King’s Health
Economics (KHE)
Professor Sarah
Byford, Director
Tel: 020 7848 0198
Fax: 020 7848 0458
http://www.kcl.ac.uk/cemph
KHE and KCTU Support Request Form
King’s Health Economics (formerly CEMPH) is affiliated to the KCTU and uses the same Support Request
Form. Investigators need only complete one form, which can be submitted to either KHE or KCTU.
If you have already submitted a form to KCTU and included a request for health economics support, there
is no need to complete the form again.
Otherwise, please complete this form and return to linda.parker@kcl.ac.uk
Requests for support will be considered monthly by the KHE and KCTU management groups. Dates for KHE
proposal request review meetings, and further information on KHE collaboration, can be found on our web
pages: http://www.kcl.ac.uk/ioppn/depts/hspr/research/khe/Work-with-us.aspx
For KCTU support, please read leaflets at www.ctu.co.uk before completing this form
Q1. Contact details
Name
Tel no
Email
Preferred contact
time/day
Q2. Is the planned
project an interventional
trial?
Go to Q3
Please seek alternative support unless health
economic input alone needed
Q3. Have you already
approached Research
Design Service?
Go to Q4
Please visit the website
http://www.rds.nihr.ac.uk/
Q4. Is the planned
project funded?
Please seek advice
from the Research
Design Service
Go to Q5
Go to Q5
Go to Q6
Please seek alternative
support
Q5. Submission deadline
Q6. Planned grant
funding
1
Click here to enter a date.
Start date
End date
Click here to enter a date.
Click here to enter a date.
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King’s Health
Economics (KHE)
Q7. Planned start
date of patient
recruitment
Professor Sarah
Byford, Director
Tel: 020 7848 0198
Fax: 020 7848 0458
http://www.kcl.ac.uk/cemph
Click here to enter a date.
Q8. Describe disease
area
Q9. Has a draft case
for support been
written?
Please attach a copy with this form.
Please attach an A4 PICOT summary of your study proposal.
For your reference, see
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430448/
Q10. Funder
Please specify:
Q11. Please provide
funding call URL
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King’s Health
Economics (KHE)
Professor Sarah
Byford, Director
Tel: 020 7848 0198
Fax: 020 7848 0458
http://www.kcl.ac.uk/cemph
Q12. