Bayesian Economic Evaluation: A Multidisciplinary Future

1. Bayesian Economic Evaluation: A Multidisciplinary Future George Sarna 17 December 2002

2. Summary • MRC - mission/principles • Scientific challenges • Links with other organisations • MRC support - health economics/statistics • What we have tried and what has failed • What should we be doing to develop this field?

3. MRC Background • Set up in 1914 • 1 of 6 Research Councils • Funded by Government (£350m pa) • Research - Investigator initiated • Support high quality research with aim of maintaining & improving human health • Train skilled people • Advance & disseminate knowledge & technology to meet national needs for health, quality of life & economic competitiveness

4. Principles • Will support good work in all sectors of medical research • Excellence is key • Proposals from all areas compete for funding available • Do not as a rule earmark funds for particular topics though good proposals in strategic areas may receive priority

6. Short versus long term funding

7. Health Services and Public Health MRC Spend on People & Population Studies

8. MRC & Clinical Trials

9. PARTNERSHIPS NICE HTA HDA SDO NEAT Methodology Panel MRC HDs Gvn - DfID, MoD etc Charities INDUSTRY

10. MRC Support • Clinical Trials - 120 ongoing trials • Justification for inclusion/exclusion of health economics in applications; planned analyses • Burden of disease, present and future resource implications for NHS/economy • MRC Biostatistics Unit (Cambridge) • MRC Health Services Research Collaboration (Bristol) • MRC Clinical Trials Unit (London)

11. Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002) • MRC/DH funded study - Alan Scott • Clinical analysis + cost effectiveness study • 6800 deaths in England + Wales in 2000; 2.1 % of all deaths in men older than 65 • Screening study - ultrasound scans • RCT of 67800 men aged 65-74 (1997-1999) • Randomised to receive scan or not • Primary outcome was mortality related to abdominal aortic aneurysm

12. Multicentre Aneurysm Screening Study (MASS - BMJ + Lancet 16 Nov 2002) Clinical analysis • Deaths - 65 (intervention) cf 113 (control) • Risk reduction - 53% Costs • Additional cost of screening - £2.2m • Cost per life year gained - £28k (4 year follow-up) and ?? £8k (over 10 years) • Both within perceived NHS threshold Policy/Practice???

13. What we have tried/failed Capacity building • HSR/Public Health Fellowships • MSc courses - medical statistics Failed • Health economics: discipline hopping scheme • Strategic factors • Issue: cost-effectiveness - prioritisation

14. Career Path and Eligibility for Funding Schemes NON-CLINICALCLINICAL PhD training ______ Research Studentship ________ Clinical Training Fellowship Postdoctoral ______ Research Assistant on Grant ___ Research Assistant on Grant Period ______ Research Fellowship ______ Career Development Award ____ Clinician Scientist Fellowship ______ Senior Fellowship ____________ Senior Fellowship University/ Clinical Appointment * Career Establishment Grant OR * Co-ordinated Grants Scheme MRC Senior Fellow - Centre Grant (Clinical or Non- - Co-operative Grant Clinical) - Development Grant * Innovation Grant Strategic Project Grant Programme Grant MRC Readership/Professorship

15. Models for Co-ops(1) M M E CORE status only Infrastructure Resource C C MAB XBG

16. Funders’ perspective - What next? • Emerging issues? • What is urgent? • What (else) is needed in terms of infrastructure/resources - ?UK wide • Feedback to funders - advice to applicants • Strategic factors • Issue: cost-effectiveness - prioritisation

17. The Medical Research Council • Web Page: www.mrc.ac.uk • Email: george.sarna@ headoffice.mrc.ac.uk • Telephone 020 7636 5422

18. Health Services Research (HSR) The investigation of the health needs of the community and the efficiency and effectiveness of the provision of services to meet those needs

19. Trials • Importance of the Question • Burden of ill health - NHS, Community, Family? • The right question: clinical, timely, feasible? • Prior knowledge & evidence - systematic reviews? • Impact? Generalisable? Particularisable? • Design • Will the design answer the question? • Feasible? Pilot / preliminary data? Staging? • Outcome measures? • Effect sizes? Sampling size and strategy • Bias? Randomisation - 3rd party?

20. Council Board, Panel and Group Structure Innovation Grant Panel Council Career Establishment Grants Panel Cross- Board Group Strategy Development Group Awards Advisory Group Molecular and Cellular Medicine Board Physiological Medicine and Infections Board Neurosciences and Mental Health Board Health Services and Public Health Board MRC Advisory Board

21. Investigator Initiated FundingSchemes for Research . Programme Grants • To support both focussed and more broadly based long term programmes of research. Co-operative Group Grants • To establish or bring together critical research mass, in ways which add value to individual research projects and improve the productivity of research environments. Development Grants – for Co-operative Groups • To help get to the point where they can make competitive applications for funding under the Co-operative Group Grants scheme. Career Establishment Grants • To provide 5yrssupport for scientists recently appointed to University academic posts to help them to establish themselves as independent research workers capable of winning support in open competition. . Strategic Grants • To support work which makes a specific contribution to MRC’s strategy

22. Models for Co-ops (2) C SF C CORE status only Infrastructure Resource SPG RCT

24. Finance

25. MRC Corporate Policies & Influences • The following represent important elements in the way the MRC has pursued its mission and national responsibilities to date: • Investing in the best science, across the whole field relevant to human health; • Responding to, and balancing the needs of, all stakeholders; • Meeting national (health and policy) needs; providing long-term support and critical mass; • Building capacity (through people and in fields of research, eg Health Services Research); • Funding national infrastructures (eg Mary Lyon, Biobank) and national facilities (eg HGMP) in response to investigator demand.

26. People