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Health Economics Research Unit

University of Aberdeen, Institute of Applied Health Services, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD

t: +44 (0)1224 553480 / 553733 f: +44 (0)1224 550926 e: [email protected]

www.abdn.ac.uk/heruANNUAL REPORT 2010

The views expressed here are those of the Unit and not necessarily those of CSO.

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H E A L T H E C O N O M I C S R E S E A R C H U N I T

Promoting Excellence in Health Economics

ANNUAL REPORT2010

HERU is supported by the Chief Scientist Office (CSO) of the Scottish Government Health Directorates (SGHD)

ANNUAL REPORT 2010

The Health Economics Research Unit (HERU) was established at the University of Aberdeen in 1977. The Unit is part of the Division of Applied Health Sciences within the College of Life Sciences and Medicine.

Core funding for the Unit is received from the Chief Scientist Office (CSO) of the Scottish Government Health Directorates. Substantial additional funding also comes from competitive research grants, training activities, commissioned research, and the University of Aberdeen.

We undertake substantial programmes of joint research with the Health Services Research Unit (HSRU) and Department of Economics in the University of Aberdeen Business School.

The aim of the Unit is to develop and encourage the application of appropriate economic methods to improve health and health care in Scotland.

More specifically, the aim is to:

• Researchintoeconomicapproachestohealthandhealthcareatstandardsofinternationalexcellence;

• DevelopandapplyeconomictechniquestoimprovehealthcareandpopulationhealthinScotland;

• Makeavailabletothehealthserviceabodyofexpertiseinhealtheconomics;and

• Buildandsustaincapacityintheeconomicsofhealth.

This aim is given specific form in the research programmes undertaken by HERU and in the many research projects and capacity building activities undertaken by the Unit.

Contact Details for HERU are:

The Health Economics Research UnitUniversity of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenAB25 2ZD

Tel: +44 (0) 1224 553733/553480Fax:+44(0)1224550926E-mail: [email protected]

http://www.abdn.ac.uk/heru

visit us at


1

contentsPro

m

otin

gEx

celle

nce

inH

ealth

Econ

omics

DIRECTOR’S OVERVIEW 2

2010 HIGHLIGHTS 3

STAFF LIST (including contact details) 4

RESEARCH

THE UNIT’S RESEARCH 7

PREFERENCE ELICITATION AND ASSESSMENT OF TECHNOLOGIES (PEAT) 8

BEHAVIOUR, HEALTH AND HEALTH SYSTEMS (BHHS) 13

KNOWLEDGE TRANSFER AND ENHANCING CAPACITY

KNOWLEDGE TRANSFER 18

ENHANCING CAPACITY 19

APPENDICES

(1) Projects in Progress and Completed in 2010 22

(2) Publications – 2010 48

(3) Presentations – 2010 53

(4) Publications – 2009 57

(5) Presentations – 2009 60

2

DIRECTOR’S OVERVIEW

I am delighted to introduce the 2010 Report of the Health Economics Research Unit (HERU). A key

event for HERU this year was the quinquennial scientific review, conducted by the Chief Scientist

Office (CSO) of the Scottish Government Health Directorates. This review assessed the Unit’s

activities and outputs over the previous five years and scrutinised our forward research plans for

2010-2014. It looked at our plans relevance to Scottish Government and NHS Scotland priorities

and the scientific quality of the Unit’s work. The review team comprised senior figures from academia, the

policy communities and CSO and they came from the UK and overseas. It was chaired by Professor Trevor

Sheldon, Professor of Health Services Research and Deputy Vice-Chancellor, University of York.

I am proud to report that the reviewers gave an extremely positive assessment, highly commending the

work of the Unit and recommending a further five years of funding.

The year saw continued engagement with a number of the policy, practitioner and research communities in

Scotland and beyond. Staff gave invited presentations at key meetings and we again welcomed world-class

researchers as visitors to the Unit. We describe these activities in more detail in the programme reports.

Other notable highlights were the further development of research capacity, personal recognition for the

contribution of HERU staff and the award of higher degrees. We warmly welcomed Ramses Abul Naga

and Silvia Mendolia to Aberdeen. Ramses was appointed as Reader and Silvia took up the post of Lecturer.

Both Ramses and Silvia are joint appointments with the Business School, University of Aberdeen, and they

lead the health economics contribution to the Scottish Institute for Research in Economics (SIRE). We also

welcomed Philip Kinghorn, who joined us as Research Fellow from the University of East Anglia.

We congratulate two members of staff on their promotions: Dr Diane Skåtun promoted to Senior Research

Fellow, and Dr Paul McNamee, promoted to Reader. Finally we are pleased to report that Divine Ikenwilo

and Yan Feng both successfully defended their PhDs.

The year also saw us say goodbye to our Senior Secretary, Anne Bews, who retired in July 2010. Anne had

worked at the University of Aberdeen for almost 40 years; 21 of those were in HERU. She will be greatly

missed and we wish her well in the future. Alasdair Munro, who held a part-time appointment, also retired,

Dr Murray Smith moved to Nottingham University and Laura Ternent moved to a new post at Newcastle

University. We thank them all for their valuable contributions over the years and wish them well in the

future.

There is no doubt that a challenging financial environment lies ahead, which is likely to mean reduced

funding for research. The Unit will meet these challenges by building on existing strengths and expertise

and establishing new international collaborations. The outcome of the Review evidences that we are well

positioned to meet the challenges of the next years.

Bob Elliott

Director

3

2010 HIGHLIGHTS

• Recognition of our research excellence

• A highly successful quinquennial CSO scientific review, leading to a further five year period of

funding

• Heather Brown awarded the Cairncross prize for the best paper by a young member of the Scottish

Economic Society, entitled “Marriage, BMI and Wages: A Double Selection Approach”.

• Invited presentations by:

- Shelley Farrar, Deokhee Yi and Ada Ma at The King’s Fund Symposium: Policy Implications of

Emerging Findings for the English NHS on Payment by Results: impact and policy implications

- Mandy Ryan at the Third Conjoint Analysis in Health Conference: How is Conjoint Analysis being

Applied in Health

- Rodolfo Hernández and Luke Vale at the International Glaucoma Association: Review of glaucoma

projects, their approaches and challenges.

• Capacity Building

• Professor Mandy Ryan and Dr Verity Watson ran their 3-day ‘Expert Workshop in Discrete Choice

Experiments’

• Hosting a one month visit by Professor Andy Willan, Senior Scientist, University of Toronto, who led

a workshop on Value of Information methods

• Running an internship scheme for economics undergraduates

• Two PhD students graduated from the Unit.

• Collaborations with clinical researchers from across Scotland

• Several new large NIHR / HTA grants commencing in the areas of: magnetic resonance imaging in

transient ischaemic attack and minor stroke; new imaging technologies for the diagnosis of glaucoma;

maintained physical activity and physiotherapy in the management of distal arm pain; oral hygiene

advice and scale & polish/periodontal instruments trial; stapled haemorrhoidopexy for haemorrhoidal

disease; drug therapy in the management of symptomatic stones in hospitalised adults

• The MRC-led Cross-Council Life-Long Health and Wellbeing Programme: Engaging with older people

to develop and deliver interventions for the self management of chronic pain (EPIC)

• MRC funded methodology project on methods for identifying target differences for randomised

controlled trials

• Engagement with policy fora

• Programme Advisory Groups (PAGs) to inform our research agenda and dissemination strategy

• Membership of the Scottish Collaboration for Public Health Research & Policy; NICE Programme

Guidance Development Group; Scottish Medicines Consortium; Scottish Health Technologies Group;

the Midwife 2020 Public Health and Workforce and Workload Groups; Technical Advisory Group on

Resource Allocation

• Evidence on Minimum Pricing of Alcohol given to the Health and Sport Committee of the Scottish

Parliament

4

STAFF LISTHERU staff, identifying their source of funding as of 31st December 2010

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7

THE UNIT’S RESEARCH

HERU’s research is structured into two programmes supported by research themes. The themes reflect

both established and emerging areas of expertise. The programmes and their themes are:

Preference Elicitation and Assessment of Technologies (PEAT) Programme

• Preference Elicitation develops and applies methods for valuing benefits beyond the

Quality Adjusted Life Year (QALY), allowing for valuation of patient

experiences in health care. The focus is currently on contingent

valuation (CV) and discrete choice experiments (DCEs).

• Experimental Economics tests theory and decision-making in health and health care within

the context of stated preference methods, through conducting

both field and laboratory experiments.

• Assessment of Technologies brings together information on the effectiveness and cost of

health care interventions to promote the efficient use of scarce

health care resources by the NHS and the Scottish Government

Health Directorates.

Behaviour, Health and Health Systems (BHHS) Programme

• Workforce conducts research to understand the behaviour of individuals in

health care systems.

• Organisations and Performance conducts research to understand the performance of organisations

that deliver health care.

• Health Behaviour and Inequalities contributes to the evidence base relating to the effectiveness

and cost-effectiveness of public health interventions and to the

understanding of inequalities in health and health behaviour.

A prominent feature of the research we undertake is that it involves collaboration between the programmes

as well as across themes within programmes. An example is the MRC National Prevention Research

Initiative on obesity. This work draws on the expertise of three of our themes and both programmes. It

uses a wide variety of methods including econometric modelling of health behaviours, discrete choice

experiments, and economic evaluation.

A major strength of HERU is its size and the diversity of its expertise. This is shown by theme titles and

through collaboration across themes and programmes, enabling us to make a distinct and significant

contribution to health care policy and practice. Critical mass enables HERU to build expertise in a number

of priority areas for the Scottish Government and NHS Scotland and to draw together this expertise on

large projects.

The main achievements and activities of the two research programmes are described in the following

pages. These summaries are supported by a series of appendices giving details of recent completed

projects, projects in progress and our publications and presentations.

8

PREFERENCE ELICITATION ANDASSESSMENT OF TECHNOLOGIES

(PEAT) PROGRAMME

Programme Director: Dr Paul McNamee

The Preference Elicitation and Assessment of Technologies (PEAT) Programme develops and applies

methods to improve the efficiency of health care delivery, through focus on economic methods for

valuing the benefits and costs of alternative health care interventions. Research is concerned both

with assessing the value for money of different forms of health care and with measures of value that take account of

patient experience when receiving such care.

Projects in progress, together with those completed and starting in 2010, are detailed in Appendix 1; Appendices 2 and

3 provide information on presentations and publications. We published in leading peer-reviewed health care and health

economics journals, such as the Lancet, Health Technology Assessment and Health Economics. Staff gave a number

of invited presentations at key meetings, with examples including Rodolfo Hernández speaking at a meeting of the

International Glaucoma Association, Professor Mandy Ryan, who gave a presentation at the Third Conjoint Analysis in

Health Care Conference, and Paul McNamee, at the Symposium on Imaging Research in Cognitive Impairment and

Dementia, an event organised by the Scottish Imaging Network (SINAPSE).

Training in the application of techniques extensively used within the programme was continued this year, with a 3-day

Discrete Choice Experiment workshop delivered by Mandy Ryan and Verity Watson, and the publication of a book

edited by Professor Luke Vale (with colleagues Shemilt, Mugford, Donaldson, and Marsh) entitled Evidence Based

Economics. Further training was also provided on Value of Information methods by Visiting Professor Andy Willan,

Senior Scientist, University of Toronto.

In 2009 we established our Programme Advisory Group. The remit of the group is to advise the programme on

the policy relevance of work, dissemination strategies and future research priorities. Group members are Dr Lesley

Holdsworth (Associate Director, NHS24), Professor James N’Dow (Professor of Surgery, Division of Applied Health

Sciences, University of Aberdeen), Noelle O’Neill (Public Health Scientist, Directorate of Public Health and Health

Policy, Highland Health Board) and Carol Sinclair (Programme Director, Better Together, Directorate for Healthcare

Policy & Strategy, Scottish Government Health Directorates). We held our inaugural meeting in 2010, where focus

was placed on establishing remit and discussion of research prioritisation systems.

Our engagement with Scottish policy-makers was enhanced further this year, with Paul McNamee becoming a member

of the Later Life Working Group of the Scottish Collaboration for Public Health Research & Policy. The purpose of the

Collaboration is to build capacity for the robust evaluation of public health programmes and policies in Scotland.

9

PREFERENCE ELICITATION AND ASSESSMENT OFTECHNOLOGIES (PEAT) PROGRAMME

Assessment of Technologies

The Assessment of Technologies theme, led by Professor Luke Vale, focuses on the development and application

of economic evaluation methods to the assessment of health technologies. In the past year the theme completed

seven projects in priority areas. These include optimal forms of surveillance for women previously treated for breast

cancer, treatment of bowel cancer, exercise training for heart failure, studies in critical care and treatments for primary

or secondary prevention of osteoporotic fractures.

In addition to these projects, the theme completed an MRC funded trial platform study which sought to develop a

strategy for a national screening programme for glaucoma, one of the main causes of blindness within the UK, for

testing in a subsequent trial.

The size of the project portfolio has been maintained with six new grants awarded, with the majority funded by the

National Institute of Health Research (NIHR). These projects address key areas of clinical uncertainty, and are mainly

commissioned in response to calls by the NIHR HTA programme to conduct research to address specific questions

of importance to the UK NHS.

This year also saw the award of new Research Council grants. The theme was successful in securing a Medical

Research Council commissioned project to assess optimal methods for calculating a target difference, used as the

basis for sample size calculations in randomised controlled trials. This work, conducted in collaboration with colleagues

from HSRU and elsewhere in the world, will systematically review and critically appraise economic and non-economic

methods, leading to the production of methods guidance to aid the design of future trials.

Further, we commenced two projects that are considering use of new and existing technologies for pain management

among the older population. The first is a joint research council funded programme of work, led by the Medical

Research Council as part of the Life Long Health and Well-being Initiative, to investigate the role of self-management

for chronic pain, in collaboration with partners in the Centre for Academic Primary Care and other investigators at

Glasgow Caledonian University and Teesside University. The second is a study funded by Research Councils UK, and

will consider the value of existing and new forms of support for older people with chronic pain.

10


Two members of staff were nearing the end of their PhD’s in 2010. Graham Scotland’s PhD is concerned with valuing

outcomes in economic evaluations of maternal and reproductive health care interventions. His thesis draws on three

case studies where novel approaches have been used to value and incorporate patient or population preferences into

economic evaluations. Graham is now in his final write-up phase with an anticipated completion date of September

2011. Laura Ternent has completed her empirical work and is now writing up, with an anticipated submission date in

March 2011 for her PhD on testing methods to value health outcomes in low income countries. Two further members

of staff, Zahidul Quayyum and Rodolfo Hernández, are also conducting PhDs on a part-time basis. Zahidul Quayyum

is undertaking research to develop a need based resource allocation mechanism for allocating health care budget

across regions of Bangladesh. Using household survey data on demand for health care and morbidity, the study

will determine weights for adjusting the regional allocation in order to achieve an equitable allocation of health care

expenditure. Rodolfo Hernández is undertaking research to develop economic evaluation methods for the design

and evaluation of complex interventions. The empirical work is based on a common cause of blindness in the UK,

glaucoma, and will be completed in 2011.

Preference Elicitation

The Preference Elicitation theme, led by Professor Mandy Ryan, develops economic valuation methods that broaden

measures of value beyond the widely used Quality Adjusted Life Year (QALY). A strong motivation for this research

is to value patient experiences in the delivery of health care. The theme focuses mostly on the development and

application of Discrete Choice Experiments (DCEs) and Contingent Valuation (CV) methods in health economics.

During 2010 the second stage of a project (what healthcare experiences

matter to patients and how values can be assigned to them), funded by the

MRC commenced. This project is carried out in collaboration with colleagues

at the HSRU, University of Aberdeen and Professor Entwistle from University

of Dundee. Following completion of Stage 1 in early 2010, which identified

the range of patient experiences that matter, clarified why they matter, and

produced a conceptual map to represent them, the second stage is exploring

economic methods for valuing the components of the conceptual map. Philip

Kinghorn, who worked on this second stage, will take up a 1-year HERU post-doctoral fellowship in 2011.

11

Collaborative work between the Assessment of Technologies and Preference Elicitation theme, within a NIHR

HTA Programme funded project to identify the most effective and cost-effective way to monitor individuals with

ocular hypertension, conducted a DCE to elicit public preferences for alternative monitoring strategies for ocular

hypertension. Despite the increased use of DCEs in health economics over the last 20 years, their application to an

economic evaluation framework is limited. Future work will incorporate the output from the DCE into an economic

modelling framework. The work forms part of Rodolfo Hernández’s RCUK Modelling Fellowship and PhD.

Collaborative work between PEAT and BHHS, and funded by MRC National Prevention Research Initiative (NPRI), has

been looking at lifestyle interventions to reduce obesity. This is a multiphase project and Mandy Ryan and Deokhee

Yi completed a DCE to look at preferences for lifestyle interventions to reduce obesity. This work was presented at

the UK Society for Behavioural Medicine 6th Annual Scientific Meeting in association with the National Prevention

Research Initiative (NPRI) Annual Scientific Meeting.

During this year a National Patient Safety Agency-funded project was also completed. This project, led by Verity

Watson, was conducted in collaboration with the Office of Health Economics, and investigated the value of support

services that help NHS organisations manage clinical performance concerns.

Two projects starting in 2010 were collaborative projects with the Health Economics Unit, University of Cape Town,

using a DCE to elicit preferences in relation to National Health Insurance in South Africa and a CSO funded project

in collaboration with Centre for Academic Primary Care, University of Aberdeen, looking at Attitudes, Knowledge &

Experience of the General Public Towards Drug Misuse & Drug Treatment Strategies. This latter project examines

public attitudes and knowledge of drug use and treatment strategies and applies contingent valuation to assess the

value the public place on alternative drug treatment strategies.

Professor Mandy Ryan acted as a consultant to the World Bank, advising on the application of DCEs to address

issues around the recruitment and retention of medical staff in remote and rural areas in low and middle income

countries (Vietnam, Liberia and India). She was invited to a Joint World Bank and WHO funded workshop to explore

issues around the application of DCEs to human resource issues in low and middle income countries. The outcome

of this will be a User Guide for applying DCEs to address retention and recruitment issues in low and middle income

countries.

As part of training strategy, a 3-day Expert Workshop on Discrete Choice Experiments has been developed. The aim of

this Workshop is to provide information on practical and theoretical issues faced when conducting DCEs. During 2010

Mandy Ryan and Verity Watson ran the 3-day workshop. This was the 7th time the Workshop had taken place.


12


Two ESRC/MRC post-doc fellowships are being mentored by Mandy Ryan. Terry Porteous (Centre for Academic

Primary Care, University of Aberdeen), as part of her fellowship (How do people choose between self-care, supported

self-care and GP consultation in minor illness?) completed a DCE to see how preferences vary depending on the

perceived seriousness of three different symptom scenarios (diarrhoea, back pain and rectal bleeding). Michela Tinelli

presented work from her fellowship (Applying discrete choice experiments in pharmacy: applied and methodological

issues) at the 3rd Conjoint Analysis in Health Conference.

Experimental Economics

Research within this theme, led by Dr Verity Watson, applies laboratory based experimental economic methods to

better understand how individuals respond to survey questions. Whilst experimental economics methods are well-

established in Economics, there are few applications in Health Economics. Such experiments use cash motivated

subjects to create real-world incentives, and aim to improve understanding of how markets or exchange mechanisms

(such as auctions or contracts) work. Similar conceptually to experiments in the natural sciences, such as randomised

control trials, economic experiments provide controls that observational data, including survey data, lack. Experiments

allow researchers to separate the effects of different variables and to infer causality.

In 2010, pilot research continued to investigate how context and complexity influence responses to DCEs. This project

compares hypothetical and real DCE responses to estimate the magnitude of any hypothetical bias, and to consider

if DCE responses are better explained by models of bounded rationality than utility maximisation. Preliminary findings

from this research were presented at the European Conference in Health Economics, in Helsinki. Future research will

develop further the findings of the pilot research, and based on these results, seek funding for a full scale study.

13

Programme Director: Dr Marjon van der Pol

Understanding the behaviour of the individuals and organisations which play the main roles in improving

population health is key to ensuring the best use of the resources devoted to health care. Economic

analysis of the effects of the incentives and constraints that confront these individuals and organisations

is central to understanding the resulting behaviours. The Behaviour, Health and Health Systems (BHHS) Programme

undertakes a programme of applied health economics research that uses economic theory and the econometric

analysis of primary and secondary data sets to study the behaviours of health professionals and organisations in the

NHS and the health behaviours of the population at large. This research provides evidence to policy makers about how

behaviour affects the efficiency of health production and on the most efficient ways to influence behaviour.

In 2010 several projects were completed and several new ones were started – these are detailed under the different

themes and in Appendix 1. We continued to publish our work in high quality international journals including The

Economic Journal, Health Economics, the Scottish Journal of Political Economy, Economic Modelling and Economic

Letters. We disseminated our research findings to policy makers and academic audiences. The conferences we

presented at include the annual Public Health Conference in Scotland, European Conference on Health Economics

and the Scottish Economic Society. We also presented some results from our completed project at the economic

evaluation of obesity prevention at the UK Society for Behavioural Medicine 6th Annual Scientific Meeting in association

with the National Prevention Research Initiative (NPRI) Annual Scientific Meeting. Heather Brown was awarded the

Cairncross Prize for the best paper by a young researcher at the Scottish Economic Society Conference for her paper

Marriage, BMI, and Wages: A Double Selection Approach.

The Programme also further extended its direct contribution to policy this year. Professor Anne Ludbrook was a

member of the NICE Programme Guidance Development Group which published guidance on prevention of alcohol

misuse in June. She also gave evidence to the Health and Sport Committee of the Scottish Parliament relating to the

potential impact of minimum pricing for alcohol on different income groups.

