Grant, funded by the NIHR.

The ReTrain programme is pilot study to evaluate the feasibility and acceptability of procedures to deliver a rehabilitation programme for stroke survivors. The ReTrain training is led by personal trainers and is designed to help people with stroke continue their recovery. Anne Spencer is leading the Health Economics component of this pilot. Stroke Association, Jan 2015-Sept 2016, Award 161,180.

Use of neonatal care data and computer simulation technology to improve design and organisation of neonatal care networks

PenCLAHRC have developed a discrete event simulation model to simulate movements of infants in the South West neonatal network. Anne Spencer’s role is to look at the impact of moving from localised to centralised neonatal services and the impact this has upon costs and mortality.

Associated publications and presentations:

Spencer A, Allen M, Matthews J, Pitt M, Gibson A. The right cot, at the right time, at the right place – evaluating the design and organisation of neonatal care. (Oral Presentation by A Spencer) Sheffield HESG, 8-10 January 2014.

(In collaboration with School of Sports & Health Sciences, University of Exeter, and others)
An exploratory trial to evaluate the effects of a physical activity intervention as a smoking cessation induction and cessation aid among the 'hard to reach'. Funded by NIHR HTA Programme, circa. £435,000.

(In collaboration with PCMD Clinical Neurology Research Group, and others)
A longitudinal study of MS from the patient perspective. Funded by the MS Society (and others)

Funding has recently been secured for a multi-centre randomised controlled trial to assess the effectiveness and cost effectiveness of a home-based self-management standing frame programme in people with progressive MS. This project, due to begin on 1st January 2015, is led by Dr Jenny Freeman from the University of Plymouth and secured funding from Research for Patient Benefit to the tune of £346,000.

 Improving health, under community supervision, with the support of a Health Trainer: Developing and evaluating a pilot randomised controlled trial.

(In collaboration with Plymouth University Peninsula Schools of Medicine and Dentistry)
This research project will complete initial pilot research for a future RCT and full economic evaluation to assess the effectiveness and cost-effectiveness of a Health Trainer (HT) intervention, for people receiving community supervision, to quit smoking and/or reduce alcohol consumption at six months, compared to usual support. Annie Hawton and Colin Green are co-applicants on the above study led by Professor Adrian Taylor, Plymouth University Peninsula Schools of Medicine and Dentistry. £698,104.

The clinical and cost-effectiveness of Teen Online Problem Solving for adolescents who have survived a traumatic brain injury in the UK (TOPS-UK): A feasibility study Annie Hawton is a co-applicant on the above study led by Dr Anna Adlam, School of Psychology, University of Exeter. £250,000. Funded by Research for Patient Benefit Programme.

(In collaboration with Primary Care Research Group, and others)

Pilot study for a randomised controlled trial of a primary care based intervention to support lifestyle change for people with high cardiovascular risk. Funded by NIHR Research for Patient Benefit Programme.

Recently completed

OPERA Trial - Exercise for depression in care home residents. A cluster randomised controlled trial with cost-effectiveness analysis.

(In collaboration with University of Warwick)
Associated publication: