The CLAHRC HEOM theme aims provide high quality relevant, flexible and accessible research capability in health economics and outcome measurement to the CLAHRC YH and its local NHS collaborators. The HEOM theme will explore the potential costs and effects of the alternative treatments, strategies or services and their implementation across all themes.
In understanding how the CLAHRC HEOM theme will work in practice, three objectives are specified:
1) To develop methods in economic evaluation and outcome measurement that facilitate the CLAHRC
By developing methods in economic evaluation and outcomes measurement that facilitate the CLAHRC, opportunities for capacity building and collaboration will emerge and evidence generated will be more useful for local decision making. This objective is intended to be cross cutting with objectives 2 and 3.
This component of the HEOM theme will focus on several key areas, although this does not preclude the possibility that other areas may emerge during the CLAHRC period. These key areas will include:
i) Cross sectoral outcomes. Through the work with the public health theme, it is likely that issues relating to cross sectoral outcomes and health vs. non-health outcomes will emerge. These are particularly apparent in the evaluation of interventions where benefits are wider than just health related quality of life, such as smoking cessation. How to consider wider societal benefits and the trade-off between health and non-health outcomes are also methodological challenges for economic evaluation more generally (see Work Package 1).
ii) Use of routine data sources. We will explore the use and usefulness of routine data sources such as Hospital Episode Statistics and GPRD. Methods to link these, and other routine databases, are being developed and we will engage with relevant NHS partners to exploit the use of such data, looking at the possibility of linkage between these and other datasets in generating patterns of resource use and outcomes (see Work Packages 1, 3, 4).
iii) Equity/distributional issues. We will also explore the potential for incorporating issues of equity and distribution into cost-effectiveness analysis conducted for CLAHRC (see Work Packages 1-4).
iv) Service redesign models. An important question for the NHS is how to introduce changes to the way in which services are delivered in the NHS without compromising patient care, outcomes and encountering significant costs. We will explore the use of service redesign models for a number of applications taken from CLAHRC themes (see Work Package 4).
2) To enhance capacity building and collaborations
A key aim of the HEOM theme is to build collaborations with other CLAHRC themes and linked networks, including NHS and industry. The purpose of this is:
i) To increase understanding of the economic evidence generated through dissemination, which will hopefully increase uptake and implementation.
ii) Through enhanced understanding and engagement, we will increase opportunities to forge links that will benefit CLAHRC and beyond in future grant capture.
iii) To ensure the most appropriate economic evidence is generated for the CLAHRC (see objective 3).
To enable this we will develop a set of short ‘bite sized’ workshops on the concepts and principles of HEOM. These will be delivered to NHS partners and will be tailored to their specific needs and interests. Through establishing these links we will also explore the possibility of short term fellowships (around 2-3 months), for either a health economist to spend time in the NHS or NHS research staff to spend time at a health economics academic unit (York or Sheffield). This will enable cross-fertilisation of ideas and training for both parties. It is hoped that this could lead to capacity within the NHS to conduct relevant economic analyses. The success of this component will depend on establishing the appropriate links with the NHS early on in the CLAHRC process. We will also be responsive to the training needs of other CLAHRC themes and collaborators during the CLAHRC period and as such may develop further workshops if needed.
3) To generate timely economic evidence for local decision making
The HEOM theme intends to be responsive to the needs of the other CLAHRC themes and collaborators. Any economic evidence generated must meet local needs, be timely, appropriate and useful, whilst maintaining scientific rigour.
This will consider a range of economic frameworks that could be “fit-for-purpose” for local decision makers. We will engage with other CLAHRC themes, formally (see objective 2) and informally to identify potential research questions and consider economic approaches that can be used alongside their theme. We will identify key local clinicians and decision makers and present a range of economic tools that could be useful. We will seek their input to ascertain which tools are most applicable to each research question. Where the needs identified are outside the capacity of CLARHC, we will consider applying to other funding sources (also ongoing as part of objective 2).
Alignment of the HEOM theme with the objectives of the CLAHRC
The objectives of the CLAHRC HEOM theme are intended to align with the wider aims of CLAHRC. Reducing health inequalities is a core principle to the CLAHRC and the HEOM theme will work with the Public Health and Inequalities theme in exploring methods to incorporate inequalities into cost-effectiveness studies. The intention will be to present guidance on applying these methods. This will exploit data gathered from the Yorkshire and Humber population.
Patient and Public Involvement (PPI) is a critical component of CLAHRC. The HEOM theme is cross cutting over all the CLAHRC themes and will therefore link with relevant patient groups within each theme, to ensure appropriate patient and public involvement e.g., working with patients on PROMs in mental health and child health. This will ensure the outcome measures that are developed and selected are appropriate. We will also work with these groups in order to establish the best ways of collecting PROMS information and frequency for collecting outcomes. The HEOM theme will link with individual work packages that will have PPI involvement at various stages, including representatives on steering groups. We will also consult with patients as regarding resource use collection and quality of life to ensure the information we are collecting is appropriate to them, we will also consult with patients and the public on appropriate questionnaire design. In disseminating research findings we will include patient accessible journals. This will be further aided by targeting open access journals.
Through the activities of objectives 1, 2 and 3, greater collaboration within CLAHRC themes and other stakeholders will emerge. These activities will also enable greater understanding and appreciation of health economics concepts and hopefully the capacity for further collective thinking leading to grant capture. Through the training workshops and possible fellowship within the NHS, we will help to build capacity in health economics analysis skills.