Workforce

The Workforce theme led by Dr Diane Skåtun focuses on the nature and competitiveness of health care labour markets

and factors influencing the labour market decisions of health professionals. This includes the relative attractiveness

of jobs and the role of both pay and non-pay factors in recruitment and retention and other related labour market

behaviour of the health care workforce. The aim of the theme is to improve the evidence-base for policy-making

through analysis of the factors determining the behaviour and performance of individuals in health care systems.

In 2010, a new research project was completed into the differences found

between local labour markets in the relative pay of NHS professionals

with other employees. These differences affect the NHS through the

resulting relative attractiveness of NHS employment and can result in

unavoidable variations in staff costs. This is the basis of the Staff Market

Forces Factor (MFF) which is used to adjust funding for PCTs in England.

Previous research by HERU commissioned by the Advisory Committee

on Resource Allocation (ACRA) led to important changes in the way the

BEHAVIOUR, HEALTH ANDHEALTH SYSTEMS (BHHS)PROGRAMME

14

staff MFF was estimated. This current research provided up to date MFF values for use in the PCT allocations from

2011-12 and, within the general framework, reviewed and where appropriate suggested further refinements to the

method for estimating the MFF.

The workforce theme continued with its strong links with NHS Education Scotland (NES) with a member of the theme

Divine Ikenwilo extending his secondment as a Senior Research and Information Officer until September 2010. This

secondment included work analysing the determinants of attrition in nursing courses and the transition of nurses

between training and employment.

Work has also begun on a new project in collaboration with NHS Education Scotland and the Royal College of

Physicians in Edinburgh. This project intends to understand the possible consequences of the introduction of a

mandatory revalidation processes on the working lives of Consultants and Speciality & Associate Specialist Doctors in

NHS in Scotland. It will document how doctors currently use their time across the variety of activities they undertake

and it will elicit the priority given by doctors to different activities including the current appraisal system. This will help

understand the likely impact of mandatory participation in revalidation.

Research towards two PHDs also continued throughout 2010. Divine Ikenwilo successfully defended his thesis

entitled “Studies of the Job Satisfaction and Labour Supply of Hospital Consultants” and was awarded his PhD in

November. Jean-Baptiste Combes continues with his MRC Capacity Building PhD studentship that considers the

role of reward structures, shortages and competition in determining the mix of the NHS workforce. The research

is investigating whether health providers adjust skill-mix to adapt to local labour market conditions. This research

has now expanded to consider the French health care system where a larger private health care system operates in

parallel to the state system.

Organisation and Performance

To ensure that improvements in the provision of health care are achieved, we need to be able to effectively

measure, monitor and evaluate mechanisms put in place to improve performance. The aim of the Organisations and

Performance theme led by Dr Shelley Farrar is to address these challenges by providing an evidence base to increase

our understanding of the organisational behaviour and performance. This evidence base informs health policy makers

on the effects of specific policy interventions as well as contributing to a body of evidence which provides a growing

knowledge of the expected responses to incentives and organisational configuration within the health care sector.

Research was completed on a second major evaluation of hospital financing in England: Payment by results: Key

outcomes and variations across HRGs providers and patients in 2006/07 and 2007/08. This project was funded by the

Department of Health under the Health Reform Evaluation Programme. The work was led by researchers in BHHS

in collaboration with Professor Martin Chalkley in the Department of Economic Studies at the University of Dundee.

Lessons for the Scottish tariff are being explored.

How to measure performance is clearly an important issue in health care. Work exploring the potential for using

different statistical measures of organisational efficiency in a Scottish context has continued and initial data analysis

began on the use of Data Envelopment Analysis. This work is in collaboration with academics at the University of St.

Andrews and Widener University in the USA.

BEHAVIOUR, HEALTH AND HEALTH SYSTEMS (BHHS) PROGRAMME

15

Work began on a grant from the CSO to examine the change introduced in the Quality and Outcomes Framework

in 2006/07 and their effects on the delivery of primary care in Scotland. This research will use on-going contractual

modifications to examine the changes introduced in the Quality and Outcomes Framework (QOF) in 2006/07 and their

effects on the delivery of primary care.

Yan Feng, a PhD student in the programme was successfully examined and graduated in November. The thesis is

concerned with intrinsic and extrinsic motivation of health care workers. Her thesis develops a theoretical model of

intrinsic motivation drawing on economics and psychology. Her empirical findings suggest that changes in financial

incentives affect the level of intrinsic motivation. We are exploring how these concepts and findings can be applied

to individual health behaviour.

Health Behaviours & Inequalities

The aim of the Health Behaviours and Inequalities theme led by Professor Anne Ludbrook is to contribute to the

development of the evidence base for public health interventions and to the understanding of inequalities in health and

health behaviour. It has a particular focus on alcohol misuse, smoking and obesity and the contribution of inequalities

in these health behaviours to inequalities in health.

As described above, the theme continued to contribute to alcohol policy during 2010.

A feasibility study was undertaken with colleagues at the University of Dundee to

identify study options for investigating the economic impact on the alcohol industry of

pricing and non-pricing to regulate the affordability and availability of alcohol in Scotland

funded by NHS Health Scotland.

Research was conducted on the effect of smokefree

legislation on exposure to environmental tobacco smoke and health outcomes. As part

of the MRC National Prevention Initiative (NPRI) project on the economic appraisal of the

choice and targeting of lifestyle interventions to prevent disease in deprived areas, research

was conducted on how smoking behaviour impacts on other health behaviours. Work on

“Modelling the participation decision and duration of sporting activity in Scotland” was

published. The project is progressing well and is due to complete in Autumn 2011. Analysis

of early data on the evaluation of the Quit4u smoking cessation scheme in Dundee was

conducted.


16

The final report of our MRC National Prevention Initiative (NPRI) project on the economic

evaluation of obesity prevention was submitted. This included econometric analyses

looking at the impact of lifestyles on obesity related diseases and treatment costs, the

elicitation of strength of preferences of the general population for different lifestyle

interventions (as described under the PE theme) and the incorporation of these data

into an economic evaluation. The Weighwell study, a pilot of a weight management

intervention for post partum women, was completed and the results are being used to

inform the design of a full trial. Another weight management trial, (BeWEL), commenced

and will run until the end of 2012.

Frauke Becker successfully completed her second year assessment for her PhD on physical activity and dietary

behaviour. With two chapters completed she is moving into the final analysis, using panel data to explore changes in

behaviour over time.

Work began on a 3 year grant awarded by the Chief Scientist Office to investigate socioeconomic inequalities in health

and behaviour. The project aims to analyse the potential mechanisms by which overall health inequalities may be

generated by health behaviours and the inequalities inherent in health behaviours to provide evidence about effective

policy interventions.

Research into the relationship between individuals’ time preferences and health behaviours was also taken forward. A

questionnaire was developed for a large population survey in Canada with colleagues at the University of Calgary which

will explore the relationship between time preference and risk attitude and lifestyle choices and medical adherence.

Work was started with the Glasgow Centre for Population Health. The research will investigate several hypotheses

for the Glasgow effect including differences in time preferences between Glasgow and other similar cities. This work

will also form part of Ewan Gray’s PhD thesis. Research was also conducted on the intergenerational transfer of time

preferences and whether this can partly explain the intergenerational transfer of health behaviours. This work was

conducted as part of Heather Brown’s ESRC/MRC/NIHR Early Career Fellowship in the economics of health.


Knowledge Transfer & Enhancing Capacity…

18

• Presentations to policy-makers and health service professionals attending the Annual Public Health

Conference, the Health Technology Assessment International Society meeting, the Society for Medical

Decision-Making Annual Conference, the UK Society for Behavioural Medicine Annual Scientific

Meeting, the Annual Meeting of the European Society for Human Reproduction and Embryology and

the World Ophthalmology Congress.

• Presentations to our peers at the major health economics conferences including the Health

Economists Study Group (HESG), the European Conference on Health Economics, and the Third

Conjoint Analysis in Health Conference.

• Presenting papers on health economics to audiences of economists attending the annual Scottish

Economic Society Conference, the Foundations and Applications of Utility, Risk and Decision Theory

Conference, the Panel Study of Income Dynamics Conference on Health & Socio-Economic Status,

and the Econometrics of Healthy Human Resources meeting.

• Running workshops, editing books, writing invited book chapters:

– “Using Discrete Choice Experiments in Health Economics: Theoretical and Practical Issues”,

Aberdeen;

– Edited book: “Evidence Based Economics” I. Shemilt, M. Mugford, C. Donaldson, L. Vale and

K. Marsh. (eds)

– Book chapter: “Fiscal Policy and Health Related Behaviours” in: Evidence Based Public Health

(A. Ludbrook);

• Producing briefing papers on topics including: Modelling the participation decision and duration of

sporting activity in Scotland; Economic consequences of mental health problems in older people on

other family members; Economic evaluation of urinary biomarkers and cystoscopy with photodynamic

diagnosis for detection and follow-up of bladder cancer, and Valuing patient experience factors in the

provision of Chlamydia screening.

• Membership of government advisory committees including the Scottish Health Technology Group,

the Scottish Medicines Consortium, the NHS QIS Research Governance Committee, the Scottish

Collaboration for Public Health Research & Policy, NICE Programme Guidance Development Groups,

Research and Evaluation Sub-committee of the Ministerial Working Group on Tobacco Control and

the Midwifery 2020 Workforce and Workload Group, and Technical Advisory Group of Resource

Allocation.

KNOWLEDGE TRANSFER

19

ENHANCING CAPACITY

HERU continues to devote substantial resources to building capacity in health economics. Its activities

in this area in 2009 included:

• Delivering 3-day expert workshop in Discrete Choice Experiments.

• The development of a new sixth century course for first year University of Aberdeen students,

entitled the Health and Wealth of Nations, to consider the processes which may determine whether

a country’s wealth improves its health.

• Teaching health economics to undergraduates studying for a range of courses in the College of Life

Sciences and Medicine & the College of Arts and Social Science at the University of Aberdeen.

• Teaching health economics to students taking the MSc in Health Services and Public Health Research

at the University of Aberdeen and contributing to the teaching of the MSc in Health Economics at the

University of York.

• Dissertation supervision for students taking the MSc in Health Economics at the University of York.

• A further Summer Internship Scheme, awarded to three economics students to enable them to

understand how health economics research is conducted and how it is applied to a health policy.

Each intern worked in HERU for six weeks on literature-based studies and empirical projects.

• Organising and presenting the University of Aberdeen Postgraduate Certificate in Health Economics

Distance Learning course.

• The award of PhD to:

– Yan Feng An economic analysis of extrinsic and intrinsic motivation in the

supply of health care.

– Divine Ikenwilo Studies of the job satisfaction and labour supply of hospital

consultants.

• Supervision of three PhDs in health economics where students are supported by Capacity Building

Studentships from the MRC and University of Aberdeen.

– Frauke Becker Economic analysis of dietary and physical behaviours.

– Jean-Baptiste Combes Essays in nursing labour supply.

– Ewan Gray Time preferences for future health events.

• Continued Mentoring and Supervision of Fellowships.

– Rodolfo Hernández RCUK Fellowship;

– Michela Tinelli MRC/ESRC Interdisciplinary Postdoctoral Fellowship;

– Terry Porteous MRC/ESRC Interdisciplinary Postdoctoral Fellowship; and

– Heather Brown MRC/ESRC Early Career Fellowship.

• Hosting a one month visit by Professor Andy Willan, Senior Scientist, University of Toronto, who led

a workshop on Value of Information methods.

• Deputy Chair of the ESRC/MRC/NIHR panel for the award of Early Career Postdoctoral Fellowships

in the Economics of Health.

Appendices…

APPENDIX 1

PROJECTS IN PROGRESS AND COMPLETED IN 2010

APPENDIX 2

HERU PUBLICATIONS 2010

APPENDIX 3

HERU PRESENTATIONS 2010

APPENDIX 4

HERU PUBLICATIONS 2009

APPENDIX 5

HERU PRESENTATIONS 2009

22

PEAT – Projects in Progress at the end of 2010* Denotes projects started in 2010

The phases of each research project in progress are identified as follows:

Initial Phase: Literature review, scoping the empirical work, obtaining data

Analytical Phase: Empirical and theoretical analysis

Final Phase: Production and delivery of the final report and associated dissemination

Post Project Phase: Production of journal articles and further dissemination

Applying discrete choice experiments in pharmacy: applied and methodological issues.

Investigators: M Tinelli, M Ryan (HERU) and C Bond (Primary Care, University of Aberdeen)

Following the award of a PhD concerned with developing and applying discrete choice experiments to inform pharmacy policy, this postdoctoral fellowship allows the development of peer reviewed papers from the PhD, as well as research skills in the development of DCEs and their application to the evaluation of alternative pharmacy services. Papers emerging from the PhD have been accepted for publication or are currently being written, a number of conferences and training courses have been attended and a test of external validity is currently being developed.

Source of funding and total awarded: MRC/ESRC Interdisciplinary Postdoctoral Fellowship, £140,092

Amount of HERU funding: £140,092

Project phase:

* An Assessment of the cost-effectiveness of magnetic resonance including diffusion-weighted brain imaging in patients with transient ischaemic attack and minor stroke.

Investigators: JM Wardlaw, M Brazzelli, M Dennis, P Sandercock, J de Wilde (University of Edinburgh); P McNamee (HERU) and K Muir, D Hadley (University of Glasgow)

This project aims to inform health service providers in decisions on how best to diagnose minor and mini stroke. There are four main parts to the project: 1) A systematic review to determine the accuracy of magnetic resonance (MR) imaging, including diffusion-weighted, structural and blood sensitive sequences, to identify patients with mini or minor stroke; 2) A survey of UK stroke prevention clinics to assess the current access to MR imaging, within the NHS, for patients with mini or minor stroke and the current consensus on the role of MR imaging for mini or minor stroke; 3) A systematic review of published economic evaluations; 4) A cost-effectiveness model to assess the effect of MR imaging for mini or minor stroke.

Source of funding and total awarded: NIHR, HTA Programme: £264,260

Amount of HERU Funding: £49,265

Project phase:

* Attitudes, Knowledge & Experience of the General Public towards Drug Misuse & Drug Treatment Strategies.

Investigators: C Mathieson, C Bond, M Jaffray (Centre for Academic Primary Care, University of Aberdeen) and M Ryan (HERU)

Scotland’s drug problem detrimentally affects individuals, communities and society. Various treatments are used (detoxification, rehabilitation and maintenance) but methadone maintenance therapy (MMT) is the mainstay therapy. However, despite a strong evidence base of effectiveness, MMT is not always delivered as part of a holistic care package to promote long-term recovery. Furthermore, MMT attracts criticism publicly and politically, albeit sometimes ill-informed. The Government’s drugs strategy ‘The Road to Recovery’ was published last year. It is now an opportune time to assess wider opinion about drug treatment. Research has examined professionals’ and drug users’ views of treatment but views of the Scottish general public are unknown. This study examines public attitudes and knowledge of drug use, treatment strategies and applies contingent valuation to assess the value the public place on alternative drug treatment strategies. The questionnaire is currently being developed.

Source of funding and total awarded: CSO, £49,995

Amount of HERU Funding: University of Aberdeen

Project phase:

APPENDIX 1 – PROJECTS IN PROGRESS AND COMPLETED IN 2010

23

PEAT – PROJECTS IN PROGRESS AT THE END OF 2010

Clinical and cost-effectiveness of surgical options for the management of anterior or posterior vaginal wall prolapse: pragmatic evaluation by multi-centre randomised controlled trial (PROSPECT: PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial).

Investigators: C Glazener, A Grant, J Norrie, G MacLennan, A McDonald, G McPherson (HSRU, University of Aberdeen); L Vale (HERU/HSRU); D Boyers, M Kilonzo (HERU); ARB Smith (St. Mary’s Hospital Manchester); RM Freeman (Plymouth Hospital NHS Trust); C Bain, K Cooper (NHS Grampian); S Hagan (Glasgow Caledonian University) and IBG Montgomery (Aberdeen)

The lifetime risk of undergoing surgery for prolapse is nearly 10%. There are several alternative traditional surgical techniques, none of which have been properly evaluated. The study embeds two large RCTs investigating different surgical techniques for two distinct patient populations of women with vaginal prolapse within a comprehensive cohort of all patients. The economic evaluation will investigate the costs and cost-effectiveness of the interventions from the perspective of the NHS and to women and their families. Information on the cost of the intervention and the use of primary and secondary NHS services by the women including referral for specialist management will be collected as will personal costs to the women (such as costs of travelling to appointments and work/social restrictions). Trial participants will be asked to complete the EQ-5D at baseline and at 6, 12 and 24 months after randomisation and responses will be used to compute QALYs. In a sensitivity analysis, QALYs will also be estimated from the SF-12 completed at the same time points. Incremental cost-effectiveness ratios will compare the additional cost of more complex operations or the use of a synthetic mesh to repair the prolapse divided by the additional effectiveness in relation to standard management (assuming this is the least costly of the strategies). The difference in effectiveness will be expressed in terms of the number of patients cured and number of patients improved. Incremental cost-utility ratios will be computed comparing the interventions. An economic model which considers a longer time horizon will also be developed to provide additional information for policy makers. In the model, the findings of the trial will be extrapolated to the patient’s life time.

Source of funding and total awarded: NIHR HTA Programme, £2,628,330


Project phase:

* The Clinical and Short-Term NHS Costs of Maternal Obesity for Maternity Services in Scotland.

Investigators: F Denison (University of Edinburgh); G Scotland (HERU); J Norman (University of Edinburgh); C Morris (Information Services Division); T Mahmood (Forth Park Hospital) and S Bhattacharya, A Lee (University of Aberdeen)

Scotland has one of the highest rates of obesity in Europe, and the rising prevalence is particularly marked in women of reproductive age, reaching 20.6% in Scotland by 2003. This is of concern as maternal obesity is associated with increased morbidity and mortality for both mother and offspring. Obese women are more likely to experience gestational diabetes, hypertensive disorders, induction of labour, operative delivery and post partum haemorrhage, whilst the offspring of obese mothers are at higher risk of late foetal death, congenital anomaly and admission to the neonatal unit. In order to plan for the future delivery of maternal health services in Scotland, it is important to understand the impact that increasing obesity rates will have on NHS resource use.

Source of funding and total awarded: CSO via University of Edinburgh, £37,679


Project phase:

* Comparative study of new imaging technologies for the diagnosis of glaucoma.

Investigators: A Azuara-Blanco (NHS Grampian); C Ramsay, J Burr, J Cook, K McCormack (HSRU, University of Aberdeen); L Vale, R Hernández (HERU/HSRU); D Garway-Heath (Moorfield Eye Hospital NHS Foundation Trust); R Bourne (Hinchingbrooke Hospital/Moorfield Eye Hospital/Addenbrooke’s Hospital) and M Batterbury (Royal Liverpool University Hospital)

Glaucoma describes a group of eye diseases in which there is progressive damage of the optic nerve and visual field loss leading to impaired vision and sometimes blindness. The estimated prevalence of glaucoma in the UK is 2% of the adult population with approximately 4000 new cases of severe visual impairment due to glaucoma every year. Currently, a definitive glaucoma diagnosis is based on the expertise of an ophthalmologist interpreting a visual field testi. New imaging techniques have emerged and this within patient multi-centre comparative study will compare these new techniques between themselves and with current practice. We will evaluate the cost-effectiveness of adopting individual tests or combination of tests as triage tests compared with the current practice of diagnostic examination by an ophthalmologist in a secondary care setting.

Source of funding and total awarded: NIHR, HTA Programme, £368,857


Project phase:

24


Developing the intervention and outcome components or a proposed RCT screening for open angle glaucoma.

Investigators: J Burr, A Azuara-Blanco, M Campbell, J Francis, A Green, J Norrie, C Ramsay (HSRU, University of Aberdeen); L Vale (HERU/HSRU); RPL Wormald (Moorfield Eye Hospital); D Crabb (City University) and R Hernández (HERU)

Open angle glaucoma (OAG) is a common cause of blindness. Many people do not know they are developing OAG and miss out on the potential benefit of early treatment. Screening may be a good way to find and treat more people, but further knowledge is needed on whether it reduces the number of people losing vision compared with the current system of people choosing to attend for a sight test. To answer these questions we need a large, high quality research study, i.e. a randomised controlled trial (RCT). Before we can conduct a screening RCT we have to determine which screening tests should be evaluated, where testing should take place and who to include. We also need to know how best to measure benefits and harms of screening. We will seek the views of people who do and do not have glaucoma, as well as views of health care professionals involved in providing eye care services. The research includes the update of an economic model and a full cost-effectiveness analysis.

Source of funding and total awarded: Medical Research Council, £383,408


Project phase:

Development of practice-based pharmacist-led management of chronic pain in primary care for evaluation by a RCT.

Investigators: C Bond, P Hannaford, B Smith, M Watson, A Elliott (Primary Care, University of Aberdeen); P McNamee (HERU); A Lee (Population Health, University of Aberdeen) and R Holland (University of East Anglia)

The project is developing and testing a training package for pharmacists to ensure standardisation of the intervention; testing recruitment methods; estimating consent and participation rates; calculating response rates and effect sizes to inform future sample size calculations; confirming the most appropriate outcome measures and unit of randomisation; and interviewing pharmacists and GPs to ascertain feasibility and acceptability of the proposed intervention.

Source of funding and total awarded: Medical Research Council, £337,123


Project phase:

The effectiveness and cost-effectiveness of elective neck dissection in early oral cancer treatment.

Investigators: I Hutchison (Queen Mary, University of London); A Hackshaw (CRUK & UCL Cancer Trials Centre); I Martin (Sunderland Royal Hospital); K Piper (Queen Mary, University of London); G Thomas (University College London Hospital); K Webster, J Olliff (University Hospital Birmingham); A Korszun (Queen Mary, University of London) and M van der Pol (HERU)

In patients with early mouth cancer, the cancer often spreads to the lymph glands in the neck. Elective neck dissection is therefore increasingly performed at the time when the patient is treated for the early mouth cancer even though there is no evidence of neck metastases. The procedure is lengthy and expensive compared to resection of the tumour alone but may be cost-effective if it prevents the development of neck metastases that require further surgery and perhaps more radical treatments. 652 patients will be randomised to receive either resection of the primary tumour alone or resection with simultaneous selective neck dissection. The effectiveness is measured in terms of disease free survival and quality of life. A full cost-utility analysis is performed.

Source of funding and total awarded: CRUK, £799,186


Project phase:

25


Effectiveness of lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (EAGLE).

Investigators: A Azaura-Blanco, J Burr, C Ramsay, J Norrie (HSRU, University of Aberdeen); L Vale (HERU/HSRU); T Aung (Singapore National Eye Centre); P Foster (UCL); D Friedman (The John Hopkins Hospital); J Lai (United Christian Hospital); Da-Wen Lu (Tri-Services General Hospital); C Lui (Taipei Veterans General Hospital); W Nolan (Sandwell and West Birmingham Hospital); J See (National University Hospital); D Wong (University of Hong Kong) and Z Quayyum (HERU)

The study will determine the best way of surgically treating angle closure glaucoma, one of the main causes of blindness. The active group will have early lens extraction, i.e. cataract surgery. The control group will have standard care where laser treatment is used to open drainage but does not improve sight. The outcomes will be changes in quality of life; visual field; intraocular pressure; angle closure; need for additional medications; need for further surgery (trabeculectomy). The costs of the treatment and subsequent management for both interventions will be estimated and incremental cost per QALY gained calculated, employing EQ-5D. Approximately 18 specialist centres in the UK and six centres in East Asia (from Singapore, Malaysia, Hong Kong and Taiwan) are participating in this trial.

Source of funding and total awarded: MRC, £1,514,769


Project phase:

* Engaging with older people to develop and deliver interventions for the self management of chronic pain (EPIC).

Investigators: A Clarke, B Smith, P Schofield (University of Aberdeen); P McNamee (HERU); D Martin (Teesside University) and D Jones (Glasgow Caledonian University)

The overall aim of the study is to achieve a deeper understanding of the consequences of ageing with chronic pain and, through this, to develop innovative ways in which older people can possess the knowledge, skills and confidence to live independently at home in the presence of self-managed pain. Taking a multi-disciplinary approach which emphasises the interconnections between chronic pain, physical and emotional functioning, material resources and social aspects of the everyday lives of older adults, as played out in their particular social context and linked to their earlier biographies, the project is divided into five phases: 1. Investigation of the attitudes and approaches adopted by general practitioners, primary care teams, pain clinics and older adults towards pain management in older age; 2. Assessment of the acceptability, effectiveness and cost-effectiveness of self-management strategies; 3. Measurement of the economic consequences of pain in later life; 4. Development of working prototypes of new, innovative materials (e.g. written & audiovisual, including web-based resources) that help older adults to live with pain in the community; and 5. Exploration of effective and cost-effective ways to disseminate and deliver newly developed materials.

Source of funding and total awarded: MRC (LLHW Scheme), £1,058,605


Project phase:

An Evaluation of Patient Preferences for the Treatment of Localised Prostate Cancer.

Investigators: HU Ahmed, M Emberton (UCL) and V Watson (HERU)

Men with localised prostate cancer have to choose between active surveillance or radical therapy, which can entail a variety of treatment options from radiotherapy to surgery or minimally invasive interventions. This study, applies a discrete choice experiment to elicit men’s preferences for, and trade-offs between, the attributes of pre-treatment evaluation, treatment and post-treatment follow-up for several available treatments. The study also investigates how subject’s characteristics affect their treatment preference.

Source of funding and total awarded: UCL, £8,829


Project phase:

26


How do context and complexity influence responses to discrete choice experiments?

Investigators: V Watson (HERU)

The efficient provision of health care requires information about the costs and benefits of interventions. While many costs and benefits can be measured using market prices, many health care interventions are not traded in markets and consequently have no market price. In this instance, stated preference methods, such as DCEs, may be used to estimate the benefits. Few studies have compared hypothetical discrete choice experiment (DCE) responses to the equivalent real choices. Even when hypothetical choices and real choices are compared, it is impossible to conclude that choice differences result from the question type (hypothetical or real) and not preferences differences across the two groups. Techniques developed in the experimental economics can disentangle the influence of choice context from individuals’ preferences. Using induced value experiments, this project compares hypothetical and real DCE responses, estimates the magnitude of hypothetical bias, and considers if models of bounded rationality better explain responses to DCEs.

Source of funding and total awarded: University of Aberdeen, £5,400


Project phase:

How do people choose between self-care, supported self-care and GP consultation in minor illness?

Investigators: T Porteous, C Bond (Primary Care, University of Aberdeen) and M Ryan (HERU)

Increasing demand for health services in the UK means that traditional methods of supplying health care may no longer be appropriate. Government policies place increasing emphasis on self-care by individuals. It is, therefore, important to understand how people choose between self-care and consulting a health professional. Dr Porteous’ PhD investigated decision-making in the management of minor illness, using a mixed-methods approach. A discrete choice experiment was employed alongside interviews and a survey. Results suggested that whilst most people liked to use self-care to manage symptoms of minor illness associated with analgesic use, the relationship between self-care behaviour and factors influencing it is complex. Further, interventions that aim to improve self-care should focus on providing flexible support for those who need it. As part of the Fellowship the generalisability of this result is being investigated. The initial DCE was applied to flu-like symptoms, and has recently been repeated for three separate symptom scenarios of varying severity (diarrhoea, back pain and rectal bleeding). Successive members of an online panel were invited to participate until 480 discrete choice experiment questionnaires were completed. The data is currently being analysed.

Source of funding and total awarded: MRC/ESRC Interdisciplinary Postdoctoral Fellowship, £121,809

Amount of HERU funding: University of Aberdeen

Project phase:

Improving Maternal, Neonatal and Child Survival: A Partnership Approach to Achieve Millennium Development Goals in Bangladesh (BRAC).

Investigators: J Hussein, A Cumming (IMMPACT, University of Aberdeen); Z Quayyum (HERU); P Byass (Umea University, Sweden); Peter Nicholls (Southampton University); T Ensor (Oxford Policy Unit/IMMPACT) and M Leppard (Queen Margaret University)

BRAC, a large Bangladesh non-governmental organisation has initiated maternal, neo-natal and child survival interventions to support the effort of the government of Bangladesh in achieving two major millennium development goals relating to maternal and child health. The interventions of this five year project include improving, developing and strengthening maternal and child health services, particularly amongst poorer groups, and reducing financial barriers. The project includes evaluation of the impact of service development and reducing financial barriers by assessing changes in maternal health outcomes and costs.

Source of funding and total awarded: DFID, The Netherlands, and AUSAID, 746,600 US$


Project phase:

27


Improving the value of screening for diabetic macular oedema using surrogate photographic markers.

Investigators: J Olson, P Sharp, K Goatman (Biomedical Physics, University of Aberdeen); G Scotland, P McNamee (HERU) and G Prescott (Population Health, University of Aberdeen)

Macular oedema is associated with several conditions which cause irreversible vision loss, including diabetic retinopathy. Derived sensitivity/specificity estimates will be used to assess the costs and consequences (i.e. the number of appropriate/inappropriate ophthalmology referrals) of using alternative surrogate markers and patterns of surrogate markers for the detection of macular oedema using manual, computer assisted annotation and fully automated detection systems.

Source of funding and total awarded: NIHR HTA Programme, £387,364


Project phase:

INTERVAL Dental recalls trial (Investigation of NICE Technologies for Enabling Risk-Variable-Adjusted-Length Dental Recalls Trial) – a feasibility study and follow on.

Investigators: N Pitts, J Clarkson (Dental Health Services Research Unit); H Worthington (University of Dental Hospital of Manchester); J Norrie, C Ramsay (HSRU, University of Aberdeen); L Young (NHS Education Scotland); M van der Pol (HERU) and M Ross (University of Edinburgh)

A parallel-group randomised controlled comparison of three forms of dental recall strategies (6 month recall, risk-based recall, and 24 month recall), will evaluate the effectiveness and cost effectiveness of these dental recall strategies by assessing their impact on maintaining oral health. The risk-based recall strategy is exactly that advocated by recent NICE guidance – personalised variable intervals determined according to risk information derived from comprehensive oral health assessment and review. The two fixed-period recall strategies are the traditional six month intervals between routine check-ups or 24 month recall intervals between routine check-ups.



Project phase:

Investigating the validity of responses to stated preference experiments.

Investigators: M Ryan and V Watson (HERU)

This research builds on the body of work we have generated over almost 20 years. We aim to be at the forefront of research in this area. Building on previous work, we focus on three areas. The first continues to investigate respondents’ use of decision-making strategies when completing valuation tasks. Here we propose to use novel experimental economic methods. A second focus is on developing and applying behaviourally appropriate econometric methods to analyse CV and DCE responses. In particular, we will develop econometric models that can account for respondents’ preference uncertainty and (linking to the research area above) model non-compensatory, and non-maximising decision-making rules. Third, we aim to develop our work on external validity, using field and laboratory based experiments to assess whether individuals behave in reality as they state in hypothetical surveys. We are currently exploring possible external validity tests.

Source of funding and total awarded: University of Aberdeen

Amount of HERU funding: University of Aberdeen

Project phase:

28


* Maintained physical activity and physiotherapy in the management of distal arm pain.

Investigators: G Jones, G Macfarlane (University of Aberdeen); K Palmer (University of Southampton); D Coggon (University of Southampton); K Burton (University of Huddersfield); K Walker-Bone (Brighton and Sussex NHS Trust); S Lamb (University of Warwick); P McNamee (HERU) and A McConnachie (University of Glasgow)

Distal arm pain – pain in the elbow, forearm, wrist or hand – comprises a number of specific and non-specific conditions. It is common in people of working age and results in considerable lost work time, demand for health care and disability. The best approach to management is unclear and, in addition to physiotherapy, patients are often advised to avoid presumed harmful activities. While this may be sensible where there is clear disease of local tissues, an analogy can be drawn with non-specific low back pain which for many years was managed by bed rest, until trials demonstrated an improved prognosis if patients were advised to remain mobile. It seems plausible that distal arm pain might also benefit from such a plan of care. This randomised controlled trial and economic analysis tests the hypothesis that patients with distal arm pain who are advised to maintain usual activities while waiting to receive physiotherapy will experience improvements in function at no additional cost compared to those advised to rest the arm.

Source of funding and total awarded: ARC, £669,490


Project phase:

Managing unexplained symptoms (chronic widespread pain) in primary care: Involving traditional and accessible new approaches (MUSICIAN).

Investigators: G Macfarlane, G Prescott (Population Health); P Hannaford, A El-Metwally (Primary Care, University of Aberdeen); J Norrie (HSRU, University of Aberdeen) and P McNamee (HERU)

Chronic widespread pain (CWP) has a population prevalence of approximately 10% and is amongst the most common reasons for referral to a rheumatologist. Such patients use health services extensively, with one study estimating average six-month direct costs of approximately £1000. There is currently a lack of evidence regarding how best to manage patients who frequently present with CWP. A two by two factorial design randomised controlled study is being used to assess the effectiveness and cost-effectiveness of the alternative regimes.

Source of funding and total awarded: Arthritis Research Campaign (ARC), £376,406


Project phase:

Optimal Surveillance regimes for individuals with ocular hypertension (OHT): Modelling and economic evaluation.

Investigators: J Burr, A Azuara-Blanco, J Cook (HSRU, University of Aberdeen); J Deeks (University of Birmingham); DF Garway-Heath, RPL Wormald (Moorfields Eye Hospital NHS Foundation Trust); D Crabb (City University); R Perera, A Kotecha, P Glasziou (University of Oxford); L Vale (HERU/HSRU) and R Hernández, M Ryan (HERU)

Ocular hypertension (OHT) (raised intraocular pressure (IOP) >21mmHg), is one of the major risk factors for developing glaucoma, one of the main causes of blindness in the UK. It is also the only risk factor that can be treated. Treatment, usually in the form of eye drops, can reduce the risk of progressive disease. However, the dilemma is that OHT is much more common than OAG, and not everybody with it will develop glaucoma. This study will define a clinical guideline for determining whether monitoring people with raised IOP for signs of glaucoma is required, and if so how often testing should be offered to achieve the best balance of effectiveness (e.g. cases detected, blindness prevented) and efficiency. This will involve: expert and consumer opinions; population preferences; systematic reviews; individual patient data analysis (and possible meta-analysis) and decision analytic modelling. An economic model and a full economic evaluation will be developed as part of this project.



Project phase:

29


* Oral hygiene advice and scale & polish/periodontal instruments trial: Prevention in dental primary care.

Investigators: J Clarkson, D Bonetti, N Pitts (University of Dundee); C Ramsay, J Burr (HSRU, University of Aberdeen); H Worthington, C Jones, M Tickle (University of Manchester Dental Hospital); P Heasman, J Steele (University of Newcastle); L Young, I Madden, W McCombes (NHS Education for Scotland); P Hodge (University of Glasgow Dental School); M Ross (University of Edinburgh); D Ricketts, A Hall (Dundee Dental Care Hospital & School); P Averley (Queensway Dental Practice) and M van der Pol (HERU)

Periodontal disease is the most common oral disease affecting adults. This disease is preventable, yet it remains the major cause of poor oral health worldwide and is the primary cause of tooth loss in older adults. There is a lack of strong evidence to inform clinicians and policy makers of the relative effectiveness (if any) and cost-effectiveness of different types of oral hygiene advice (OHA). The economic evaluation conducted as part of this cluster randomised controlled trial will elicit the costs of dental care to both the NHS and patients and will equate these data with benefits to patients. Benefits to patients will be estimated using a discrete choice experiment administered to a sample of the general population which will provide a scoring algorithm with which to weight the outcomes of the patient participants of the trial.

Source of funding and total awarded: NIHR, HTA Programme, £2,766,377


Project phase:

* A pragmatic multi-centre randomised controlled trial comparing stapled haemorrhoidopexy to conventional excisional surgery for haemorrhoidal disease.

Investigators: AJ Watson (NHS Highland); M Loudon (Aberdeen Royal Infirmary); L Vale, L Ternent (HERU/HSRU); D Jayne (Leeds Teaching Hospitals NHS Trust); A Maw (Glan Clwyd Hospital); F Curran (Stepping Hill Hospital); S Brown (Northern General Hospital); J Cook, J Burr (HSRU, University of Aberdeen) and B Buckley (National University of Ireland)

In England in 2004/5, approximately 23,000 haemorrhoidal procedures were performed as hospital day-case or inpatient admissions, resulting in significant calls on health service resources. Stapled haemorrhoidopexy (SH) is a new alternative to conventional haemorrhoidectomy (CH). There have been multiple randomised controlled trials (RCTs) comparing SH with CH and these have been analysed in two recent systematic reviews and an HTA monograph. SH appears to be associated with less pain in the immediate postoperative period, but a higher rate of recurrence in the longer term and need for further surgery. However, these findings are based on data from small trials, all with methodological flaws, and providing limited data on utilities in the early postoperative period. The proposed RCT will compare SH with CH. The primary outcomes: 1) Health-related quality of life profile derived from EQ-5D; 2) Incremental cost per quality adjusted life year (QALY) at 2-years. Participants will be followed up at 2 years. The trial results will guide the decision about the optimum management of haemorrhoids.

Source of funding and total awarded: NIHR, £94,078


Project phase:

* Proposal for eliciting public preference in relation to national health insurance in South Africa.

Investigators: M Naidoo (Black Sash, South Africa); D McIntyre (Health Economics Unit, University of Cape Town, South Africa) and M Ryan (HERU)

The proposed introduction of a national health insurance (NHI) in South Africa is the most important issue currently on the health policy agenda, with implications for the whole health system. There has been almost no public engagement as yet around the principles that should underlie changes in the health care system or on associated critical and contentious areas of policy design. It is essential that the views of the relatively ‘voiceless’ majority are elicited and fed into the policy process. As the NHI process is already underway, public preferences should be fed into policy discussions as soon as possible. This study will employ a discrete choice experiment to inform policy makers. Focus groups discussions are currently taking place in provinces across South Africa (Western Cape, Northwest, Eastern Cape and Mpumalanga) to inform the attributes and levels within the DCE.

Source of funding and total awarded: University of Aberdeen

Amount of HERU Funding: University of Aberdeen

Project phase:

30


A prospective collaborative study of patients with intestinal segments transposed into urinary tract following surgery for bladder cancer or benign end stage bladder disease.

Investigators: J N’Dow, A Grant (HSRU, University of Aberdeen); L Vale (HERU/HSRU) and R Hernández (HERU)

Each year in the UK around 3000 people have major surgery because their bladders are seriously diseased or must be removed. This prospective study compares the various surgical options using transposed intestinal segments and establish sufficiently large observational cohorts to allow statistically reliable comparisons between the surgical procedures. Outcomes will be quality of life and requirements for other health resources at least up to one year after the index procedure. Approximately 600 patients will be recruited from ten hospitals in Great Britain.

Source of funding and total awarded: BUPA, £179,857


Project phase:

Randomised controlled trial comparing foam sclerotherapy, alone or in combination with endovenous laser therapy, with conventional surgery as a treatment for varicose veins.

Investigators: J Brittenden, K Cassar, P Bachoo (School of Medicine & Dentistry, University of Aberdeen); J Norrie (University of Glasgow); MJ Gough, IAD Mavor, J Scott (University of Leeds); P McCollum (University of Hull); IC Chetter (Hull NHS Trust); J Burr, M Campbell, C Ramsay (HSRU, University of Aberdeen) and L Vale, L Ternent (HERU/HSRU)

A randomised controlled trial comparing foam sclerotherapy, alone or in combination with endovenous laser therapy, with conventional surgery as a treatment for varicose veins. The study will involve participants from hospitals throughout the UK and in addition to clinical measures will seek to elicit NHS and patient costs and QALYs measured from responses to the EQ-5D and SF-36. Given the follow-up is six months, results will be extrapolated to a longer time horizon using an economic model.



Project phase:

The Scottish cervical cancer prevention programme: Assessing and modelling the impact of HPV 16/18 immunisation on the performance of current cervical screening performance and the effectiveness of alternative cervical screening strategies to optimise cancer prevention in the HPV immunisation era.

Investigators: M Cruickshank (University of Aberdeen); C Campbell (University of Edinburgh); Y Choi (Health Protection Agency); H Cubie (Lothian University NHS Trust); K Cuschieri (Edinburgh Royal Infirmary); M Donaghy (Health Protection Scotland); J Imrie (Monklands General Hospital); C Robertson (Health Protection Scotland & University of Strathclyde); F Sullivan (University of Dundee); P McNamee (HERU) and D Weller (University of Edinburgh)

The Scottish HPV vaccination programme started in 2008, with vaccination amongst all girls aged 12-13 years and a catch-up programme for 16-18 year olds in 2008 and 14-15 year olds in 2009. All of this population will be invited to participate in the Scottish Cervical Screening Programme at the age of 20 years. This study evaluates the performance of this Programme, by estimating predicted rates of cervical cancer among the vaccinated cohort, predicted rates of markers of cervical disease, numbers of colposcopies per year, and the cost effectiveness of different screening strategies.

Source of funding and total awarded: Scottish Government – CSO, £515,298


Project phase:

31


Screening for disorders of glucose in cystic fibrosis.

Investigators: N Waugh, P Royle (Population Health, University of Aberdeen); P Helms (Clinical Sciences, University of Aberdeen) and R Hernández (HERU/HSRU)

People with cystic fibrosis suffer damage to the pancreas that, over time, reduces their ability to produce insulin. In some patients, this progresses to diabetes. The onset of diabetes can be insidious, and it can cause damage before symptoms of diabetes occur and lead to diagnosis. There are a number of different screening tests, some less popular than others. The research will include a systematic review of the evidence, an economic evaluation using de novo economic modelling, and surveys of current practice and patients’ views.



Project phase:

Surgical Trial in Traumatic interCerebral Haemorrhage (STITCHT).

Investigators: D Mendelow (University of Newcastle); B Gregson (University of Newcastle); P Mitchell (University of Newcastle); A Unterberg (University of Heidelberg); E McColl (University of Newcastle); P McNamee (HERU) and I Chambers (South Tees NHS Trust)

At present it is known that patients with a bleed on the surface of the brain following a head injury benefit from urgent surgery but it is not known whether patients with a bleed inside the brain would also benefit from surgery or not. These patients have a poor outcome with between 30% and 60% being dead, vegetative or with severe disability at six months. Using a multi-centre randomised controlled design with economic analysis, this study will provide evidence for whether or not surgery is of benefit to patients at reasonable cost with a bleed or bruise inside the brain following a head injury.

Source of funding and total awarded: HTA via University of Newcastle, £2,328,920


Project phase:

* Technologies to support older people at home: maximising personal and social interaction – TOPS.

Investigators: D Godden, L Philip, P Schofield, P Edwards, J Farrington (University of Aberdeen); G Rodger (University of Highlands & Islands); F Williams (Institute of Rural Health, Wales); V Hanson (University of Dundee); P McNamee (HERU) and P Oliver, P Wright (University of Newcastle)

The role of new technologies in health and social care for older people is attracting increasing interest as part of government agendas for modernising public services across the UK. However, there is concern that such technology, if used to substitute for social care provision, will lead to detrimental effects due to loss of personal and social interaction with nurses and other community-based service providers. This study will determine the extent and nature of personal and social interaction between health and social care professionals and older adults with chronic pain, explore the impact of telecare and telehealth technologies on these personal and social interactions for older adults experiencing chronic pain, and integrate understanding of social and personal interactions into the design and application of technologies for the management of chronic pain.

