Economic Evaluation alongside surgical trials meeting, Nov 2017


I recently attended a 1-day workshop on Economic Evaluations alongside surgical trials organised by the University of Bristol and the MRC Hubs for Trials Methodology Research.

The meeting was a mixture of presentations and open discussions.

As expected the majority of attendees and presenters were health economists who shared their personal experiences and methodological challenges they have faced working in surgical trials. Some practical challenges that came up where methods of cost data collection , long-term follow-up, lost to follow-up, blinding, patients attitude to risk, timing of collecting health related outcome collection.

Case studies from complete RCTs for surgery vs non-surgery (ie placebo surgery or rehabilitation) where presented with particular emphasis on the difficulties to define the non-surgical intervention in these trials as well as cross-over from the non-surgical arm (patients moving between treatments).

Modelling beyond the time horizon of the trial was presented with a case study from the EAGLE trial, with a Markov cohort model being incorporated into the trial design. Some general points being addressed included the role of decision modelling in RCTs and how can we tell in advance which trial might benefit from a model or not.

Another health economist presented the findings of a multicentre-multinational trial, pointing out the difficulties of collecting health resource use data in non-UK studies, the difficulties of mapping health care services to UK health care system as well as value sets of EQ-5D that should be applied in such cases. Her proposed approach was to take the UK perspective as a reference case and the UK EQ-5D value sets as it does not make any sense to mix and match different value sets as they represent different population preferences.

A surgeon had an interesting presentation on the importance of communication between trial team members and lessons learnt from poor communication with the health economics team.

Finally, a methodologist working in surgical RCTs provided examples of the heterogeneity of conducting surgical procedures across NHS trusts, the timing and the development of new surgical procedures, the institution vs individual surgeon training and how could these be incorporated into the trials design.