ESMI Guest Lecture Series

Incorporating Prior Beliefs Into Meta‐Analyses of Health‐State Utility Values Using the Bayesian Power Prior

Anthony Hatswell will present on meta‐analysing utility values, and a recent paper showing how this can be done including weightings for beliefs on which study is more relevant – an approach known as the Bayesian Power Prior (BPP).

The method is illustrated using 4 case studies, with the only prerequisite being a vague understanding of the aims of cost-utility analysis/evidence based medicine. The case studies are then analysed using the ‘preferred’ value, fixed‐ and random‐effects meta analysis, and the BPP, with
comparisons made, and time for discussion on the subject more generally.

Anthony Hatswell is a health economist and statistician. After his education at the University of York, he worked at Sanofi and GSK, as well as in consulting where he now runs Delta Hat.

In addition to this he performs research at UCL where he looks at statistical methods to analyse uncontrolled clinical studies (otherwise known as single arm trials) and sits on the NICE interventional procedures committee.

Anthony Hatswell

Delta Hat

Informal caregiving and health-related quality of life
Becky Pennington, Senior Research Fellow, School of Health and Related Research, University of Sheffield (ScHaRR)

Economic evaluations may include health outcomes for informal/unpaid caregivers as well as patients. Some health technology assessment bodies across the globe permit caregivers’ utilities to be included in cost-utility analysis and this has been done across a number of case studies. However, the data used to inform the size of the effect of caregiving on HRQoL are oŌen of poor quality and limited by cross-sectional study designs.

This talk discusses how longitudinal data can be used to explore the relationship between providing informal care and HRQoL. The analysis uses data from Understanding Society (UK Household Longitudinal Survey) with fixed and random effects models. This is ongoing work as part of Becky’s NIHR doctoral fellowship and Becky would love to hear your feedback on her research.

The QALY is Ableist

Paul Schneider, University of Sheffield

Paul is currently finishing his PhD in public health, economics, and decision science at the University of Sheffield, UK. In his research, he tries to figure out how to value things that are invaluable (health, well‐being, life, etc). Occasionally, he also develops health economic models and interactive user interfaces.

Paul’s background is in clinical medicine and health service research: he initially trained as a medical doctor; and got a doctoral degree from the Institute for Health Systems Research, University of Witten/Herdecke, Germany.

Paul also holds a Research Master’s degree in health sciences from Maastricht University, the  Netherlands.

Survival extrapolation with external data: a new Bayesian model and R package

Chris Jackson, MRC Biostatistics Unit, University of Cambridge

Chris's work involves statistcal methods in public health and health policy. His research interests include
Bayesian modelling, evidence synthesis, decision theory, uncertainty quantificaton, survival analysis and multi‐state modelling. He has developed several popular staistical software packages, and is an Associate Editor
of the journal Biometrics.

Deciding what to do with predatory journals in systematic reviews

Dr Zachary Munn will be talking about his 2021 paper ‘Should I include studies from “predatory” journals in a systematic review? Interim guidance for systematic reviewers’

How to consider health equity in systematic reviews: tools and examples.

Dr. Vivian Welch will be talking about equity in systematic reviews with a focus on methods in general and applying them to rapid reviews

Regulatory flexibilities and evolving routes to patient access

This talk will cover the role of the medicines regulatory authority (the MHRA) in supporting timely access to medicines, including the Innovative Licensing and Access Pathway (ILAP) and the Early Access to Medicines Scheme (EAMS)

A non-parametric approach for jointly combining evidence on restricted mean progression free and overall survival time for partitioned survival models

Cost-effectiveness of testing for latent tuberculosis infection in people living with human immunodeficiency virus
 
Diagnosis and treatment of latent tuberculosis infection (LTBI) through screening remains a key public health priority in the elimination of tuberculosis (TB). TB is a prevalent opportunistic infection and is a leading cause of death in people living with human immunodeficiency virus (PLHIV). TB is more aggressive and accelerates the clinical course of HIV. Co-infection with HIV is the primary risk factor for the progression of LTBI to active TB, increasing the rate of progression by 20-fold. Rate of progression can be reduced if people receive anti-tuberculous preventative treatment. A clear need exists for health technology assessment to support guidance. Current methods are limited and have not used the best available clinical evidence. This analysis used empirical evidence to explore the cost-effectiveness of strategies for identifying LTBI that progresses to active tuberculosis in PLHIV.