Source of funding and total awarded: RCUK Digital Economy Research, £92,569


Project phase:

32


Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multi-centre randomised controlled trial of antibiotic and antiseptic impregnated urethral catheters (The Catheter Trial).

Investigators: J N’Dow (School of Medicine, University of Aberdeen); A Grant (Institute of Applied Health Sciences, University of Aberdeen); J Norrie, C Glazener (HSRU, University of Aberdeen); R Pickard, K Orr (University of Newcastle upon Tyne); B Buckley (Galway); L Vale (HERU/HSRU); T Lam (Department of Urology, Aberdeen Royal Infirmary) and M Kilonzo (HERU)

The study design is a multi-centre randomised controlled trial testing three short-term urinary catheter policies in a range of high-volume clinical settings. The study includes adult patients (≥16 years of age) requiring urethral catheterisation (expected to be required for a maximum of two weeks), in pre-selected units with a high volume of short-term catheterisation. There will be two experimental groups managed with: (a) silver alloy impregnated hydrogel urethral catheter (b) nitrofurazone impregnated silicone urethral catheter. There will be one control group managed with a PTFE coated latex urethral catheter – the ‘standard’ control. The primary clinical outcome will be incidence of symptomatic urinary tract infection up to six weeks post catheter insertion (number of participants with at least one occurrence) and the economics one will be incremental cost per infection averted and QALYs gained, using the EQ-5D measured over a six week follow-up period.



Project phase:

* (SUSPEND) Use of drug therapy in the management of symptomatic stones in hospitalised adults: multi-centre placebo controlled randomised trial of calcium channel blockers (nifedipine) and alpha blockers (tamsulosin).

Investigators: S McClinton, J N’Dow, J Burr, G MacLennan, K Schumm, R Thomas (University of Aberdeen) and M Kilonzo (HERU)

1 in 8 adults are affected by urinary stones with 50% having a recurrence within 5 years resulting in significant calls on health service resources. Two recent meta-analyses have reported a potential role of alpha blockers and calcium channel blockers in facilitating ureteric stone passage. However, the quality of included trials was poor and there was insufficient evidence that they were cost-effective. The proposed three-group placebo controlled randomised trial will compare the use of an alpha blocker (tamsulosin), a calcium channel blocker (nifedipine) and placebo. All three tablets will look identical. Primary outcome is passage of stone. The hypothesis being tested is that use of either nifedipine or tamsulosin will result in an absolute increase in stone free rate of 15% relative to placebo and that there is an absolute difference of 10% in stone free rate between calcium channel blockers (nifedipine) and alpha blockers (tamsulosin).

Source of funding and total awarded: Department of Health – HTA, £1,439,954


Project phase:

33


What healthcare experiences matter to patients and how can we assign value to them for policy making purposes?

Investigators: M Ryan (HERU); J Francis, C Fraser (HSRU, University of Aberdeen) and V Entwistle (Social Dimensions of Health Institute, University of Dundee)

Many aspects of healthcare experience are important to patients, and for reasons beyond their impact on health. This suggests that health state outcomes should not be the only factors considered in evaluations of healthcare interventions and services. The importance of patients’ experiences is increasingly recognised in policy documents. This project has two stages: (i) Identify and characterise aspects of health care experience that matter to people (presented as a conceptual map); (ii) review methods which could potentially be used to value (quantitatively) patient experiences and identify cases in which this has been done. Finding from Stage 1, developing a conceptual map, highlights the emphasis that patients place on the ways in which healthcare can support (or undermine) their capability to flourish – within as well as beyond healthcare encounters. Our review of valuation methods identified several that are, in principle, capable of providing a quantitative value of patient experiences, but their application to the range of aspects of patient experiences highlighted on the conceptual map is challenging. One challenge is ensuring that the scenarios presented to respondents in valuation tasks are plausible and acceptable. We are currently reviewing the valuation of patient experiences. Initial results suggest that a broad range of ‘process attributes’ have been included within previous valuation exercises. These may have important implications for patients’ capabilities, but are not always simply and directly related to these.

Source of funding and total awarded: MRC, £237,671


Project phase:

34


PEAT – Projects Completed in 2010

The clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer.

Investigators: F Gilbert (Clinical Services, University of Aberdeen); L Vale, L Ternent (HERU/HSRU); JM Dixon (Western General Hospital); SE Pinder, ARM Wilson (King’s College London); G MacLennan, R Thomas, C Fraser, J Burr (HSRU, University of Aberdeen); RW Blamey (Nottingham City Hospital) and SD Heys (University of Aberdeen)

Large numbers of women each year undergo treatment for breast cancer and many of these need long term surveillance to identify if new cases of cancer or recurrences. Currently, while much surveillance is conducted mammographically there is variation in how frequently these mammograms are performed and in how many years women are followed. This evaluation examined the clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer in the UK in primary and secondary care settings. It used a combination of systematic reviews of diagnostic performance and relative effectiveness; patient level analysis of large registry data sets collected in different regions of the UK and cost-effectiveness modelling.

Source of funding and total awarded: National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme, £241,532


Project phase:

Conservative treatment for urinary incontinence in Men after Prostate Surgery (MAPS).

Investigators: C Glazener, A Grant, C Ramsay, J Norrie, J N’Dow (HSRU, University of Aberdeen); L Vale (HERU/HSRU); M Kilonzo (HERU); G Dorey (University of West England); S Hagan (Nursing Research Initiative) and K Moore (University of Alberta)

The study involved two contemporaneous, but separate multi-centre randomised controlled trials (following radical prostatectomy or endoscopic resection), each with two parallel groups. Men were recruited from about 34 UK hospitals. The men in the intervention groups received a physiotherapist or continence nurse assessment of their symptoms at about six weeks after surgery. Men in the control groups only received supportive lifestyle advice by post after randomisation. NHS and personal costs were estimated for every participant. Outcomes were subjective continence at 12 months and QALYs based on responses to the EQ-5D administered at baseline 3, 6, 9 and 12 months. Additional information to policy makers was derived from a simple economic model that considered what difference in continence rates would result in change in the conclusions about which treatment would be cost-effective.



Project phase:

Cost effectiveness of exercise training in older patients with heart failure.

Investigators: M McMurdo, M Witham, AD Struthers (Ninewells Hospital & University of Dundee); D Johnston (University of Aberdeen); C Lang (Ninewells Hospital & University of Dundee) and M van der Pol (HERU)

Whilst exercise training is known to be beneficial in younger people with heart failure, this evidence is not applicable to typical patients who are older. A 112 patient two arm randomised trial was conducted to evaluate the effectiveness and cost-effectiveness of exercise training in older patients with heart failure. The exercise training program comprised of eight weeks of twice per week therapist-led supervised small group intermittent functional aerobic exercise and strength training, with the duration of sessions gradually increased to 60 minutes. This was followed by a 16 week home-based exercise phase which will include self-monitoring and telephone instruction and encouragement from the therapist. The results showed that the exercise training was not effective and also not cost-effective.



Project phase:

35

PEAT – PROJECTS COMPLETED 2010

* Denosumab for the prevention of osteoporotic fractures in post-menopausal women (Single Technology Assessment for NICE).

Investigators: N Waugh, P Royale (University of Aberdeen); G Scotland, P McNamee (HERU); R Henderson (Highland Health Board) and R Hollick (NHS Grampian)

This project was carried out as part of the National Institute for Health and Clinical Excellence (NICE) Single Technology Appraisal Process. The manufacturer of denosumab (Amgen UK Ltd) submitted an evidence review and an economic model assessing cost-effectiveness of denosumab against a range of treatment comparators. The Aberdeen HTA group were commissioned to act as the Evidence Review Group (ERG) for the project, and to provide an independent report reviewing the manufacturer’s evidence submission. Following the ERG report, denosumab was recommended by NICE as a treatment option for the primary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures, and only amongst those unable to tolerate or comply with oral bisphosphonates, or where their use is contraindicated.

Source of funding and total awarded: Department of Health, £146,640


Project phase:

Eltrombopag for the treatment of chronic idiopathic (immune) thrombocytopenic purpura (ITP): A Single Technology Appraisal.

Investigators: D Boyers (HERU); X Jia, D Jenkinson, C Fraser, G Mowatt (HSRU, University of Aberdeen); M Crowther (Department of Haematology, Aberdeen Royal Infirmary) and L Vale (HERU/HSRU)

This project was carried out as part of the National Institute for Health and Clinical Excellence (NICE) Single Technology Appraisal Process. The manufacturer of eltrombopag (GlaxoSmithKilne ltd.) submitted an evidence review and an economic model assessing cost-effectiveness of eltrombopag against a range of treatment comparators for two distinct treatment scenarios (Watch and Rescue care and long-term treatment of ITP) in two patient groups (splenectomised patients and non-splenectomised patients). The Aberdeen HTA group were commissioned to act as the Evidence Review Group (ERG) for the project, and to provide an independent report reviewing the manufacturer’s evidence submission.



Project phase:

Imatinib at escalated doses of 600 mg/day or 800 mg/day for the treatment of people with unresectable and/or metastatic gastrointestinal stromal tumours whose disease has progressed on treatment with Imatinib at a dose of 400 mg/day: systematic review and economic evaluation.

Investigators: J Hislop, G Mowatt (HSRU, University of Aberdeen); L Vale (HERU/HSRU) and Z Quayyum (HERU)

The study provided evidence on clinical and cost-effectiveness of using Imatinib at an escalated dose of 600 mg per day or 800 mg per day to treat patients with GISTs, compared with treating them with Sunitinib and best supportive care. An economic model was developed to compare the cost-effectiveness and cost-utility of use of Imatinib at a dose of 600 mg per day or 800 mg per day, or use of Sunitinib, or best supportive care only, for treating people with unresectable gastrointestinal tumours (GISTs). The model was based on insufficient effectiveness data. The economic evaluation determined the incremental cost per quality adjusted life year (QALY) gained with escalated doses of imatinib.

Source of funding and total awarded: Technology Assessment Review (TAR) contract, £146,640

Amount of HERU funding: TAR contract, £22,093

Project phase:

36


Investigation of the value placed on the National Clinical Assessment Service services by referrers in the National Health Service.

Investigators: V Watson, M Ryan (HERU) and J Sussex, E Tetteh (Office of Health Economics)

In 2008 around 800 performance concern cases were referred to the attention of the NHS National Clinical Assessment Service (NCAS) from all parts of the UK. These cases required NCAS support, which ranges from phone advice to major and multidimensional assessment with the possibility of suspending or excluding the health care professional. A ‘mixed methods’ approach was used to investigate NHS organisations preferences for the services provided by NCAS. The study combined interviews, discussion groups and a DCE. The discussion groups explored which aspects of the services provided by NCAS are important and why, and the discussion groups were used to identify drivers of preference heterogeneity for NCAS services. The focus groups and discussion groups informed the DCE, which was administered during 2010. The final report was published in June 2010 by NCAS.

Source of funding and total awarded: National Patient Safety Agency (NCAS) via the Office of Health Economics, £78,200


Project phase:

* Pazopanib for the first line treatment of patients with advanced and/or metastatic renal cell carcinoma: A Single Technology Appraisal.

Investigators: M Kilonzo (HERU); L Vale (HERU/HSRU); J Hislop, A Elders, C Fraser, G Mowatt (HSRU, University of Aberdeen); D Bissett (Department of Clinical Oncology, Aberdeen Royal Infirmary) and S McClinton (Department of Urology, Aberdeen Royal Infirmary)

Kidney cancer caused 3,848 deaths in the UK in 2008. It is the seventh most common cancer in men, 5165 new cases were diagnosed in 2007. Until 2009 the only licensed treatments available to NHS patients with metastatic kidney cancer were IFN and interleukin-2. The benefits of these are believed to be modest. Pazopanib hydrochloride (GlaxoSmithKline) is an oral multi-targeted kinase receptor inhibitor with anti-tumour activity. Pazopanib inhibits vascular endothelial growth factor receptor (VEGFR) -1, -2 and -3, platelet-derived growth factor receptor (PDGFR), and c-kit, which may result in inhibition of angiogenesis in tumours in which these receptors are upregulated.

The project appraised the clinical and cost effectiveness of pazopanib within its licensed indication for the first-line treatment of advanced and/or metastatic renal cell carcinoma. This involved reviewing the clinical and cost effectiveness of the technology based on a review of the Manufacturer Evidence Submission. Additional analysis was also carried out to assess the cost effectiveness of Pazopanib.



Project phase:

Pragmatic multi-centre randomised trial (1) routing postoperative ICU care and/or (2) pre-operative fluid loading in high risk surgical patients undergoing major elective and urgent surgery (FOCCUS).

Investigators: B Cuthbertson, M Campbell, J Norrie, A Grant (HSRU, University of Aberdeen); S Stott (ICU, Aberdeen Royal Infirmary); L Vale (HERU/HSRU); J Brittenden (Vascular Surgery, Aberdeen Royal Infirmary) and J Kinsella (Anaesthesia, University of Glasgow)

In Scotland about 4,500 patients die each year around the time of surgery. Because of a lack of critical care facilities, patients usually receive post-operative care in either the general surgical ward environment or a ward-based surgical HDU. This study was an economic evaluation as part of a multi-centred randomised trial to evaluate both the roles of (a) high dependency care versus intensive care in the post-operative period after high-risk major surgery and (b) pre-operative fluid loading, using a 22 factorial design.



Project phase:

37

PEAT – PROJECTS COMPLETED 2010

Prognosis and management of intercranial vascular malformations and non-traumatic intracerebral haemorrhage in adults.

Investigators: A-S Rustam (University of Edinburgh) and P McNamee (HERU)

Intracranial vascular malformations (IVMs) are responsible for over one third of spontaneous (non-traumatic) intracerebral haemorrhage (ICH) in young adults, making them the leading cause in this age group. Therefore, IVMs are likely to be directly costly to the NHS (prolonged and repeated inpatient stays in acute and rehabilitation sectors) and indirectly costly to society (loss of productivity). This study assessed the scale of both sets of costs, using responses from a national population-based cohort.

Source of funding and total awarded: Medical Research Council Clinical Fellowship via University of Edinburgh, £575,105


Project phase:

Scottish multi-centre trial of glutamine and selenium supplemented parenteral nutrition for critically ill patients (SIGNET trial).

Investigators: P Andrews (University of Edinburgh); A Avenell, M Campbell (HSRU, University of Aberdeen); B Croal, D Noble, W Simpson (NHS Grampian); F MacKirdy (Scottish Intensive Care Audit); L Vale (HERU/HSRU) and M Kilonzo (HERU)

Intensive care unit (ICU) and subsequent hospital mortality are high, and infections in ICU are associated with a two-three times increased risk of death. Systematic reviews suggest that supplementing parenteral nutrition (PN) in critical illness with glutamine or selenium may reduce infections and mortality. Three different strategies were evaluated in this randomised controlled trial: glutamine supplement, selenium supplement, and both glutamine and selenium supplements. A pilot study with 20 participants evaluated recruitment procedures, data collection procedures and delivery of trial materials. 500 patients were recruited to the main trial. The primary outcomes were length of stay, mortality and episodes of sepsis. Secondary outcomes included antibiotic usage, quality of life and cost-effectiveness. Data collection was facilitated by the involvement of the Scottish Intensive Care Society (SICS) audit.

Source of funding and total awarded: MRC, £968,152


Project phase:

38


BHHS – Projects in Progress at the end of 2010

* Avoidable cost of alcohol project.

Investigators: U-G Gerdtham, CH Lyttkens, J Jarl (Lund University); P Lundborg (Vrije Universiteit Amsterdam); A Ludbrook (HERU) and D Petrie (University of Dundee)

Swedish data are used to estimate the avoidable costs associated with feasible reductions in future alcohol use. Estimates will consider impacts on different groups, for example by age and gender. An Excel simulation model will be developed to allow for estimates to be updated easily.

Source of funding and total awarded: Swedish Research Council, £115,713.00

Amount of HERU Funding: CSO CORE

Project phase:

* BeWel the impact of a body weight and physical activity intervention on adults at risk of developing colorectal adenomas.

Investigators: A Anderson, J Belch, F Daly, R Steele, S Treweek (University of Dundee); M Stead (University of Stirling); A Kirk (University of Strathclyde); J Wardle (University College London); J Thomson (NHS Tayside) and A Ludbrook (HERU)

The study will assess the effectiveness and cost-effectiveness of the intervention in preventing colorectal cancer. The economic analysis will take the form of a cost-consequence analysis (CCA). The analysis will be undertaken from both an NHS and societal perspective. For interventions that require individual behaviour change to be successful, it is particularly important to consider the costs and benefits from the perspective of individual participants and their families. These will be explored in the context of the CCA and in more depth in the post-intervention interviews. CCA also allows for a very flexible presentation of results in contexts where there is more than outcome of interest.

Source of funding and total awarded: MRC/NPRI (3), £1,167,404


Project phase:

Data Envelopment Analysis: an application to investigate differences in performance in NHS Scotland.

Investigators: S Farrar (HERU); M Tavakoli (University of St. Andrews) and M Rosko (Widener University, USA)

Hospital performance in Scotland is usually measured using uni-dimensional approaches, e.g. cost per case, length of stay. These can be useful indicators. However, because hospitals are multi-dimensional in their output this rarely captures an overall picture of how efficiently a hospital is functioning. This study will investigate the application of a multi-dimensional approach to measuring hospital efficiency in Scotland: data envelopment analysis. This is a non-parametric method of measuring efficiency in organisations, most commonly used where the relative efficiency of a small number of organisations (such as hospitals in Scotland) is being analysed. We will explore the usefulness of such measures for the Scottish Government Health Directorates in their assessment of hospital and NHS Board performance.

Source of funding and total awarded: CSO Core

Amount of HERU Funding: CSO Core

Project phase:

39

BHHS – PROJECTS IN PROGRESS AT THE END OF 2010

Economic Analysis of dietary and physical activity behaviours: Consequences for obesity interventions (MRC Capacity Building PhD).

Investigators: F Becker, A Ludbrook and B Eberth (HERU)

Diet and physical activity are two of the five key risk factors being addressed to improve health in the UK. The evidence base relating to the effectiveness and cost-effectiveness of public health interventions designed to influence such behaviours is weak. In other lifestyle behaviours, such as smoking and alcohol, empirical models of behaviour based on secondary data have been developed. Studies have considered models of single lifestyle behaviours with varying concentration on the roles of prices, information, regulation and peers. With respect to diet and physical activity there has been less research and this thesis will study individuals’ combined diet and physical activity behaviours, the factors influencing those behaviours and their responses to changes in the choice factors, using a range of data sources. The behaviour model developed will be used to estimate the impact of potential policy interventions. Particular attention will be given to differences in behavioural responses for different social groups.

Source of funding and total awarded: MRC Capacity Building PhD Studentship and University of Aberdeen, £58,645


Project phase:

Economic Appraisal of the choice and targeting of lifestyle interventions to prevent disease in deprived populations.

Investigators: MD Smith, A Ludbrook (HERU); L Vale (HERU/HSRU); P Boyle (University of St. Andrews); D Stockton (ISD) and P Craig (Scottish Government Health Directorates)

The likelihood that conditions such as heart disease, cancers, diabetes and strokes will occur can be affected by the lifestyles that we adopt – such as smoking, over eating, not taking enough exercise, etc. We aim to provide information for policy-makers, the NHS and individuals about which interventions to change unhealthy behaviours are effective, as well as cost-effective. Such information will assist in making decisions about how best to use the limited resources available to improve the health of the nation. The idea is that the consequences (in terms of ill health and costs) of different types of lifestyle are affected by an individual’s personal circumstances and the environment in which they live. It is these factors that either promote or provide barriers to an individual changing their behaviour.

The main research questions to be addressed are: the contribution of different lifestyle factors to the ill-health and mortality from CHD, cancer, stroke and diabetes that might be prevented; how this preventable ill-health varies between different areas and different social groups who differ in the amount of deprivation they suffer; and the relative costs and benefits of alternative ways of changing behaviour and their impacts on health inequalities.

Source of funding and total awarded: Medical Research Council, National Prevention Research Initiative, £261,319


Project phase:

An evaluation to assess the effectiveness of “Quit 4 U” a smoking cessation service in Dundee combining financial incentives and behavioural support.

Investigators: C Martin, R Armstrong (Scottish Centre for Social Research); A Amos (University of Edinburgh) and M van der Pol, A Ludbrook (HERU)

The uptake of smoking cessation services by smokers living in relatively deprived areas tends to be low. NHS Tayside is introducing a new scheme where smokers are paid a financial incentive if the participant is verified as smoke-free. This study will assess the effectiveness and cost-effectiveness of supplementing standard smoking cessation services with financial incentives. The effectiveness of the intervention is assessed using the ISD minimum dataset on smoking cessation services.

Source of funding and total awarded: NHS Health Scotland, £135,000


Project phase:

40


EVEREST – Explaining the Variation in Epidemiology of RRT outcomes through Expert opinion, Secondary data sources and Technology adoption.

Investigators: FJ Caskey (North Bristol NHS Trust, University of Bristol); AM MacLeod (School of Medicine & Dentistry, University of Aberdeen); K Jager (European Renal Association, Amsterdam) and R Elliott (HERU)

The EVEREST Study is an international collaborative project involving nephrologists, epidemiologists and health economists in different countries aiming to examine how much of the variation in RRT incidence is explained by economic and organisational factors rather than medical factors. Having collected information on the organisation of healthcare systems and delivery of renal services, EVEREST will be able to quantify the influence of non-medical factors on RRT incidence independent of population need. Analyses will also identify the characteristics of healthcare systems and renal services that are most strongly associated with higher rates of RRT, information that will be relevant to policy makers in all countries, especially those in countries with developing economies.

