economics-epidemiology collaboration james g. kahn, md, mph professor of health policy,...
DESCRIPTION
Why collaborate? Regardless of timing - amplify impact of epidemiologic study ▫Descriptive & interventional If prospective: Influence epidemiologic design as member of team Fully explore and refine economic question(s) Better measurement of: ▫costs - for program (concurrent costing, time and motion) and household (interviews) ▫health events and associated medical utilization Accelerate economics resultsTRANSCRIPT
![Page 1: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/1.jpg)
Economics-Epidemiology CollaborationJames G. Kahn, MD, MPHProfessor of Health Policy, Epidemiology, & Global HealthUniversity of California, San Francisco
![Page 2: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/2.jpg)
Overview• Why collaborate?• Examples from my work• Funding & timing• Challenges• Useful practices
![Page 3: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/3.jpg)
Why collaborate?• Regardless of timing - amplify impact of epidemiologic
study▫ Descriptive & interventional
• If prospective:• Influence epidemiologic design as member of team
• Fully explore and refine economic question(s)
• Better measurement of:▫ costs - for program (concurrent costing, time and motion)
and household (interviews)▫ health events and associated medical utilization
• Accelerate economics results
![Page 4: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/4.jpg)
Collaboration examples from my work• PETRA PMTCT studies, via UNAIDS
(coordinating unit)
• Tororo HBAC (Home-Based AIDS Care), with CDC Kenya
• Community Integrated Prevention Campaign, with Vestergaard Frandsen & Kenya partners
• SEARCH and related studies of ART expansion in Uganda and Kenya, with UCSF AIDS Program
• HOPE – keeping IDUs in ART care (U.S.), NIDA-funded research, U. of Miami
![Page 5: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/5.jpg)
Funding and timing of economics portion• Part of original award: more timely, can
strengthen initial proposal, but often limited amount, may be questioned prior to efficacy data.
• Supplement to original award: Can occur once efficacy known, larger amount, but missed chance for parallel data collection.
• Separate flexible economics funding: wonderful if possible.
![Page 6: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/6.jpg)
Challenges• Education on economics
▫ terms & concepts (eg economic vs financial costs, time and motion, sensitivity analyses, ICERs),
▫ methods (eg survey approaches, forest / trees)
• Education on epidemiology▫ My perspective as MD/epidemiologist is atypical … health
economists might require more assistance on epidemiology
• Occasional temptation to:▫ treat preliminary favorable results (which may have order-of-
magnitude errors) as meaningful
▫ tweak decisions eg on program implementation to low cost
▫ treat high (unattractive) final ICERs as inconsequential
![Page 7: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/7.jpg)
Useful collaboration practices• Participate in protocol & operational manual development,
and work with data & statistics teams.
• Lots of team and economics meetings, and joint travel to the field.
• Hire dedicated economics RA(s), on site and at home (within constraints) – for expertise and focus. Use an economics knowledge / skills test to assess candidates.
• Specify reasonable expectations & priorities given available resources.
• Repeatedly describe and illustrate economics … develop facility to clearly explain key concepts, methods, and results (oral and written)
• Sensitivity analyses (more than usual) for persistently divergent or uncertain program costing visions
![Page 8: Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco](https://reader036.vdocuments.site/reader036/viewer/2022082723/5a4d1b1d7f8b9ab05999423e/html5/thumbnails/8.jpg)
Products•Presentations at team meetings•Abstracts & talks at professional meetings•Papers – nothing compares for formality,
comprehensiveness, shared ownership, finality. ▫Collective scrutiny of methods, findings,
conclusions.
▫Creation of common voice.
▫Sometimes intense process, always excellent resolution and product.