Making evidence credible for public health policy

Debates about the role of evidence in policymaking have tended to focus primarily on how to increase the influence of academic research evidence on policy.  In health care in particular, this has tended to mean a focus on creating evidence synthesis (as the most robust and reliable form of evidence).  But this approach to the role of knowledge in policy sidesteps the question of what types of knowledge are actually used and valued in policymaking, and how different forms of knowledge may interact with policy.  Instead, we can ask - what do policymakers find useful and credible?  Why?  This question lets us explore the pathways to impact, and the different roles of evidence within policy and practice.

In this seminar, Kathryn will explore the implications of these strengths and limitations of credible knowledge in policy practices, and place our conclusions within a discussion of current approaches to understanding the role of knowledge in policymaking. She will close with some reflections on the importance of transparent and reflexive policymaking and knowledge-generation practices, and the implications of this for public health.

Joint ESMI/LKD Seminar

Methodology Guidance – Where are the methods?

There is an increasing stream of published “methodology  guidance” covering the conduct and reporting of almost every kind of observational study, randomised trial, systematic review and meta-analysis. In some cases, journals require that this guidance is followed as a condition for publication. But what are the methods that generate this guidance?

Using Network Meta-analysis (NMA) as an example, we look at guidance issued by GRADE (Grading of Recommendations  Assessment, Development, and Evaluation) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). We find that, in common with the majority of “methodology guidance”, the GRADE and PRIMA extensions for Network Meta-analysis are based on no more than opinion, and issued without any explicit empirical or theoretical underpinning. We identify aspects of GRADE-NMA and PRSIMA-NMA that are incorrect or even incoherent, and illustrate alternatives.

The current approach to methodology guidance is leading to ossification and hegemonism, and feeds a “post-truth” agenda in which the investigator’s priority is conformity with guidelines rather than a search for scientific truth. We distinguish between prescriptive and descriptive methodology guidance, and suggest that a debate is needed on what form methodology guidance should take.

Tony is a Professor of Public Health Science at Bristol Medical School. Trained as a psychologist, influenced by structural linguistics, he eventually became an epidemiologist and statistician interested fitting things together.

Campbell Collaboration : Better evidence for a better world

Dr. Vivian Welch, Editor in Chief of the Campbell Collaboration, will introduce the types of evidence synthesis conducted by the Campbell Collaboration across social sciences including international development, social welfare, crime & justice, education and knowledge translation and implementation, including their impact.

She will also describe ongoing research on an evidence gap map of ageing and current research being led by the Campbell and Cochrane Equity Methods Group.

Vivian is a Clinical Epidemiology Methodologist at the Bruyère Research Institute, lead of the BRI Method Centre, Assistant Professor at University of Ottawa, and Deputy Director of the Centre for Global Health, University of Ottawa.  Vivian's research interests include systematic reviews, health equity, global health, knowledge translation and clinical guidelines.

Increasing value and reducing waste in implementation research

JG Implementation Research

Jeremy Grimshaw, Ottowa Hospital Research Institute

Seeing the forest and the trees – getting more value out of systematic reviews of complex interventions

Systematic reviews and meta-analyses of complex interventions raise conceptual and methodological challenges that traditional systematic review and meta -analysis approaches fail to address.

We have undertaken a series of systematic reviews of diabetes quality improvement interventions (published
in JAMA 2006 (50 trials), Lancet 2012 (142 trials), Cochrane Library in preparation (278 trials)).

To enhance the value of the systematic review, we have explored procedural (contacting authors) and statistical (Bayesian hierarchical multivariate analyses) innovations to extract more information for decision makers  planning diabetes quality improvement activities.

We are also converting the current update into a living (complex) systematic review to maintain a current  systematic review for decision makers.

 

JG Evidence Synthesis 05 Feb

Slides available on request, please contact esmi@exeter.ac.uk

Jeremy Grimshaw, Ottowa Hospital Research Institute

We can see the forest, but where are the trees?  Methods to bridge diversity and meta-analysis

G.J. Melendez-Torres Seminar

Slides available on request, please contact esmi@exeter.ac.uk

G J Melendez Torres, Cardiff University

Enhancing the portability of public health intervention review evidence for localised decision-making

https://evidsynthteam.wordpress.com/2017/12/20/can-we-improve-the-usefulness-of-systematic-review-findings-in-public-health/

Dylan Kneale slides

Dylan Kneale, Institute of Education, UCL