Source of funding and total awarded: ERA-EDTA Registry, Amsterdam Medical Centre, £16,000


Project phase:

* An Examination Of Changes Introduced in The Quality And Outcomes Framework in 2006/07 And Their Effects On The Delivery Of Primary Care In Scotland.

Investigators: A Ma, D Skåtun (HERU); M Sutton (University of Manchester); B Guthrie (University of Dundee) and H Gravelle (University of York)

The Quality and Outcomes Framework (QOF) was introduced in 2004 across the UK National Health Service. It is an expensive and elaborate performance related pay scheme for general practices. All participating practices report their achievements on almost 150 quality indicators to receive a performance-related bonus that could increase their income by up to 25%.

Most of the quality indicators are related to clinical diagnosis and treatment. Rewards increase linearly with the proportion of patients treated to provide an incentive to practices to treat more patients up to a maximum threshold. Changes in the reward structure were introduced in 2006/7, 2007/8 and 2009/10.

Using data from 1,000 practices in Scotland and 8,000 in England, we will examine how general practices responded to these changes. We will model treatment rates in later years as functions of earlier years’ treatment rates and changes to the reward functions across the years. This will inform future adjustments to the QOF.

Source of funding and total awarded: The Scottish Government – CSO, £49,132


Project phase:

* Feasibility Study of Use of Direct Payments for Informal Care.

Investigators: A Ludbrook and P McNamee (HERU)

The study involved a review of relevant literature to inform the design of a questionnaire for older people and their carers or potential carers. The questionnaires aims to collect a range of information about older people and their carers and to relate these to their attitudes towards the use of direct payments and how it would affect the supply of care.

Source of funding and total awarded: SCPHRP (CSO), £19,737


Project phase:

41


* Impact of revalidation on the clinical and non clinical activity.

Investigators: B Frier, E Tait, C Pottinger (RCPE); D Skåtun, D Ikenwilo (HERU); G Youngston, A Rooney (RCSEd); R Nothcote (RCPSG); I Starke (RCPL); C Dodds (RCoA); B Cunliffe, K Rodgers (NHS North East) and F French (NES/ISD)

Using a survey, the project aims to achieve a greater understanding of how consultants (and SAS doctors) currently use their time across the variety of activities they undertake. It will elicit the priority given by doctors to different SPA activities (including the current appraisal system) through two methods. The first is the actual time spent in activities (given their current job plan) and the second through a discrete choice experiment using hypothetical scenarios.

Source of funding and total awarded: The Royal College of Physicians of Edinburgh, £110,622


Project phase:

Improving the efficient and equitable care of patients with chronic medical conditions interdisciplinary chronic disease collaboration (ICDC).

Investigators: B Hemmelgarn, BJ Manns (University of Calgary); MA Tonelli, S Bowen, A Timothy, TA Caulfield, JA Johnson, SW Klarenbach, FA McAlister, RC Plotnikoff, RT Tsuyuki (University of Alberta); D Gordon (University of Alberta Hospital); NR Campbell, KM King, L McLaren, K McLaughlin (University of Calgary); RZ Lewanczuk, P Sargious, S Viner (Alberta Health Services); D Huserau (Canadian Agency for Drugs & Technologies in Health); C Sanmartin (Statistics Canada); SE Straus (University of Toronto); MW Rosenberg (Queen’s University) and M van der Pol (HERU)

Obesity, smoking, physical inactivity, and an aging population have contributed to an epidemic of high blood-pressure, diabetes, kidney disease, and vascular disease. These chronic conditions, which often occur together, are major causes of death and disability. Effective treatments exist but many patients do not adhere to the prescribed treatment and or their lifestyle choices reduce the effectiveness of the treatments. The economics component of this study will investigate the correlation between individuals’ time preference and risk attitude and lifestyle choices and treatment adherence. This will provide insights into how to increase the effectiveness of care.

Source of funding and total awarded: Alberta Heritage for Medical Research, CAD $5,854,920


Project phase:

The intergenerational transfer of eating habits, physical activity, behaviour and body composition: Evidence from the UK. (MRC Early Career Fellowship).

Investigators: H Brown (HERU)

Following the award of a PhD, this postdoctoral fellowship allows the development of peer reviewed papers from the PhD, as well as research skills in the area of social interactions. Further research will be conducted on the intergenerational transfer of BMI and lifestyle characteristics using the Panel Study of Income Dynamics. The research will attempt to disentangle the family effects from the neighbourhood effects. The analysis will control for time invariant individual and family effects as well as neighbourhood characteristics.

Source of funding and total awarded: ESRC/MRC/NIHR Early Career Fellowship, £127,308


Project phase:

42


* Investigating the Glasgow effect.

Investigators: D Walsh, R McLaughin, C Tannahill (Glasgow Centre for Population Health); G McCartney (NHS Health Scotland); P Hanlon (University of Glasgow) and M van der Pol (HERU)

The ‘Scottish Effect’ (and more recently, the ‘Glasgow Effect’) are terms that have been coined in recent years to describe the excess levels of poor health experienced in Scotland (and, particularly, Glasgow) in comparison to other parts of the UK over and above that explained by higher levels of socio-economic deprivation. The causes of this ‘effect’ are unknown. The aim of the project is to carry out a population survey in three cities of the UK (Glasgow, Liverpool and Manchester) to gather new data on three potential explanations for Glasgow’s relatively poorer health profile. The three hypotheses are:

1. that individual values are different in Glasgow to those in Liverpool and Manchester (e.g. Glaswegians have a different psychological outlook to others, in terms of their aspirations or ‘time preferences’ (and related levels of, and attitudes to, risk-taking);

2. that there are lower levels of social capital in Glasgow;

3. that Glasgow’s poor health derives from particular Thatcherite policies of the late 1970s/1980s (the ‘political attack’ hypothesis)



Project phase:

Local Evaluation of Keep Well in Aberdeen City Community Health Partnership.

Investigators: A Ludbrook (HERU) and F Douglas (Population Health, University of Aberdeen)

The Keep Well programme is a Scottish Government funded initiative to increase the rate of health improvement in deprived communities by enhancing primary care services to deliver anticipatory care to those aged 45-64; identifying and targeting those at particular risk of preventable serious ill-health (including those with undetected chronic disease); offering appropriate interventions and services to them; and providing monitoring and follow-up. The local evaluation of Keep Well is addressing service redesign and sustainability, as well as value for money issues.

Source of funding and total awarded: NHS Grampian, £41,009


Project phase:

NHS staff skills mix and local labour markets: the role of reward structures, shortages and competition in determining the mix of the NHS workforce.

Investigators: J-B Combes, R Elliott and D Skåtun (HERU)

The NHS has undergone rapid changes in recent years. These have had a significant impact on the pay and work of all major staff groups in the NHS including medical and nursing staff. The drivers of change include the new consultant contract and the introduction of Agenda for Change – the new system of pay for all non-medical staff. These changes come at a time when there are shortages of staff in some areas of the country. Research already undertaken has revealed how local labour market conditions impact on the NHS workforce. Health providers faced with staff shortages but unable to adjust pay, as a means of alleviating the shortage, will find alternative ways of resolving the problem. One way is to adjust skill-mix, to change the relative contributions of health professionals by workforce restructuring. This study will examine how changes in skill-mix may impact on service delivery and patient outcomes.

Source of funding and total awarded: Medical Research Council Capacity Building PhD Studentship, £59,863


Project phase:

43


* Screening and Brief Interventions for Alcohol Misuse Delivered in the Community Pharmacy Setting: A Pilot Study.

Investigators: M Watson (University of Aberdeen); D Stewart (Robert Gordon University) and A Ludbrook (HERU)

The economic component of this study focuses on the identification of cost and resource issues that will be important in developing a full trial. The main factors are delivery costs in the pharmacy and the opportunity cost of pharmacist time.



Project phase:

Smarter choices, smarter places programme.

Investigators: J Anable, D Haldane, J Nelson (School of Geosciences, University of Aberdeen); J Parker (Integrated Transport Planning Ltd) and A Ludbrook (HERU)

In August 2008 the Scottish Government announced a programme of ‘Sustainable Travel Demonstration Communities’ to showcase ways of saving people money, improving their health, building stronger communities and improving the environment. This project aims to evaluate the impacts. The health economics component focuses on increases in physical activity directly or indirectly associated with the programme and the impact of these on health.

Source of funding and total awarded: Scottish Government, £738,863


Project phase:

* Socioeconomic inequalities in health and behaviour: Application of novel approaches to identify health inequalities in Scotland and England to inform policy.

Investigators: B Eberth, A Ludbrook (HERU); R Hernández (HERU/HSRU) and U-G Gerdtham (Lund University)

Reducing health inequalities is a major focus of the Scottish Government. Understanding the mechanisms that generate health inequalities requires an in depth understanding of the underlying determinants. Health behaviours and their associated socio-economic inequalities are viewed here as health inequality determinants. The project aims to understand how and to what extent health behaviours and socio-economic inequalities in health behaviours are a mediating factor in health inequalities. It further aims to provide new evidence on the mechanisms by which health inequalities are generated by investigating the determinants of health behaviours and health behaviour inequalities and how they contribute to overall health and health inequality across the population and additionally across specific geographic areas. The analysis will simulate policy interventions through the socio-economic health behaviour inequality determinants and through changes in the distribution of the health behaviours themselves.

Source of funding and total awarded: The Scottish Government – CSO, £94,311


Project phase:

Telemetric support self-monitoring of long term conditions.

Investigators: B McKinstry, W MacNee, A Sheikh, C Pagliari, H Pinnock, S Wild, C Sudlow (University of Edinburgh); P Padfield, J McKnight (Lothian Health); J Hanley (Napier University); S Auld (Scottish Centre for Telehealth); D Kelly (NHS Lothian) and M van der Pol (HERU)

The aim of this programme grant is to assess the effectiveness and cost-effectiveness of telemetry systems in a range of long term conditions. Four different trials are conducted, one for each of the following conditions: Uncontrolled high blood pressure in patients who do not have diabetes, kidney problems or previous stroke; uncontrolled blood pressure in patients who have had strokes; patients with chronic obstructive pulmonary disease; patients with several uncontrolled conditions (diabetes/blood-pressure/obesity).

Source of funding and total awarded: CSO NHS Applied Research Grant, £930,277


Project phase:

44

APPENDIX 1 – PROJECTS IN PROGRESS AND COMPLETED IN 2010APPENDIX 1 – PROJECTS IN PROGRESS AND COMPLETED IN 2009

Testing the Validity of Discrete Choice Experiment Responses for Predicting Workforce Behaviour.

Investigators: D Skåtun, B Eberth (HERU) and M Sutton (University of Manchester)

This study investigates whether employment behaviour can be predicted using stated preferences. Using data on consultant’s behaviour from survey data in 2001 and 2006, we examined whether stated preference data eliciting valuations of job characteristics using discrete choice experiments are validated by changes in employment behaviour. Analysis is currently being extended to explore the use of alternative econometric analysis to gain a deeper understanding of sources of preference heterogeneity in consultant’s preferences for contract characteristics.



Project phase:

Time preference for future health events.

Investigators: E Gray, M van der Pol (HERU) and E Phimister (Department of Economics, University of Aberdeen)

The aim of this thesis is to increase our understanding of individuals’ preferences for future health events in order to inform discounting practices in economic evaluation and analyses of health behaviours. Issues to be explored are the validity of stated preference methods to elicit time preferences and the relationship between time preference and health behaviours.

Source of funding and total awarded: MRC and Division of Applied Health Sciences, University of Aberdeen, £41,928 and £12,719 respectively


Project phase:

45

BHHS – PROJECTS COMPLETED IN 2010

BHHS – Projects Completed in 2010

Economic aspects of alcohol: pricing and taxation.

Investigators: A Ludbrook, L McKenzie (HERU) and D Petrie (University of Dundee)

Various approaches to alcohol pricing have been proposed, including minimum pricing per unit of alcohol, increases in current duty rates and restrictions on below cost selling. This project considered the economic impacts and equity effects of alternative approaches and also considered the comparative effectiveness of non financial interventions.


Amount of HERU funding: CSO Core

Project phase:

An economic evaluation of obesity problems for UK adults.

Investigators: L Vale, R Hernández (HERU/HSRU); MD Smith, M Sutton, M Ryan, D Yi (HERU); A Avenell (HSRU, University of Aberdeen); L Aucott, E van Teiljingen, F Douglas, J Greener (Department of Public Health, University of Aberdeen) and K Mavromaras, A Goode, A Scott (University of Melbourne)

The prevalence of obesity has been rising continuously in the UK with a major impact on mortality, morbidity and well-being for a large part of the population. Achieving and maintaining a lower weight significantly reduces the risk of developing many diseases, especially diabetes, coronary heart disease (CHD) and cancer. The investigation of the acceptability and cost-effectiveness of alternative preventive interventions is necessary for the design and targeting of evidence-based policy.

The study used the conventional obesity measure of Body Mass Index (BMI) and concentrated on persons over the age of 18 with BMI values between 25 and 34.9 (the WHO pre-obese and obesity class 1 categories, as the emphasis was on prevention). Various different outcomes were considered, dependent upon the phase of the research. Final outcomes of phase 6, a cost-benefit analysis, are estimates of relative efficiency reported as net benefits and balance sheets comparing the alternative interventions considered.

Source of funding and total awarded: Medical Research Council, National Prevention Research Initiative, £495,656


Project phase:

MRC IES Platform Grant: Scoping and feasibility preparation for an RCT on post partum weight loss (Weigh Well).

Investigators: A Anderson, R Barbour, AF Kirk, G Mires, A Symon, S Treweek, B Williams (University of Dundee); R Fraser (University of Sheffield); JM Thompson (NHS Dundee) and A Ludbrook, L McKenzie, D Yi (HERU)

This project was a pre-trial feasibility study of a weight loss intervention. The economic component informed questions relating to the scale and significance of the difference in costs and benefits between intervention and control groups, including health service costs and benefits, other social costs and benefits & costs and benefits to the women and their families. Alternative data collection methods were evaluated to establish which costs and benefits should be collected in a full trial and allow power calculations to be carried out for the economic analysis. Some pre-trial modelling was carried out.

Source of funding and total awarded: Medical Research Council, IES Platform Grant, £193,576


Project phase:


46


Nurse Labour Markets: Preferences for Pecuniary and Non-Pecuniary Rewards.

Investigators: D Skåtun, R Elliott (HERU) and A Scott (University of Melbourne)

This study investigated the importance of non-pay aspects within the reward structure for nurses in the UK. A crucial requirement of the current modernisation of the National Health Service (NHS) is the supply of an adequate number of nurses. A key policy question is whether an increase in resources devoted to recruiting and retaining nurses is best spent on wages or upon improving working conditions. There is some evidence of the effect of wages on nursing labour supply, but little on the value placed by nurses on working conditions. Working conditions may become a more important policy instrument in the future with the introduction of the new more uniform pay structures agreed in ‘Agenda for Change’. The study distinguished the ‘price’ that nurses are willing to pay to improve their working conditions. It identified how nurses’ trade-off pay against other working conditions.

Source of funding and total awarded: ESRC, £116,505


Project phase:

Payment by results: Key outcomes and variations across HRGs providers and patients in 2006/07 and 2007/08.

Investigators: S Farrar, D Yi, A Ma (HERU) and M Chalkley (University of Dundee)

This project identified the medium-term consequences of activity-based funding for hospitals in the English NHS. It built on a completed project examining the implementation and early effects of Payment by Results policy. Activity-based funding systems in other countries, similar to PbR, have been shown to have significant effects on the costs, quality and volume of care. Research on some of these payment systems shows the effects to be short-lived. Using micro-econometric techniques we: (i) charted the evolving impact of the new financial regime on key indicators of activity, cost and quality; and (ii) rolled forward previous work using Scotland (where the policy is not being implemented) as a comparator, and (iii) investigated variability of the effects across three key dimensions: (a) patient group; (b) provider organisation and; (c) type of treatment.



Project phase:

Personal and professional motivation and the supply of health care.

Investigators: Y Feng, S Farrar, A Ma (HERU) and M Sutton (University of Manchester)

The project included a comprehensive review of the theoretical and empirical literature with the objectives (i) to identify different existing models of intrinsic motivation and consider their relevance to the health care sector and (ii) to review empirical analysis of applications of this theory and again consider what lessons can be learned from this for the design of future analysis. Models of intrinsic motivation with testable hypotheses for application to the health care sector were developed. Opportunities to test these models have been identified within the changing policy and contractual environment of the UK NHS.

Source of funding and total awarded: Division of Applied Health Sciences (DAHS) PhD Studentship, £39,000


Project phase:

* Scoping Study of the economic impact on the alcohol industry of pricing and non-price policies to regulate the affordability and availability of alcohol in Scotland.

Investigators: D Petrie (University of Dundee) and A Ludbrook (HERU)

A logic model was developed to identify where the impact of different policies was likely to be and the supply chains for the alcohol industry were mapped. A review of potential data sources was carried out, including consultation with industry sources. Four study options were explored in detail and an assessment was made of the likely outputs of each study in relation to the evaluation objectives and the risks associated with each option.

Source of funding and total awarded: NHS Health Scotland via University of Dundee, £15,941


Project phase:

47


* The Staff Market Forces factor Component of the Resource Allocation Weighted Capitation Formula.

Investigators: R Elliott, D Skåtun, A Ma (HERU); M Sutton (University of Manchester); N Rice (University of York); S Morris (UCL) and A McConnachie (University of Glasgow)

Previous research by HERU commissioned by the Advisory Committee on Resource Allocation (ACRA) led to important changes in the way the staff MFF was estimated. The MFF is an element of the formula that funds PCTs in England and Wales. More recent estimates were required, using the latest data along with testing any refinements to the method that would increase the reliability and robustness of the method. This research provided up to date MFF values and, within the general framework, reviewed and where appropriate suggested refinements for the method for estimating the MFF.



Project phase:

48

APPENDIX 2 – HERU PUBLICATIONS 2010

Peer Review Journal Articles

Abul Naga, R. Statistical Inference for Multidimensional Inequality Indices. Economics Letters. 2010; 107(1): 49-51.

Alyamani, N.A., Smith, M.D., Williams, D.J. and Petty, R.D. Predictive biomarkers for personalised anti-cancer drug use: discovery to clinical implementation. European Journal of Cancer. 2010; 46(5): 869-879.

Baker, R., Bateman, I., Donaldson, C., Jones-Lee, M., Lancsar, E., Loomes, G., Ryan, M. et al. Weighting and valuing quality-adjusted life-years using stated preference methods: preliminary results from the Social Value of a QALY project. Health Technology Assessment. 2010; 14 (27): 1-162.

Bardisa-Ezcurra, L., Ullman, R. and Gordon, J. Guideline Development Group (including Tinelli, M.). Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance. British Medical Journal. 2010; 1: 340.

Black, C., Sharma, P., Scotland, G., McCullough, K., McGurn, D., Robertson, L., Fluck, N., MacLeod, A., McNamee, P., Prescott, G. and Smith, C. Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost effectiveness and economic analysis. Health Technology Assessment. 2010; 14(21): 1-184.

Campbell, M.K., Skea, Z., Sutherland, A.G., Cuthbertson, B., Entwistle, V.A., McDonald, A.M., Norrie, J., Carlson, R. and Bridgman, S. for the KORAL study group (Vale, L. and Kilonzo, M. members of the group). Effectiveness and cost-effectiveness of arthroscopic lavage in the treatment of osteoarthritis of the knee: a mixed methods study of the feasibility of conducting a surgical placebo-controlled trial (the KORAL study). Health Technology Assessment. 2010; 14(5).

Caskey, F.J., Stel, V.S., Elliott, R., Jager, K.J., Covic, A., Cusumano, A., Geue, C., Kramer, A., Stengel, B. and MacLeod, A.M. The EVEREST study: an international collaboration. Nephrology Dialysis Transplantation (NDT) Plus. February 2010; 3(1): 28-36.

Clarkson, J., Ramsay, C., Eccles, M., Grimshaw, J., Treweek, S., Young, L., Black, I., Bonetti, D., Cassie, H., Eldridge, S., Francis, J., Johnston, M., MacKenzie, G., MacPherson, L., McKee, L., Michie, S., Pitt, N., Stirling, D., Tilley, C., Torgerson, C., Vale, L. and Walker, A. The translation research in a dental setting (TRiaDS) programme protocol. Implementation Science. 2010; 5:57.

The CLASS Trial (Vale, L. a member of the group). The CLASS Trial: Comparison of LAser, Surgery and foam Sclerotherapy. Trial protocol, The Lancet. 2010: Protocol 09PRT/2275.

Cuthbertson, B., Roughton, S., Jenkinson, D., MacLennan, G. and Vale, L. Quality of life in the five years after intensive care – a cohort study. Critical Care. 2010; 14(1):R6.

Cuthbertson, B., Campbell, M., Stott, S., Vale, L., Norrie, N., Kinsella, J., Cook, J., Brittenden, J., Grant, A. and the Foccus Study Group. Pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery: trial protocol. Trials. 2010; 11:41.

The EAGLE Trial team (Vale, L. and Quayyum, Z. members of the team). The Effectiveness of Early Lens action with Intraocular Lens Implantation for the treatment of Primary Angle Closure Glaucoma: A Randomised Controlled Trial. Trial protocol publication in The Lancet. 2010; Protocol 09PRT/4479.

Eberth, B. and Smith, M.D. Modelling the participation decision and duration of sporting activity in Scotland. Economic Modelling. Special Edition on Health Econometrics. 2010; 27(4): 822-834.

Elliott, R., Sutton, M., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. The role of the staff MFF in distributing NHS funding: taking account of differences in local labour market conditions. Health Economics. 2010; 19(5): 532-548.

