Summary of current HEOM projects 

HEOM009

Health Economics Advice to the Vale of York Clinical Commissioning Group

Contacts: Laura Bojke and Gerry Richardson

The aim of the collaboration is to increase the economic input into decisions made by the Clinical Commisioning Group around which interventions and/or services to commission (or de-commission). This evidence must meet local needs, be timely, appropriate and useful, whilst maintaining scientific rigour. There are a series of projects which sit under this study.  Due to the nature of this work some of these projects are now complete so please check the completed projects list.

Read about our work with the Vale of York Clinical Commissioning group in Issue 4 of our newsleter.
HEOM009a

Health Economics Advice to the Vale of York Clinical Commissioning Group


Care Hubs evaluation


Contacts: Laura Bojke and Gerry Richardson


We are assessing the potential cost-effectiveness of the pilot Care Hubs implemented in York, Pocklington and Selby. These “hubs” all focus on reducing non-elective hospital inpatient admissions and/or length of stay at the hospital, but provide very different levels/types of care for differing communities. 

We are conducting exploratory analyses using Hospital Episode Statistics, to assess whether each type of hub is cost-effective. This is be based on a comparison between the predicted numbers of admissions (without the hub) versus the observed number of admissions post implementation. We are describe characteristics of the hubs that are potential drivers of cost-effectiveness, by comparing the York hubs with their statistical neighbours.

HEOM009g

A collaborative partnership with the Vale of York Clinical Commissioning Group, working jointly to improve local decision making, increase involvement of decision makers in research and improve processes for prioritisation of research. Actioned through a series of timely health economics projects - ‘Added Value’ for organising Mental Health Services in the Vale of York (VoY) by continuing to fund core 24-hour service and avoiding emergency admissions

Contacts: Laura Bojke and Gerry Richardson

A short term project looking at the ‘Added Value’ for organising Mental Health Services in the Vale of York (VoY) by continuing to fund core 24-hour service and avoiding emergency admissions. 
HEOM009h

Health Economics Advice to York Clinical Commissioning Group - providing a rapid response for evidence-informed decision making


Contacts: Laura Bojke and Gerry Richardson
As panel members on the Clinical Research and Effectiveness Committee (CREC) and the Research sub group of VoY CCG our role on these committees is to ensure that wherever feasible, cost-effectiveness evidence is used in decision making. This input has impacted directly on local policy and provision of services, including the commissioning of additional rehabilitation beds to serve York and East Yorkshire.
HEOM018

ReQoL Implementation


Contact: Lizzie Taylor Buck
ReQoL (Recovering Quality of Life) is a new short generic patient reported outcome measure (PROM)
for people with mental health conditons, which was made available for use in May 2016. 

This project will focus on how to meaningfully implement the data in the NHS to improve health outcomes for patients with mental health conditions.  A licence is required to use ReQoL and these licences are free to the National Health Service and publicly funded research.  Over 91 licences have been granted to a range of organisations, including 23 mental health trusts. 
We are currently leading on implementation, collaborating with partners across the NHS to implement ReQoL.

ReQoL is currently available in English and Hindi and work is taking place to translate the questionnaire into other languages. 

Read about our work with the Leeds and York Partnership NHS Foundation Trust.
HEOM020

Assessment of the EQ-5D-5L compared to EQ-5D-3L and generation of population norms in England


Contact: Clara Mukuria


Comparing EQ-5D-5L and EQ-5D-3L data in the United Kingdom using the GP Patient Survey (GPPS). The study will also generate population norm data for the EQ-5D-5L. EQ-5D-5L was developed to address concerns with the discriminative properties of EQ-5D-3L. Results will add to the growing body of knowledge on the performance of EQ-5D-5L as well as population norm data that can be used by researchers in the UK.
HEOM021

HEE: Developing a reference protocol for expert elicitation in health care decision making


Contact: Laura Bojke

In many countries, decisions concerning the adoption of new health technologies (e.g. drugs, diagnostics) are informed by evidence relating to the cost effectiveness of competing interventions. The range of costs considered in the assessment of cost effectiveness will depend on the perspective of the analysis, with a health service perspective implying a more narrow range of costs than a societal perspective. In terms of relevant outcomes (health benefits), many national and regional decision makers require that outcomes reflect both mortality and morbidity effects, with the latter typically measured using the EuroQol 5-dimension (EQ-5D) instrument, a generic preference-based measure of health-related quality of life (HR-QOL or utility), which can be used to generate quality-adjusted life-years (QALYs).

This project considers the current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients’ characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters.

Read more about our research by reading our paper on Informing reimbursement decisions using cost-effectiveness modelling: a guide to the process of generating elicited priors to capture model uncertainties
HEOM024

A cluster randomised controlled trial to investigate the effectiveness and cost -effectiveness of a Structured Health Intervention For Truckers (The
SHIFT Study)


Contact: Gerry Richardson
Three years' work undertaken in partnership with a large transport company in the East Midlands. We have developed a Structured Health Intervention For Truckers (the SHIFT programme), a multicomponent, theory driven, health behaviour intervention designed to promote positive lifestyle changes in relation to physical activity (PA), diet, and sitting in lorry drivers.

This intervention has been informed by extensive Patient Public Involvment (PPI) involving drivers and relevant stakeholders, an observational study (n=157) and a pre-post pilot intervention (n=57) with full process evaluation. Pilot testing revealed favourable increases in PA (steps/day), reductions in fasting blood glucose, LDLcholesterol, total cholesterol and waist-hip ratio. 