Fleming, A.D., Goatman, K.A., Philip, S., Williams, G.J., Prescott, G.J., Scotland, G., McNamee, P., Leese, G.P., Wykes, W.N., Sharp, P.F. and Olson, J.A. The role of haemorrhage and exudate detection in automated grading of diabetic retinopathy. British Journal of Ophthalmology. 2010; 94(6): 706-711.

Gravelle, H., Sutton, M. and Ma, A. Doctor behaviour under a pay for performance contract: treating, cheating, and case finding. The Economic Journal. 2010; 120(542): F129-F156.

Guinness, L., Vickerman, P., Quayyum, Z., Foss, A., Watts, C., Rodericks, A., Azim, T., Jana, S. and Kumaranayake, L. The cost effectiveness of consistent and early intervention of harm reduction for injecting drug users in Bangladesh. Addiction. 2010; 105(2); 319-328.

Hislop, J., Quayyum, Z., Flett, G., Boachie, C., Fraser, C. and Mowatt, G. Systematic review of the clinical and cost-effectiveness of rapid point-of-care tests for the detection of genital Chlamydia infection in women and men. Commissioned for the NHS R&D HTA Programme on behalf of the National Institute for Health and Clinical Excellence. Health Technology Assessment. 2010; 14(29): 1-126.

Hutchings, D., Vanoli, A., McKeith, I., Brotherton, S., McNamee, P. and Bond, J. Good days and bad days: the lived experience and perceived impact of treatment with cholinesterase inhibitors for Alzheimer’s disease in the United Kingdom. Dementia. 2010; 9(3): 409-425.

Hutchings, D., Vanoli, A., McKeith, I., Brotherton, S., McNamee, P. and Bond, J. Cholinesterase inhibitors and Alzheimer’s disease: patient, carer and professional factors influencing the use of drugs for Alzheimer’s disease in the United Kingdom. Dementia. 2010; 9(3): 427-443.

Imamura, M., Abrams, P., Bain, C., Buckley, B., Cardozo, L., Cody, J., Cook, J., Eustice, S., Glazener, C., Grant, A., Hay-Smith, J., Hislop, J., Jenkinson, D., Kilonzo, M., Nabi, G., N’Dow, J., Pickard, R., Ternent, L., Wallace, S., Wardle, J., Zhu, S. and Vale, L. Systematic review and economic modelling of the effectiveness and efficiency of non-surgical treatments for women with stress urinary incontinence. Health Technology Assessment. 2010; 14(40).

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Jarl, J., Gerdtham, U-G., Ludbrook, A. and Petrie, D. On Measurement of Avoidable and Unavoidable Cost of Alcohol: An Application of Method for Estimating Costs Due To Prior Consumption. International Journal of Environmental Research and Public Health. 2010; 7(7): 2881-2895.

Kamrul Islam, M., Gerdtham, U-G., Clarke, P. Burstrom, K. Does income related health inequality change as the population ages? Evidence from Swedish panel data. Health Economics. 2010; 19(3): 334-349.

Kilonzo, M.M., Sambrook, A.M., Cook, J.A., Campbell, M.K. and Cooper, K.G. A Cost-Utility Analysis of Microwave Endometrial Ablation versus Thermal Balloon Endometrial Ablation. Value in Health. 2010; 13(5): 528-534.

Lourenco, T., Grant, A., Burr, J. and Vale, L. Local decision-makers’ views of national guidance on interventional procedures in the UK. Journal of Health Services, Research and Policy. 2010; 15(Supplement 2): 3-11.

The MAPs Trial team (Vale, L. a member of the team) Conservative treatment for urinary incontinence in men after prostate surgery (MAPS): multi-centre randomised controlled trial of pelvic floor muscle training. Trial protocol for publication in The Lancet. 2010; Protocol 07PRT/588.

Maheshwari, A., Scotland, G., McTavish, A., Bell, J., Hamilton, M. and Bhattacharya, S. Direct health services costs of providing assisted reproduction services in older women – retrospective cross-sectional analysis. Fertility and Sterility. 2010; 93(2): 527-536.

McKenzie, L., de Verteuil, R., Cook, J., Shanmugam, V., Loudon, M., Watson, A.J.M. and Vale, L. Economic evaluation of the treatment of grade II haemorrhoids: a comparison of stapled haemorrhoidopexy and rubber band ligation. Colorectal Disease. 2010; 12(6): 587-593.

McNamee, P., Ternent, L., Gbangou, A. and Newlands, D. A game of two halves?: Incentive incompatibility, starting point bias and the bidding game contingent valuation method. Health Economics. 2010; 19(1): 75-87.

McNamee, P., Vanoli, A., Hutchings, D., McKeith, I. and Bond, J. Savings from sub-groups? Policy guidance and Alzheimer’s Disease treatments. Journal of Nutrition, Health and Ageing. 2010; 14(8): 664-668.

Mowatt, G., Zhu, Z., Kilonzo, M., Boachie, C., Fraser, C., Griffiths, T.R.L., N’Dow, J., Nabi, G., Cook, J. and Vale, L. Systematic review of the clinical and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer. Health Technology Assessment. 2010; 14(4).

Pol, M. van der. and McKenzie, L. Costs and benefits of tele-endoscopy clinics in a remote location. Journal of Telemedicine and Telecare. 2010; 16(2): 89-94.

Pol, M. van der., Shiell, A., Au, F., Johnston, D.W. and Tough, S. Eliciting individual preferences for health care: a case study of perinatal care. Health Expectations. 2010; 13(1): 4-12.

Quayyum, Z., Nadjib, M., Ensor, T. and Sucahya, P.K. Expenditure on obstetric care and the protective effect of insurance on the poor: lessons from two Indonesian districts. Health Policy and Planning. 2010; 25(3): 237-247.

Scotland, G., McNamee, P., Fleming, A.D., Goatman, K.A., Philip, S., Prescott, G.J., Sharp, P.F., Williams, G.J., Wykes, W., Leese, G.P. and Olson, J.A. Costs and consequences of automated algorithms versus manual grading for the detection of referable diabetic retinopathy. British Journal of Ophthalmology. 2010; 94(6): 712-719.

Seymour, J., McNamee, P., Scott, A. and Tinelli, M. Shedding new light onto the ceiling and floor? A quantile regression approach to compare EQ-5D and SF-6D responses. Health Economics. 2010; 19(6): 683-696.

Shanmugam, V., Muthukumarasamy, G., Cook, J.A., Vale, L., Watson, A.J.M. and Loudon, M.A. Randomised Controlled Trial Comparing Rubber Band Ligation With Stapled Haemorrhoidopexy for Grade II Circumferential Haemorrhoids Long Term Results. Colorectal Disease. 2010; 12(6): 579-586.

Sharma, P., McCullough, K., Scotland, G., McNamee, P., Prescott, G., MacLeod, A., Fluck, N., Smith, W.C. and Black, C. Does stage 3 chronic kidney disease matter? A systematic literature review. British Journal of General Practice. 2010; 60(575): 442-448.

Shemilt, I., Mugford, M., Vale, L., Marsh, K., Donaldson, C. and Drummond, M. Evidence synthesis, economics and public policy. Research Synthesis Methods. 2010; 1(2): 126-135.

Ternent, L., McNamee, P., Newlands, D., Belemsaga, D., Gbangou, A. and Cross, S. Willingness to pay for maternal health outcomes: are women willing to pay more than men? Applied Health Economics and Health Policy. 2010; 8(2): 99-109.

Tinelli, M., Ryan, M. and Bond, C. Discrete choice experiments (DCEs) to inform pharmacy policy: going beyond Quality Adjusted Life Years (QALYs). Supplement to the International Journal of Pharmacy Practice. 2010; 18(S1): 1.

Vale, L. Health technology assessment and economic evaluation: arguments for a national approach. Value in Health. 2010; 13(6): 859-861.

Wilcox-Gok, V. and McNamee, P. Economic consequences of mental health problems in older people for other family members. Journal of Health Services Research & Policy. 2010; 15(Supplement 2): 35-40.

Forthcoming Journal Articles

Bissell, P., Sadler, S., Anderson, C. and Avery, A.J. on behalf of the Community Pharmacy Medicines Management Project Evaluation Team (including Jaffray, M., Bond, C.M., Watson, M.C., Hannaford, P., Tinelli, M., Scott, A., Lee, A., Blenkinsopp, A. and Krksa, J.). General Practitioners’ views about a pharmacy led medicines management service for patients with coronary heart disease. Pharmacy World & Science.

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Boyers, D., Jia, X., Crowther, M., Jenkinson, D., Fraser, C., Mowatt, G. and Vale, L. Eltrombopag for the treatment of chronic immune (idiopathic) purpura. Health Technology Assessment.

Brown, H. Marriage, BMI and Wages: A double selection approach. Scottish Journal of Political Economy.

de Bekker-Grob, E., Ryan, M., Gerard, M., Steyerberg, E. and Essink-Bot, M. Applying discrete choice experiments to value health and health care: a review of the literature. Health Economics. doi:10.1002/hec.1697

Dickey, H., Watson, V. and Zangelidis, A. Is it all about money? An examination of the motives behind moonlighting. Applied Economics.

Donaldson, C., Baker, R., Mason, H., Jones-Lee, M., Lancsar, E., Wildman, J., Bateman, I., Loomes, G., Robinson, A., Sugden, R., Pinto, J., Prades, L., Ryan, M., Shackley, P. and Smith, R. The social value of a QALY: raising the bar or barring the raise? BMC Health Services Research.

Glazener, C, Boachie, C., Buckley B., Cochran, C., Dorey, G., Grant, A., Hagen, S., Kilonzo, M., McDonald, A., McPherson, G., Moore, K., N’Dow, J., Ramsay, C. and Vale, L. Conservative treatment for urinary incontinence in men after prostate surgery (MAPS). Health Technology Assessment.

Hislop, J., Quayyum, Z., Elders, A., Fraser, C., Jenkinson, D., Mowatt, G., Sharma, P., Vale, L. and Petty, R. Systematic review of the clinical and cost-effectiveness of imatinib at escalated doses of 600 mg/day or 800 mg/day for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours which have progressed on treatment at a dose of 40 mg/day. Health Technology Assessment.

Lourenco, T., Burr, J., Grant, A. and Vale, L. The introduction of new interventional procedures in the British National Health Service – a qualitative study. Health Policy. doi: 10.1016/j.healthpol.2010.08.012

Macdiarmid, J., I., Loe, J., Douglas, F., Ludbrook, A., Comeford, C. and McNeill, G. Developing a timeline for evaluating public health nutrition policy interventions. What are the outcomes and when should we expect to see them? Public Health Nutrition. doi: 10.1017/S1368980010002168

Mentzakis, E., Ryan, M. and McNamee, P. Using Discrete Choice Experiments to value informal care tasks: exploring preference heterogeneity. Health Economics. doi: 10.1002/hec.1656

Morris, S., Goudie, R., Sutton, M., Gravelle, H., Elliott, R., Hole, A., Ma, A., Sibbald, B. and Skåtun, D. Determinants of general practitioners’ wages in England. Health Economics. doi: 10.1002/hec.1573

Morton, C., Downie, F., Auld, S., Smith, B., Pol, M. van der., Baughan, P., Wells, J. and Wootton, R. Community Photo-triage for Skin Cancer Referrals: An Aid to Service Delivery. Clinical and Experimental Dermatology. doi: 10.1111/j.1365-2230.2010.03960.x

Pol, M. van der. and Cairns, J. Descriptive validity of alternative intertemporal models for health outcomes: an axiomatic test. Health Economics. doi: 10.1002/hec.1628

Pol, M. van der. Health, education and time preference. Health Economics. doi: 10.1002/hec.1655

Robertson, C., Boachie, C., Dixon, M., Fraser, C., Hernández, R., Heys, S., Jack, W., Kerr, G., Ragupathy, S., Lawrence, G., MacLennan, G., Maxwell, A., McGregor, J., Mowatt, G., Pinder, S., Ternent, L., Thomas, R., Vale, L., Wilson, R., Zhu, S. And Gilbert, F. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer. Health Technology Assessment.

Scotland, G., McNamee, P., Hundley, V., Barnett, C. and Cheyne, H. Women’s preferences for aspects of labour management: results from a discrete choice experiment. Birth.

Snaith, A., Royle, P., Gillett, M., Scotland, G., Poobalan, A., Imamura, M., Black, C., Boroujerdi, M., Jick, S., Wyness, L., McNamee, P., Brennan, A. and Waugh, N. Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: systematic review and economic evaluation. Health Technology Assessment.

Tinelli, M., Blenkinsopp, A. and Bond, C., on the behalf of the Community Pharmacy Medicines Management Evaluation Team. Development, validation and application of a patient satisfaction score for a community pharmacy medicines management service. International Journal of Pharmacy Practice.

Waugh, N., Royle, P., Scotland, G., Henderson, R., Hollick, R. and McNamee, P. Denosumab for osteoporotic fractures in post menopausal women primary and secondary prevention. Health Technology Assessment.

Williams, L., Kunkler, I., King, C., Jack, W. and Pol, M. van der. A randomised controlled trial of post-operative radiotherapy following breast-conserving surgery in a minimum-risk population. Quality of Life at five years in the PRIME trial. Health Technology Assessment.

Yi, D., Ryan, M., Campbell, S., Elliott, A., Torrance, N., Chambers, A., Johnston, M., Hannaford, P. and Smith, B. Using Discrete Choice Experiments to inform Randomised Controlled Trials: an application to chronic back pain management. European Journal of Pain. doi:10/1016/j.ejpain.2010.10.008

Books

Shemilt, I., Mugford, M., Donaldson, C., Vale, L. and Marsh, K. (eds) Evidence Based Economics. Wiley Books, London. 2010.

Book Chapters

Ludbrook, A. Fiscal Policy and Health Related Behaviours. In: Evidence Based Public Health. Killoran, A. and Kelly, M. (eds.) Oxford University Press. 2010.

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Mugford, M., Shemilt, I., Vale, L., Marsh, K., Donaldson, C. and Mallender, J. From effectiveness to efficiency? An introduction the evidence-based decisions and economies for healthcare, social welfare, education and criminal justice. In: Evidence Based Economics. Shemilt, I., Mugford, M., Donaldson, C., Vale, L. and Marsh, K. Wiley Books, London. April 2010.

Vale, L. Evidence-based decisions and economics: lessons for practice. In: Evidence Based Economics. Shemilt, I., Mugford, M., Donaldson, C., Vale, L. and Marsh, K. Wiley Books, London. April 2010.

Book Chapters Forthcoming

Elliott, R. Comment on “Achieving a Self-Sufficient Workforce? The Utilisation of Migrant Labour in Healthcare” by Stephen Bach. In: Who Needs Migrant Workers? Labour Shortages, Immigration, and Public Policy. Ruhs, M. and Anderson, B. (eds.), Oxford University Press. 2010.

Vale, L. Economics of inguinal hernia repair. In: Management of Abdominal Wall Hernias. Kingsnorth, A. and LeBlanc, K. 4th Edition. Springer Books.

Reports

Cuthbertson, B., Stott, S., Campbell, M., Vale, L., Cook, J., Norrie, J., Brittenden, J., Kinsella, J., Grant, A., Alcorn, D., Serpell, M., McColl, A., Rae, D., Shepherd, K., Addison, J., McPherson, G., McDonald, A., Cotton, S., Elders, A., MacLennan, G., Boyers, D. and Hernández, R. Pragmatic multi-centre randomised trial of (1) routine postoperative ICU care and/or (2) pre-operative fluid loading in high-risk surgical patients undergoing major elective and urgent surgery. Final report submitted to Chief Scientist Office. April 2010.

Glazener, C., Boachie, C., Buckley, B., Cochran, C., Dorey, G., Grant, A., Hagen, S., Kilonzo, M., McDonald, A., McPherson, G., Moore, K., N’Dow, J., Ramsay, C. and Vale, L. Conservative treatment for urinary incontinence in men after prostate surgery (MAPS). Final Report Submitted to NIHR HTA Programme. March 2010.

Hislop, J., Quayyum, Z., Elders, A., Fraser, C., Jenkinson, D., Mowatt, G., Sharma, P., Vale, L. and Petty, R. Systematic review of the clinical and cost-effectiveness of imatinib at escalated doses of 600mg/day or 800mg/day for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours which have progressed on treatment at a dose of 400mg/day. Final report submitted to NIHR HTA Programme. March 2010.

Ludbrook, A. Purchasing patterns for low price off sales alcohol: evidence from the Expenditure and Food Survey. Commissioned report for Scottish Health Action on Alcohol Problems. May 2010.

Ma, A., Battu, H. and Elliott, R. Local pay differences and vacancy rates for school teachers in England and Wales: regional differences in teachers’ rates of pay and teacher vacancy rates. Final Report for Office of Manpower Economics. July 2010.

McMurdo, M.E., Witham, M., Struthers, A., Boyers, D., Pol, M. van der. and the project team. A Randomised Controlled Trial of the Effect of Exercise Training on Exercise Capacity in Older Patients with Heart Failure. Final Report to the Chief Scientist Office. October 2010.

Petrie, D., Ludbrook, A., Gobey, M., Dewhurst, J., Montagna, C. and Molana, H. Scoping study of the economic impact on the alcohol industry of pricing and non-price policies to regulate the affordability and availability of alcohol in Scotland. Final Report to NHS Health Scotland November 2010.

Rao, K., Ramani, S., Murthy, S., Hazarik, I., Khandpur, N., Choskshi, M., Khanna, S., Vujicic, M., Berman, P. and Ryan, M. Health Worker Attitudes Towards Rural Services in India: Results from Qualitative Research. Health, Nutrition and Population Discussion paper, World Bank, November 2010.

Robertson, C., Boachie, C., Dixon, M., Fraser, C., Hernández, R., Heys, S., Jack, W., Kerr, G., Ragupathy, S., Lawrence, G., MacLennan, G., Maxwell, A., McGregor, J., Mowatt, G., Pinder, S., Ternent, L., Thomas, R., Vale, L., Wilson, R., Zhu, S. and Gilbert, F. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer. Final Report Submitted to NIHR HTA Programme. February 2010.

Sussex, J., Watson, V., Tetteh, E. and Ryan, M. Investigation of the value placed on NCAS services by referrers in the NHS. National Clinical Assessment Service (NCAS). June 2010.

Vujicic, M., Alfano, M., Ryan, M., Sanford Wesseh, C. and Brown-Annan, J. Policy Options to Attract Nurses to Rural Liberia. Evidence from a Discrete Choice Experiment. Health, Nutrition and Population Discussion paper, World Bank, November 2010.

Other Publications

Eberth, B. and Smith, M.D. Modelling the Participation Decision and Duration of Sporting Activity in Scotland. HERU Briefing Paper. University of Aberdeen, November 2010.

Feng, Y. An economic analysis of intrinsic and extrinsic motivation in the supply of health care. PhD Thesis. University of Aberdeen, 2010.

Ikenwilo, D. Studies of the job satisfaction and labour supply of hospital consultants. PhD Thesis. University of Aberdeen, 2010.

Kilonzo, M. and Vale, L. Economic Evaluation of Urinary Biomarkers and Cystoscopy with Photodynamic Diagnosis and for Detection and Follow-up of Bladder Cancer. HERU Briefing Paper. University of Aberdeen. April 2010.

Ludbrook, A. Asking the Right Questions about Substitution and Complementarity: a Comment on Moore’s Paper. Alcohol and Alcoholism. 2010; 45(5): 412-413.

McNamee, P. The Economic Consequences of Mental Health Problems in Older People on Other Family Members. HERU Briefing Paper. University of Aberdeen. April 2010.

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Watson, V. and Ryan, M. Valuing patient experience factors in the provision of Chlamydia screening. HERU Briefing Paper. University of Aberdeen. March 2010.

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Invited Presentations

Boyers, D., McNamee, P. and EPIC Team members. Self-Management interventions for older adults with chronic pain – a systematic review of the cost-effectiveness literature. Life Long Health and Well Being Research Retreat. Newcastle, October 2010.

Farrar, S., Yi, D., Chalkley, M., Ma, A., Sutton, M. and Sussex, J. Payment by Results: impact and policy implications. Symposium on Policy Implications of Emerging Findings for the English NHS. London, King’s Fund, February 2010.

Hernández, R. and Vale, L. Review of glaucoma projects, their approaches and challenges. International Glaucoma Association, Health Economics Special Interest Group. Madrid, September 2010.

Ludbrook, A. Minimum pricing of alcohol. Association of Clinical Biochemists, Annual Meeting. Edinburgh, March 2010.

Ludbrook, A. Alcohol by the numbers. Holyrood event, ‘Alcohol in Scotland’. Edinburgh. June 2010.

McNamee, P. Measuring health economic impact of diagnostic tests in dementia. Symposium on Imaging Research in Cognitive Impairment and Dementia. Aberdeen, November 2010.

Ryan, M. Valuing the patient experience in HTAs (and healthcare delivery assessments): going beyond QALYs. The European Organisation for Rare Diseases (EURODIS) Summer School. Barcelona, September 2010.

Ryan, M. How is conjoint analysis being applied in health? 3rd Conjoint Analysis in Health Conference, Newport Beach, October 2010.

Conference Presentations

Becker, F., Ludbrook, A. and Eberth, B. Determinants of diet and physical activity – Empirical evidence from the Scottish Health Survey. European Conference on Health Economics. Helsinki. July 2010.

Brown, H. Marriage, BMI, and Wages: A Double Selection Approach. Scottish Economic Society Conference. Perth. April 2010. Paper available.

Brown, H. and Roberts, J. Going the Same Way? Spousal Correlation in Obesity. European Conference on Health Economics. Helsinki. July 2010. Paper available.

Brown, H. and Roberts, J. Born to Be Wide: Examining Maternal and Adolescent Correlations in BMI. European Conference on Health Economics. Helsinki. July 2010. Paper available.

Brown, H. The Role of Lifestyle Characteristics in Influencing Correlations in BMI for Two Cohorts of Siblings. The Panel Study of Income Dynamics Conference on Health and Socioeconomic Status. Ann Arbour, MI, USA, September 2010. Paper available.

APPENDIX 3 – HERU PRESENTATIONS 2010

Bruhn, H., Watson, M., Blyth, A., Bond, C.M., on behalf of Pharmacy-Led Management of Chronic Pain Study Team. (McNamee, P. a member of the team) Pharmacist-led management of chronic pain in primary care: patient expectations, attitudes and concerns. Health Services Research and Pharmacy Practice Conference (HSRPP). Manchester, April 2010.

Combes, J-B., Elliott, R. and Skåtun, D. Nursing Workforce Skill Mix and the Competitiveness of Qualified Nurses Pay: a local labour market analysis. Econometrics of Healthy Human Resources. Rome. July 2010. Paper available.

Drummond, M., Anderson, R., Niessen, L., Shemilt, I. and Vale, L. Adding value? HTAs and systematic reviews of health economic evidence. 7th Annual Health Technology Assessment International. Dublin. June 2010.

Farrar, S., Yi, D., Ma, A., Chalkley, M. and Sutton, M. Measuring the impact of activity based hospital financing across patient group. European Conference on Health Economics. Helsinki. July 2010.

Glazener, C., Boachie, C., Buckley, B., Cochran, C., Dorey, G., Grant, A., Hagen, S., Kilonzo, M., Moore, K., N’Dow, J., Ramsay, C. and Vale, L. A randomised controlled trial on conservative treatment (pelvic floor muscle training and bladder training) for urinary incontinence in men after prostate surgery (MAPS). International Continence Society/International Urogynecological Association Annual Meeting. Toronto. August 2010.

Hislop, J. and Quayyum, Z. Creating realistic scenarios for sensitivity analysis in economic evaluation – applying parameter data from a different setting: A case study on Chlamydia testing. 7th Annual Health Technology Assessment International. Dublin. June 2010. Paper available.

Imamura, M., Jenkinson, D., Glazener, C. and Vale, L. The stress urinary incontinence review group. Effectiveness of non-surgical interventions for women with stress urinary incontinence: systematic review and meta-analysis of randomised controlled trials. International Continence Society/International Urogynecological Association Annual Meeting. Toronto. August 2010.

Khan, M.N.U., Quayyum, Z., Nasreen, H., Ensor, T. and Salahuddin, S. Household costs of obtaining maternal and newborn care in rural Bangladesh. International Conferences on War Against Chronic Poverty hosted by the Brooks World Poverty Institute (BWPI). University of Manchester and Chronic Poverty Research Centre. Manchester, September 2010. Paper available.

Kinghorn, P., Robinson, A. and Smith, R. Findings from a Pilot Study Applying a Multi-Attribute Value Method: Addressing the Suspected Presence of Part-Whole Bias. Foundations and Applications of Utility, Risk and Decision Theory (FUR) Conference. Newcastle. June 2010. Paper available.

Kinghorn, P. and Robinson, A. Valuing capability: Findings from a pilot study applying a Multi-Attribute Value Method. European Conference on Health Economics. Helsinki. July 2010. Paper available.

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Ludbrook, A., McKenzie, L. and Petrie, D. Minimum pricing for alcohol: modelling system wide responses. European Conference on Health Economics. Helsinki. July 2010.

McNamee, P., Quayyum, Z., Black, C., Clar, C., Henderson, R., Maceachran, C., Royle, P. and Thomas, S. The use of mapping in estimates of cost-effectiveness: helpful or harmful? Society for Medical Decision Making. Toronto, October 2010.

Mendolia, S. Maternal working hours and the well-being of adolescent children. Scottish Economic Society Conference. Perth. April 2010. Paper available.

Olajide, D. and Ludbrook, A. A multilevel analysis of the influence of households on sedentary behaviour among children in Scotland. European Conference on Health Economics. Helsinki. July 2010. Paper available.

Olajide, D. and Ludbrook, A. Legislative smoking bans on exposure to environmental tobacco smoke in Scotland: An analysis of longer term impacts. Annual Public Health Conference. Dunblane, November 2010. Paper available.

Olajide, D., Ludbrook, A. and Smith, M. Will quitting smoking and taking up a sport improve your diet? Investigating spillover effects of health behaviour interventions. 6th Scientific Meeting, UK Society for Behavioural Medicine (UKSBM). Leeds, December 2010. Paper available.

Regier, D. and Ryan, M. Experimental conjoint choice designs for the mixed logit model. 3rd Conjoint Analysis in Health Conference. Newport Beach, October 2010.

Ruggeri, M. and Pol, M. van der. Is risk attitude really specific within the health domain? Further evidence from a two-stage face-to-face interview using Certainty Equivalent and Probability Equivalent techniques in Italy. European Conference on Health Economics. Helsinki. July 2010.

Ryan, M., Yi, D., Avenell, A., Douglas, F., Aucott, L., van Teijlingen, E. and Vale, L. Understanding preferences for lifestyle interventions to reduce obesity: should we pay people to live well? UK Society for Behavioural Medicine 6th Annual Scientific Meeting. University of Leeds, December 2010.

Scotland, G., McNamee, P., Fleming, A.D., Goatman, K.A., Philip, S., Prescott, G.J., Sharp, P.F., Williams, G.J., Wykes, W., Leese, G.P. and Olson, J.A. on behalf of the Scottish Diabetic Retinopathy Clinical Research Network. Costs and consequences of automated algorithms versus manual grading for the detection of referable diabetic retinopathy. World Ophthalmology Congress. Berlin. June 2010.

Scotland, G., Mclernon, D., Kurinczuk, J.J., Jamieson, M., Lyall, H., Rajkhowa, M., Harrold, A. and Bhattacharya, S. Avoiding twins in IVF: the cost-effectiveness and cost-utility of elective single and double embryo transfer over a 20 year time horizon. Annual Meeting of the European Society for Human Reproduction and Embryology. Rome. June 2010.

Skåtun, D., Eberth, B. and Elliott, R. Pay or conditions? The role of workplace characteristics in nurse’s labour supply. Scottish Economic Society Conference. Perth. April 2010. Paper available.

Sussex, J., Watson, V. and Ryan, M. Investigating the value to NHS referrers of support with performance concerns. European Conference on Health Economics. Helsinki. July 2010.

Ternent, L., McNamee, P. and Newlands, D. Exploring biases in the double bounded dichotomous choice (DBDC) and DBDC with open ended follow-up methods. UK Health Economists’ Study Group Meeting. Cork. June 2010. Paper available.

Tinelli, M., Ryan, M. and Bond, C. Discrete choice experiments (DCEs) to inform pharmacy policy: going beyond Quality Adjusted Life Years (QALYs). Health Services Research & Pharmacy Practice Conference. Manchester, UK, April 2010.

Tinelli, M., Ryan, M. and Bond, C. Discrete choice experiments (DCEs) to inform pharmacy policy: going beyond Quality Adjusted Life Years (QALYs). 3rd Conjoint Analysis in Health Conference. Newport Beach, October 2010.

Vale, L. Implications for HTA and future research in Adding value? HTAs and systematic reviews of health economic evidence. Panel session: 7th Annual Health Technology Assessment International. Dublin. June 2010.

Watson, V. Using lab experiments to investigate incentive compatibility and hypothetical bias in discrete choice experiments. European Conference on Health Economics. Helsinki. July 2010.

Other Oral Presentations

Gray, E. Time preferences for future health events. University of Aberdeen PhD Symposium. Aberdeen. June 2010.

Seminars

Brown, H. He Ain’t Heavy, He’s My Brother: Examining Sibling Correlations in BMI. Academic Unit of Health Economics. University of Leeds, November 2010.

Combes, J-B. Nursing Workforce Skill Mix and the Competitiveness of Qualified Nurses Pay: a local labour market analysis. Ecole Nationale de la Statistique et de l’Analyse de l’Information – Seminar Health Economics. Rennes, France. January 2010.

Ma, A., Elliott, R. and Harminder, B. Regional differences in teacher’s rates of pay, teacher vacancy rates and school performance. Department of Economics. Dundee University, October 2010.

McNamee, P. Detection of ceiling and floor effects: a quantile regression approach. School of Health and Related Research. University of Sheffield. March 2010.

Pol, M. van der. Time and risk preferences and health investments. University of Calgary. December 2010.

Ryan, M. Measuring preferences in economic evaluations: going beyond QALYs Health and Policy Care Unit, London School of Economics. London. January 2010.

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Ryan, M. Measuring preferences in economic evaluations: going beyond QALYs. Department of Economics. University of Dundee. February 2010.

Ryan, M. Why QALYs are not enough in Economic Evaluations. Population Health Seminar Series, Department of Population Health. University of Aberdeen. March 2010.

Ryan, M. Using Discrete Choice Experiments to value non-marketed commodities: an application to health. Macaulay Research Institute. Aberdeen. April 2010.

Ryan, M. Using Discrete Choice Experiments to value non-marketed commodities: an application to health. Department of Economics. University of Bergen. September 2010.

Vale, L. and Hernández, R. Using economic evaluation to design and evaluate complex interventions. University of Newcastle. February 2010.

Workshops

Bruhn, H., Bond, C., Elliott, A., Hannaford, P., Lee, A., McNamee, P., Smith, B., Watson, M., Blyth, A., Holland, R. and Wright C. Developing a pharmacist-led chronic pain management service. International Social Pharmacy Workshop. Lisbon, August 2010.

Eberth, B. Drivers of productivity: health. Government Economic Service/Scottish Economic Society Policy Forum. Edinburgh. February 2010.

Ryan, M. and Watson, V. Expert Workshop in Discrete Choice Experiments. Aberdeen. November 2010.

Poster Presentations

Boyers, D. on behalf of the EOPIC project team (Smith, B., Schofield, P., Gray, D., Clarke, A, McNamee, P., Martin, D., Jones, D. and Roche, P.). EOPIC – Engaging with older people and their carers to develop interventions for the self-management of chronic pain. Life Long Health and Well Being Research Symposium. Newcastle. October 2010.

Brown, H. He Ain’t Heavy, He’s My Brother: Examining Sibling Correlations in BMI. University of Michigan. September 2010.

Bruhn, H., Bond, C., Elliott, A., Hannaford, P., Lee, A., McNamee, P., Smith, B., Watson, M., Blyth, A., Holland, R. and Wright, D. Developing an RCT of general practice-based, pharmacist-led, management of chronic pain: the PIPPC study. Society for Academic Primary Care (SAPC) Annual Meeting. Norwich. July 2010.

Bruhn, H., McNamee, P., Bond C. and Holland R. Is the combined WHOQOL-Bref and Pain and Discomfort Module a valuable outcome measure to use in assessing chronic pain? International Society for Quality of Life Research (ISOQOL) Annual Meeting. London. September 2010.

Kilonzo, M., Vale, L., Zhu, S., Mowatt, G., Boachie, C., N’Dow, J., Griffiths, T.R.L., Cook, J., Nabi, G. and Fraser, C. Economic evaluation of photodynamic diagnosis and urinary biomarkers for detection and follow-up of bladder cancer. 7th Annual Health Technology Assessment International. Dublin. June 2010.

Kinghorn, P., Notcutt, W., Robinson, A. “Using the Capability Approach to Assess Quality of Life in Patients with Chronic Pain”. British Pain Society Annual Scientific Meeting. Manchester. April 2010.

Mowatt, G., N’Dow, J., Zhu, S., Kilonzo, M., Boachie, C., Fraser, C., Nabi, G., Cook, J., Vale, L. and Griffiths, T.R.L. Systematic review and meta-analysis of photodynamic diagnosis of bladder cancer compared with white light cytoscopy. 7th Annual Health Technology Assessment International. Dublin. June 2010.

Sharma, P., Black, C., Scotland, G., McCullough, K., Robertson, L., Fluck, N., Macleod, A.M., McNamee, P., Prescott, G. and Smith, W.C. from ARRC HTA group. Approaches to care in Chronic Kidney Disease: supporting the development of a health economics model. 7th Annual Health Technology Assessment International. Dublin. June 2010.

Sharma, P., Black, C., Scotland, G., McCullough, K., Robertson, L., Fluck, N., Macleod, A.M., McNamee, P., Prescott, G. and Smith, W.C. from ARRC HTA group. The building blocks for complex decision making: an example of HTA in chronic kidney disease care. 7th Annual Health Technology Assessment International. Dublin. June 2010.

Policy Presentations

Boyers, D., Jia, X., Crowther, M., Jenkinson, D., Fraser, C. and Mowatt, G. Eltrombopag for the treatment of chronic immune (idiopathic) purpura, a single technology appraisal. NICE appraisal committee meeting. Manchester. January 2010.

Elliott, R., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. The staff market forces factor component of the resource allocation weighted capitation formula: New estimates. Technical Advisory Group (TAG), Department of Health, London. April 2010.

Elliott, R., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. The staff market forces factor component of the resource allocation weighted capitation formula: New estimates. Advisory Committee Resource Allocation (ACRA), Department of Health, London. May 2010.

McNamee, P. and Ludbrook, A. Feasibility study of use of direct payments for informal care. Scottish Collaboration for Public Health Research and Policy. Edinburgh. November 2010.

Pol, M. van der. and Ludbrook, A. Quantitative analysis, Implementation and Evaluation: The learning to date. A Joint Seminar between NHS Tayside, NHS Health Scotland and the Scottish Centre for Social Research, University of Edinburgh and University of Aberdeen. Dundee. June 2010.

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Scotland, G., Royle, P., Hendersen, R., Hollick, R., McNamee, P. and Waugh, N. Denosumab for the prevention of osteoporotic fractures in post-menopausal women: a single technology appraisal. NICE appraisal committee meeting. Manchester. April 2010.

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Peer Review Journal Articles

Acharya, A. and McNamee, P. Assessing Gujurat’s Chiranjeevi scheme. Economic and Political Weekly. 2009; 44: 13-15.

Armstrong, N., Vale, L., Deverill. M., Nabi, G., McClinton, S., N’Dow, J., Picard, R. and the BPE Study Group. Surgical treatments for men with benign prostatic enlargement. British Medical Journal. 2009; 338(161): b1288.

Black, C., Clar, C., Henderson, R., McNamee, P., MacEachern, C., Quayyum, Z., Royle, P. and Thomas, S. The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technology Assessment. 2009; 13(52): 1-148.

Brown, T., Avenell, A., Edmunds, E., Moore, H., Whittaker, V., Avery, L., Summerbell, C., PROGRESS team (Ryan, M. and Vale, L. members of this team). Systematic review of long-term lifestyle interventions to prevent obesity in adults. Obesity Reviews. 2009; 10(6): 627-638.

Cuthbertson, B., Rattray, J., Campbell, M.K., Gager, M., Roughton, S., Smith, A., Hull, A., Breeman, S., Norrie, J., Jenkinson, D., Hernández, R., Johnston, M., Wilson, E. and Waldmann, C. on behalf of the PRaCTICaL study group The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. British Medical Journal. 2009; 339: b3723.

Dorrian, C., Ferguson, J., Ah-See, K., Barr, C., Lalla, K., Pol, M. van der., McKenzie, L. and Wootton, R. Head and neck cancer assessment by flexible endoscopy and telemedicine. Journal of Telemedicine and Telecare. 2009; 15: 118-121.

Eberth, B., Watson, V., Ryan, R., Hughes, J. and Barnett, G. Does one size fit all? Investigating heterogeneity in men’s preferences for Benign Prostatic Hyperplasia treatment using mixed logit analysis. Medical Decision Making. September. 2009; 29(6): 707-715.

Ensor, T., Quayyum, Z., Nadjib, M. and Sucahya, P. Level and determinants of incentives for village midwives in Indonesia. Health Policy and Planning. 2009; 24:26-35.

Farrar, S., Yi, D., Sutton, M., Chalkley, M., Sussex, J. and Scott, A. Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis. British Medical Journal. 2009; 339:b3047.

Gerdtham, U-G., Clarke, P., Hayes, A., Gudbjornsdottir, S. and Nilsson, P. Estimating the Cost of Diabetes Mellitus-Related Events from Inpatient Admissions in Sweden Using Administrative Hospitalisation Data. Pharmacoeconomics. 2009; 27(1): 81-90.

Gerdtham, U-G., Ericsson, A., Andersson, L.F., Borg, S., Jansson, S-A., Ronmark, E. and Lundback, B. Factors affecting COPD-Related Costs: A multivariate analysis of a Swedish cohort. European Journal of Health Economics. 2009; 10(2): 217-226.

Geue, C., Skåtun, D. and Sutton, M. Economic influences on GPs’ decisions to provide out-of-hours care. British Journal of General Practice. 2009; 59(558): e1-e7.

Hernández, R., Sullivan, F., Donnan, P., Swann, I. and Vale, L. Early Administration of Economic evaluation of prednisolone and/or acyclovir for Bell’s Palsy. Family Practice. 2009; 26(2):137-144.

Hoddinott, P., Britten, J., Prescott, G., Tappin, D., Ludbrook, A. and Godden, D. Effectiveness of a policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: a cluster randomised controlled trial. British Medical Journal. 2009; 338(301): a3026.

Langlands, A., Dowdle, R., Elliott, A., Gaddie, J., Graham, A., Johnson, G., Lam, S., McGowan, A., McNamee, P., Morrison, J., Murphy, T., Reynard, K., Rudge, P. and Trueland, J. RCPE UK Consensus Statement on Acute Medicine. Journal of the Royal College of Physicians of Edinburgh. 2009; 39(1): 27-28.

Langlands, A., Dowdle, R., Elliott, A., Gaddie, J., Graham, A., Johnson, G., Lam, S., McGowan, A., McNamee, P., Morrison, J., Murphy, T., Reynard, K., Rudge, P. and Trueland, J. RCPE UK Consensus Statement on Acute Medicine. British Journal of Hospital Medicine. 2009; 70(1): Supplement 1 S1-S51.

Ludbrook, A. Minimum Pricing of Alcohol. Editorial. Health Economics. 2009; 18(12): 1357-1360.

Maheshwari, A., Scotland, G., Bell, J., McTavish, A., Hamilton, M. and Bhattacharya, S. The direct health services costs of providing assisted reproduction services in overweight or obese women: a retrospective cross-sectional analysis. Human Reproduction. 2009; 24(3): 633-639.

McNamee, P., Ternent, L. and Hussein, J. Barriers in accessing maternal health care: evidence from low and middle income countries. Expert Review of Pharmacoeconomics and Outcomes Research. 2009; 9(1): 41-48.

Mentzakis, E., McNamee, P. and Ryan, M. Who cares and how much? Exploring the determinants of co-residential informal care. Review of Economics of the Household. 2009; 7(3):283-303.

Millar, D., Heaney, D., McNamee, P., Selvaraj, S., Morton, M., Lindsay, S. and Bond, C. Does a system of instalment dispensing for newly prescribed medicines save NHS costs? Results from a feasibility study. Family Practice. 2009; 26(2): 163-168.

Miller, C.E., Quayyum, Z., McNamee, P. and Salman, R.A-S. Economic burden of intracranial vascular malformations in adults: prospective, population-based study. Stroke. 2009; 40: 1973-1979.

Mowatt, G., Boachie, C., Crowther, M., Fraser, C., Hernández, R., Jia, X. and Ternent, L. Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura: a single technology appraisal. Health Technology Assessment. 2009; 13(s2): 63-68.

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Mowatt, G., Houston, G., Hernández, R., de Verteuil, R., Fraser, C., Cuthbertson, B. and Vale, L. Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high risk surgical patients. Health Technology Assessment. 2009; 13(7).

Pinnock, H., Hanley, J. Lewis S., MacNee W., Pagliari C., Pol, M. van der., Sheikh A., McKinstry B. The impact of a telemetric Chronic Obstructive Pulmonary Disease monitoring service: randomised controlled trial with economic evaluation and nested qualitative study. Primary Care Respiratory Journal. 2009; 18(3): 233-235.

Pitchforth, E., van Teijlingen, E., Watson, V., Tucker, J., Kiger, A., Ireland, J., Farmer, J., Rennie, A-M., Gibb, S., Thomson, E. and Ryan, M. ‘Choice’ and place of delivery: A qualitative study of women in remote and rural Scotland. Quality and Safety in Healthcare. 2009; 18(1): 42-48.

Pol, M. van der. and McKenzie, L. Mapping the EORTC QLQ C-30 onto the EQ-5D instrument: the potential to estimate QALYs without generic preference data. Value in Health. 2009; 12(1): 167-171.

Regier, D.A., Friedman, J.M., Makela, N., Ryan, M. and Marra, C.A. Valuing the benefit of diagnostic testing for genetic causes of idiopathic developmental disability: Willingness to pay from families of affected children. Clinical Genetics. 2009; 75(6): 514-521.

Regier, D.A., Ryan, M., Phimister, E. and Marra, C. Bayesian and classical estimation of mixed logit: an application to genetic testing. Journal of Health Economics. 2009: 28(3): 598-610.

Reid, G., van Teijlingen, E., Douglas, F., Robertson, L.M. and Ludbrook, A. The reality of partnership working when undertaking an evaluation of a national well men’s service. Journal of Men’s Health. 2009; 6(1): 36-49.

Ryan, M., Watson, V. and Entwistle, V. Rationalising the ‘irrational’: A think aloud study of discrete choice experiment responses. Health Economics. 2009; 18(3): 321-336.

Ryan, M. and Watson, V. Comparing welfare estimates from payment card contingent valuation and discrete choice experiments. Health Economics. 2009; 18(4): 389-401.

Shenfine, J., McNamee, P., Steen, N., Bond, J. and Griffin, S.M. A randomised controlled clinical trial of palliative therapies for patients with inoperable oesophageal cancer. American Journal of Gastroenterology. 2009; 104(7): 1674-1685.