Research is to evaluate the effectiveness and cost-effectiveness of the SHIFT programme using a cluster randomised controlled trial (RCT). All outcome measures will be assessed at baseline, 6-and 12-months. The economic evaluation will explore the impact of changes in outcome measures at trial completion on longer term Health Related Quality of Life via changes in the likelihood of developing certain conditions (e.g. diabetes, cardiovascular disease [CVD]).

Read the news release from the National Institute for Health Research (NIHR)
HEOM025

Going beyond health related quality of life - towards a broader QALY measure for use across sectors


Contact: Clara Mukuria

 
The aim of this project is to develop a broad generic measure of quality of life that is valued on the zero to one scale necessary to calculate Quality Adjusted Life Years (QALYs) for use in economic evaluation. Three key distinctions between existing generic health and wellbeing measures and this new instrument are: the need to be applicable across a number of sectors (health, social care, carers, and public health); the explicit role of broader wellbeing aspects within the instrument; and its intended use in economic evaluation.

The project contains six stages:

Stage 1: Establishing the domains for the QoL instrument
Identifying the domains for the instrument will draw from a number of strands of qualitative and quantitative work.
Stage 2: Generate a list of potential items
Stage 3: Test the face validity of candidate items
Stage 4: Psychometric testing of items
A large survey will be conducted to generate data for psychometric testing of the final item pool from Stage 3 (30-40 items). This will identify the final items for inclusion in the classification system to be valued. We will survey five groups to achieve an overall sample of 2,000 and ensure we cover all the groups of interest.
Stage 5: Valuation
The valuation of the instrument involves two components. A large TTO valuation exercise with a representative sample of the general public and a deliberative exercise with members of NICE Citizens Council to generate an alternative valuation and better understand the results of the TTO.
Stage 6: Implementation, dissemination, and impact
HEOM027

ESEE (Enhancing Social-Emotional Health and Wellbeing in the Early Years)


Contact: Gerry Richardson
A Community-based Randomised Controlled Trial and Economic Evaluation of the Incredible Years Infant and Toddler (0-2) Parenting Programmes
HEOM028

Stand Out in Class: Introduction of sit-stand desks to primary school classrooms


Contact: Gerry Richardson
Stand Out in Class : a pilot cluster randomised controlled trial (RCT) of the introduction of sit-stand desks to primary school classrooms over 1 academic year to inform a full trial.
HEOM029

Silver Cloud Economic IAPs - online treament


Contact: Matt Franklin

A study to evaluate the clinical and cost-effectiveness of internet-delivered interventions for symptoms of depression and anxiety disorder in Improving Access to Psychological Therapies (IAPT).

Depression and anxiety are common mental health disorders worldwide.  The UK’s IAPT programme treats people with anxiety and depressive disorders. Cognitive Behavioural Therapy (CBT) is widely used, with computerised and internet-delivered CBT  (cCBT and iCBT) being a suitable IAPT approved treatment.  iCBT has a large empirical base for treating depression and anxiety disorder.  The cost-effectiveness and impact of these interventions in the longer-term is not routinely assess by IAPT services.  

The study is a parallel-group, randomised controlled trail examining the effectiveness and cost-effectiveness of iCBT for depression and anxiety disorders against a waitlist control group.

HEOM030

Sheffield Test Bed - evaluation team


Contact: Matt Franklin

Evaluation of a £2.5m 'test-bed' innovation project with NHS Trust and CCG partners. This is for economic appraisal alongside wider evaluation activity, with the proposal currently being worked up. It is a 2 year project.

The ‘Test Beds’ are new collaborations between the NHS and innovators which aim to harness technology to address issues facing patients and the health service.  The Perfect Patient Pathway (PPP) Test Bed was created in January 2016 and was fully operational two months later with funding until March 2018 (extended until June 2018).

It covers the Sheffield city region and aims to improve the lives of people with long term health conditions using technology.

A service evaluation approach was chosen for the programme.

Eight PPP Test Bed evaluation projects (seven projects focussed on the use of technology plus a programme wide evaluation) have been developed. The evaluation’s aim is to identify PPP Test Bed programme theories and what works for whom in what circumstances.

In relation to the health economics, there has been a need to adapt to the study designs to perform some form of ‘value for money’ analysis (i.e. not necessarily a formal economic evaluation).
There are 3 projects:
1. Digital Care Home – capturing care home resident’s vital signs and sharing these digitally with nursing teams and local GPs who can check for early signs of patient deterioration to avoid secondary care emergency events.
2. QTUG device – falls-risk assessment device based on improved sensitivity (true positive) and specificity (true negative) to detect future falls in order people.
3. Insulcheck Connect - for insulin dependent individuals with diabetes.  A device fits on to insulin injector pens and records how long it is since the last injection was administered; this info is also relayed to a Bluetooth smartphone app for the patient.
HEOM031

Identifying Optimal pharmacy services

Contact: Gerry Richardson
This project will look at linking data to identify optimal pharmacy services.  This is a short term project.
HEOM032

Brittle Bone Society - Explore the potential costs of early versus later diagnosis


Contact: Tracey Young
Working with Brittle Bone Society to explore the potential costs of early versus later diagnosis. 
HEOM034

Evaluation of Core 24 Psychiatric Liaison


Contact: Laura Bojke
A short term project funded by the VoY CCG looking at the ‘Added Value’ for organising Mental Health Services in the Vale of York (VoY) by continuing to fund core 24-hour service and avoiding emergency admissions.