Sullivan, F., Swan, I.R.C., Donnan, P., Morrison, J.M., Smith, B.H., McKinstry, B., Davenport, R.J., Vale, L., Clarkson, J.E., Hernández, R., Stewart, K., Hammersley, V., Hayavi, S., McAteer, A., Gray, D. and Daly, F. A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell’s palsy: the BELLS study. Health Technology Assessment. 2009; 13 (47).

Sussex, J. and Farrar, S. Activity-based funding for National Health Service hospitals in England: managers’ experience and expectations. European Journal of Health Economics. 2009; 10(2): 197-206.

Sutton, M., Elder, R., Guthrie, B. and Watt, G.C.M. Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers. Health Economics. 2009; 19(1):1-13.

Ternent, L., Vale, L., Buckley, B. and Glazener, C. Measuring outcomes of importance to women with stress urinary incontinence. British Journal of Obstetrics and Gynaecology. 2009; 116(5): 719-725.

Tinelli, M., Ryan, M. and Bond, C. Patients’ preferences for the increasing role of the pharmacist in the management of drug therapy. International Journal of Pharmacy Practice. 2009; 17: 275-282.

Vale, L., Mowatt, G., Kilonzo, M., Zhu, S., N’Dow, J. and Griffiths, T.R.L. Economic evaluation of photodynamic diagnosis and urinary biomarkers for detection and follow-up of bladder cancer. Journal of the British Association of Urological Surgeons. 2009; 103(Supplement 4).

Vallejo-Torres, L., Morris, S., Carr-Hill, R.A., Dixon, P., Law, M.R., Rice, N. and Sutton, M. Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption. Social Science and Medicine. 2009; 69(11): 1634-1642.

van Veen, N.H.J., McNamee, P., Richardus, J.H., Cairns, W. and Smith, S. Cost-Effectiveness of Interventions to Prevent Disability in Leprosy: A Systematic Review. PLoS ONE. 2009; 4(2); e4548.

Watson, V., Ryan, M. and Watson, E. Valuing experience factors in the provision of Chlamydia screening: an application to women attending the family planning clinic. Value in Health. 2009; 12(4): 621-623.

Book Chapters

Battu, H., Ma, A. and Phimister, E. Housing tenure, job mobility and unemployment in the UK. In: Homeownership and the Labour Market in Europe. Leuvensteijn. M.V.(ed.) Oxford University Press. 2009.

Battu, H., Ma, A. and Phimister, E. Family Migrations and Labour Market Outcomes: A Panel Investigation. In: Homeownership and the Labour Market in Europe. Leuvensteijn. M.V.(ed.) Oxford University Press. 2009.

Gerdtham, U-G. Hälsoekonomi: hur ekonomi kan bidra till folkhälsan (How can economics contribute to better health). In: Folkhälsa som tvärvetenskap: möten mellan ämnen (Public Health as Multidisciplinary Research). Ejlertsson, G. and Andersson, I. (eds.) (In Swedish). Studentlitteratur AB, Lund. 2009.

Reports

Campbell, N., Macleod, U., Mitchell, E., Weller, D., Johnston, M. and Ryan, M. Establishing the potential for primary care to tackle social inequalities in established colorectal cancer. Cancer Research UK ref: C542/A6502 Research Report 2009.

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Cuthbertson, B., Rattray, J., Campbell, M.K., Gager, M., Roughton, S., Smith, A., Hull, A., Norrie, J., Jenkinson, D., Hernández, R., Johnston, M., Wilson, E. and Waldmann, C. on behalf of the PRaCTICaL study group. A Pragmatic Randomised Controlled Trial of Intensive Care post-discharge review clinics in improving Longer-term Outcomes from critical illness. The PRaCTICaL Trial. Report commissioned by the Chief Scientist Office. February 2009.

Cuthbertson, B., Rattray, J., Gager, M., Roughton, S., Smith, A., Campbell, M.K., Hull, A., Norrie, J., Jenkinson, D., Hernández, R., Johnston, M., Wilson, E. and Waldmann, C. on behalf of the PRaCTICaL study group. A Pragmatic Randomised, Controlled Trial of Intensive Care follow up clinics in improving Longer-term outcomes from critical illness. The PRaCTICaL study. Focus on Research. Scottish Government Health Directorate Chief Scientist Office, May 2009.

Farrar, S., Yi, D., Chalkley, M., Ma, A. and Sutton, M. Interim Report on the Medium term consequences of Payment by Results. Department of Health, May 2009.

Guthrie, B., Davies, H., Greig, G., Rushmer, R., Walter, I., Duguid, A., Coyle, J., Sutton, M., Williams, B., Farrar, S. and Connaghan, J. Delivering health care through managed clinical networks (MCNs): lessons from the North. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO), July 2009.

Imamura, M., Abrams, P., Bain, C., Buckley, B., Cardozo, L., Cody, J., Cook, J., Eustice, S., Glazener, C., Grant, A., Hay-Smith, J., Hislop, J., Jenkinson, D., Kilonzo, M., Nabi, G., N’Dow, J., Pickard, R., Ternent, L., Wallace, S., Wardle, J., Zhu, S. and Vale, L. Systematic review and economic modelling of the effectiveness and efficiency of non-surgical treatments for women with stress urinary incontinence. Final report submitted to NIHR HTA Programme. March 2009.

Khan, M.N.U., Quayyum, Z., Nasreen, H., Ensor, T. and Salahuddin, S. Household Costs of Obtaining Maternal and Newborn Care in Rural Bangladesh: Baseline Survey. Research Monograph Series No. 43. BRAC & University of Aberdeen. December 2009.

Lois, N., Burr, J., Norrie, J., Vale, L., Cook, J., McDonald, A. and Ternent, L. Clinical and cost-effectiveness of internal limiting membrane peeling for patients with idiopathic full thickness macular hole. Final grant report submitted to Chief Scientist Office. September 2009.

Pol, M. van der. and McKenzie, L. An Economic Evaluation of Tele-Endoscopy clinics in Shetland. Report to the Scottish Centre for Telehealth. May 2009.

Ryan M. Using discrete choice to elicit patient and public preferences. Final Report to the Health Foundation. July 2009.

Skåtun, D. and Elliott, R. (with Geue, C., Eberth, B. and Ikenwilo, D.). Nurse Labour Markets: Preferences for pecuniary and non-pecuniary rewards. Economic and Social Research Council Final Report, 2009.

Tinelli, M., Scotland, G. and Watson, M. An economic evaluation of the NHS Grampian Chlamydia Testing Study. NHS Grampian Final Report. June 2009.

Tucker, J., Parry, G., Draper, E., McKee, L. and Skåtun, D. The impact of changing workforce patterns in UK paediatric intensive care services on staff practice and patient outcomes” Final report National Institute for Health Research Service Delivery Organisation Programme. March 2009.

Other Publications

Caskey, F., Jager, K., Elliott, R. and MacLeod, A.M. for the EVEREST Study Group. The EVEREST Study: Explaining variation in RRT through expert opinion secondary data sources and trend analysis. NDT Educational. February 2009.

Caskey, F., Jager, K., Elliott, R. and MacLeod, A.M. for the EVEREST Study Group. The EVEREST Study: Explaining variation in RRT through expert opinion secondary data sources and trend analysis. ERA-EDTA Registry Newsletter. February 2009.

Elliott, R. Distributing public funding to the NHS in England: taking account of differences in local labour market conditions on NHS recruitment and retention. HERU Briefing Paper, University of Aberdeen, January 2009.

Hernández, R. Economic Evaluation of Economic Administration of Prednisolone and/or Acyclovir for the Treatment of Bell’s Palsy. HERU Briefing Paper, University of Aberdeen, April 2009.

Ljungvall, Å. and Gerdtham, U-G. More equal but heavier: A longitudinal analysis of income-related obesity inequalities in an adult Swedish cohort. Department of Economics, Lund University Working Paper 2009:3. March 2009.

Pol, M. van der. Economic Evaluation of Tele-Endoscopy Clinics in Remote Locations. HERU Briefing Paper, University of Aberdeen, November 2009.

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Invited Presentations

Ma, A., Elliott, R. and Battu, H. Geographical Wage Variation and the Labour Market for Teachers. Supporting Regional Analysis with Devolved Administrations, Opening of the VML (ONS) in Glasgow, organised by the Micro-data Analysis and User Support team. January 2009.

McNamee, P. Cost-effectiveness in health care. Royal College of Physicians Edinburgh Rheumatology Symposium. Edinburgh, September 2009.

Pol, M. van der. Valuing future health: empirical evidence and implications for discounting practices. Valuing Future Flexibility. Institute for Advanced Studies, Glasgow, September 2009.

Pol, M. van der. How to conduct a cost-effectiveness analysis of telemedicine/telecare. Telemed and eHealth, Royal Society of Medicine, London, November 2009.

Ryan, M. Valuing the Patient Experience in health care: going beyond QALYs and using Discrete Choice Experiments. 2nd Conference on Conjoint Analysis in Health Care, Delray Beach, Florida, March 2009.

Ryan, M. Measuring values in HTA: Going beyond QALYs. Health Technology – burden or benefit in an economic crisis? 12th European Health Forum Gastein, Bad Hofgastein, September 2009.

Ryan, M. Measuring utility within pharmacy. ESRC Funded Seminar Series, University of Aberdeen, October 2009.

Ryan, M. Values missed by HTA – an Alternative Approach. Drug Information Association Health Technology Assessment Forum, Hotel Marriott Rive Gauche Hotel, Paris. November 2009.

Vale, L. on behalf of the SUI review group. Effectiveness and cost-effectiveness of non surgical treatments of stress urinary incontinence. Association of Continence Nurses. Coventry. June 2009.

Conference Presentations – Papers Available

Combes, J-B., Elliott, R. and Skåtun, D. Skill Mix and Labour Market Competition: how hospitals adjust the nursing skill mix in response to local labour market conditions. HESG, Sheffield July 2009.

Eberth, B. and Smith, M.D. Modelling the participation decision and the time spent on sporting activity in Scotland. Scottish Economic Society Annual Conference, Perth. April 2009.

Hernández, R. and Cuthbertson, B. PRaCTICaL Trial: cost-effectiveness analysis of Intensive Care post-discharge review clinics. 6th Annual Meeting of the Health Technology Assessment International (HTAi). Singapore, June 2009.

Jenkinson, D., Imamura, M., Hislop, J. and Vale, L. for the Stress Urinary Incontinence Review Group. Non-surgical treatment for stress urinary incontinence in women: a systematic review incorporating a mixed treatment comparison analysis. Health Technology Assessment International (HTAi). Singapore, June 2009.

McNamee, P. and Acharya, A. Public-private partnerships to reduce maternal mortality: silver bullet or smoking gun? 26th International Population Conference of the IUSSP. Morocco, September 2009.

Mentzakis, M., McNamee, P. and Ryan, M. Valuing care experience using the compensating income variation method: a comparison of subjective well-being with health status. HESG. Sheffield, July 2009.

Mowatt, G., N’Dow, J., Zhu, S., Kilonzo, M., Boachie, C., Fraser, C., Nabi, G., Cook, J., Vale, L. and Griffiths, T.R.L. Photodynamic diagnosis of bladder cancer compared with white light cystoscopy. European Association of Urology Congress. Stockholm, March 2009.

Olajide, D. and Smith, M.D. Obesity-related disease incidence modelling using hospitalisation records: correcting for sample selection bias. Scottish Economic Society Annual Conference, Perth. April 2009.

Ruggeri, M. and Pol, M. van der. Is risk attitude really specific in a health context? iHEA. Beijing, China, July 2009.

Vale, L. on behalf of the Stress Urinary Incontinence Review Group. Non-surgical treatment for stress urinary incontinence in women: a systematic review and economic analysis. Association for Continence Advice. Coventry, June 2009.

Other Oral Presentations

Becker, F. Patterns in dietary and physical activity behaviour in Scotland consequences for obesity intervention. Annual Public Health Conference. Peebles, November 2009.

Caskey, F., Stel, V.S., Jager, K.F., Kamer, A., McLeod, A., Elliott, R. and Geue, C. The EVEREST Study: Exploring the worldwide variation in RRT incidence. World Congress of Nephrology. Milan, May 2009.

Elliott, R. and Geue, C. The EVEREST Study: Exploring the worldwide variation in RRT incidence. World Congress of Nephrology 2009. Milan, May 2009.

Farrar, S., Yi, D., Ma, A., Sutton, M. and Chalkley. M. Behaviour of English hospitals in the early stage of implementing payment by results: Difference in differences analysis using Scotland as control. ‘Exploiting Existing Data for Health Research.’ Scottish Health Informatics Programme. St. Andrews, September 2009.

Farrar, S., Yi, D., Chalkley, M., Sutton, M. and Ma, A. Impact of Payment by Results on providers and services: latest findings from the national evaluation. Department of Health, Health Reforms Evaluation Programme meeting, London, November 2009.

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Farrar, S., Yi, D., Chalkley, M., Ma, A. and Sutton, M. Impact of Payment by Results on providers and services: latest findings from the national evaluation. Department of HealthPRP Health Reforms and Evaluation Programme. London School of Hygiene and Tropical Medicine, London, November 2009.

Kilonzo, M. Economic evaluation of photodynamic diagnosis and urinary biomarkers for detection and follow-up of bladder cancer. British Association of Urological Surgeons. Glasgow, June 2009.

Ludbrook, A. Alcohol intake: review of evidence of effectiveness of interventions and policy options. Health Behaviour Change Symposium: Do we know what works and is this being implemented in Scotland? Edinburgh, March 2009.

Ludbrook, A. Can the UK cohort resource be used to answer key scientific questions about the emergence and development of the obesity epidemic? Population interventions. The Wellcome Trust. London, March 2009.

Ludbrook, A. Minimum pricing: economic overview. Westminster Health Select Committee. Edinburgh, June 2009.

MacDiarmid, J.I., Loe, J., Douglas, F., Ludbrook, A., Comerford, C. and McNeill, G. A stakeholder-driven approach for developing a realistic framework for outcome evaluations of diet-related interventions and policy. ‘Public Health in a Change of Age’. Annual Public Health Conference. Peebles, November 2009.

McNamee, P. Effects of the Free Personal Care Policy on care decisions: what can we learn from Scottish Household Survey data? Informing Public Policy: New Agendas for Social Research Conference. National Centre for Social Research, London, April 2009.

Newlands, D., McNamee, P., Chikwama, C. and Asante, F. The effect of maternal morbidity on productivity: a household level analysis in Ghana. African Health Economics Association Conference. Accra, April 2009.

Olajide, D. and Smith, M.D. Implications of missing data amongst linked hospitalisation records. Exploiting existing data in health research conference. Scottish Health Informatics Programme International Conference. University of St. Andrews, September 2009.

Olajide, D. Deprivation and Household Effects on Healthy Eating among Children in Scotland. Annual Public Health Conference. Peebles, November 2009.

Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F. Incentives and Targets in Hospital Care: Evidence from a Natural Experiment. iHEA. Beijing, July 2009.

Quayyum, Z. Need based resource allocation as means of achieving equitable and efficient allocation for health care in Bangladesh. iHEA. Beijing, July 2009.

Skåtun, D., Elliott, R. and Geue, C. The role that working conditions play in the employment decisions of nurses. “Delivering better health services” Health Services Research Network and National Institute for Health Research Service Delivery and Organisation (NIHR SDO) Programme annual conference. Birmingham, June 2009.

Smith, M.D., Eberth, B. and Olajide, D. Heart Disease and intensity of Smoking. Exploiting existing data in health research conference. Scottish Health Informatics Programme International Conference, St. Andrews, September 2009.

Wilcox-Gok, V. and McNamee, P. Economic consequences of mental health problems in older people on other family members. Service Delivery (SDO)/Health Services Research (HSR) Annual Conference, Birmingham. June 2009.

Seminars

Lourenco, T., Grant, A.M., Burr, J. and Vale, L. The introduction of new interventional procedures in the British NHS. Quality Improvement Scotland (QIS). Glasgow, March 2009.

Ma, A., Elliott, R., Skåtun, D., Sutton, M., McConnachie, M., Morris, S. and Rice, N. Geographical Wage Differentials. Supporting Analysis with Devolved Administrations. Opening of the VML (ONS) in Glasgow. January 2009.

McNamee P. Detection of ceiling and floor effects: a quantile regression approach. Health Economics Unit. Birmingham, 2009.

Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F. Incentives and Targets in Hospital Care: Evidence from a Natural Experiment. Health Economics Research Centre. University of Oxford. May 2009.

Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F. Incentives and Targets in Hospital Care: Evidence from a Natural Experiment. Centre for Health Economics. University of York. June 2009.

Ryan, M. Measuring utility within Pharmacy. Economic and Social Research Council. University of Aberdeen. October 2009.

Smith, M.D. The ordered switching regimes model: with applications in health and education. Socioeconomic Institute. University of Zurich. February 2009.

Smith, M.D. The ordered switching regimes model: with applications in health and education. Department of Economics. Lancaster University. March 2009.

Smith, M.D. The Ordered Switching Regimes Model: with applications in health and education. Institute for Statistics. Ludwig Maximilians University, Munich, July 2009.

Smith, M.D. Applications in health of econometric models of sample selection. Economic Studies, University of Dundee. November 2009.

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Tinelli, M., Bond, C., Ryan, M. and Scott, A. QALY approach in benefit evaluation for a new pharmacy-based medicines management service. EQ-5D and SF-6D. Economics and Social Research Council (ESRC) Economic Evaluation. Aberdeen, October 2009.

Tinelli, M., Ryan, M. and Bond, C. Analysis Issues in Discrete Choice Experiments with multiple options. London School of Economics, Social Policy Department. London, November 2009.

Tinelli, M., Ryan, M. and Bond, C. Alternative approaches to modelling Discrete Choice Experiment Responses: implication to policy. London School of Economics Health and Social Care. London, May and December 2009.

Workshops

Guthrie, B., Davies, H., Greig, G., Rushmer, R., Walter, I., Duguid, A., Coyle, J., Sutton, M., Williams, B., Farrar, S. and Connaghan, J. Delivering health care through managed clinical networks (MCNs): lessons from the North. Service Delivery and Organisation (SDO) national workshop on research in managed clinical networks. Manchester, February 2009.

Ryan, M. Using Discrete Choice Experiments in Health Economics: Theoretical and Practical Issues. 3 day workshop. University of Cape Town, February 2009

Shemilt, I. and Vale, L. Incorporating economics into Cochrane protocols: Part 1. UK Cochrane Collaborators Meeting. Edinburgh, March 2009.

Shemilt, I. and Vale, L. Incorporating economics into Cochrane protocols: Part 2. UK Cochrane Collaborators Meeting. Edinburgh, March 2009.

Poster Presentations

Alyamani, N.A., Smith, M.D. Williams, D. and Petty, R.D. The impact of physician attitudes on personalised prescription of novel targeted anti-cancer drugs using predictive biomarkers. British Pharmacological Society Winter Meeting. London, December 2009.

Black, C., Sharma, P., Scotland, G., McCullough, K., McGurn, D., Robertson, L., Fluck, N., MacLeod, A., McNamee, P., Prescott, G. and Smith, C. Early referral for chronic kidney disease: the evidence and economic case. American Nephrology Association. San Diego, November 2009.

Jenkinson, D., Imamura, M., Hislop, J. and Vale, L. for the Stress Urinary Incontinence Review Group. Non-surgical treatment for stress urinary incontinence in women: a systematic review incorporating a mixed treatment comparison analysis. HTAi. Singapore, June 2009. (2nd Prizewinner)

McAteer, A., Elliott, A.M., Yi, D., Watson, V. and Ryan, M. Investigation preferences for symptom management using Discrete Choice Experiment. Society for Academic Primary Care Conference. St. Andrews, July 2009.

Policy Presentations

Farrar, S. and Yi, D. Interim report on PbR 2. External Advisory Group. Department of Health, June 2009.

Mowatt, G., Boachie, C., Crowther, M., Fraser, C., Hernández, R., Jia, X. and Ternent, L. Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura (ITP): A Single Technology Appraisal. National Institute for Health and Clinical Excellence (NICE). London, February 2009.

The Health Economics Research Unit (HERU) was established at the University of Aberdeen in 1977. The Unit is part of the Division of Applied Health Sciences within the College of Life Sciences and Medicine.

Core funding for the Unit is received from the Chief Scientist Office (CSO) of the Scottish Government Health Directorates. Substantial additional funding also comes from competitive research grants, training activities, commissioned research, and the University of Aberdeen.

We undertake substantial programmes of joint research with the Health Services Research Unit (HSRU) and Department of Economics in the University of Aberdeen Business School.

The aim of the Unit is to develop and encourage the application of appropriate economic methods to improve health and health care in Scotland.

More specifically, the aim is to:

• Researchintoeconomicapproachestohealthandhealthcareatstandardsofinternationalexcellence;

• DevelopandapplyeconomictechniquestoimprovehealthcareandpopulationhealthinScotland;

• Makeavailabletothehealthserviceabodyofexpertiseinhealtheconomics;and

• Buildandsustaincapacityintheeconomicsofhealth.

This aim is given specific form in the research programmes undertaken by HERU and in the many research projects and capacity building activities undertaken by the Unit.

Contact Details for HERU are:

The Health Economics Research UnitUniversity of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenAB25 2ZD

Tel: +44 (0) 1224 553733/553480Fax:+44(0)1224550926E-mail: [email protected]


visit us at


Health Economics Research Unit

University of Aberdeen, Institute of Applied Health Services, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD

t: +44 (0)1224 553480 / 553733 f: +44 (0)1224 550926 e: [email protected]

www.abdn.ac.uk/heruANNUAL REPORT 2010

The views expressed here are those of the Unit and not necessarily those of CSO.

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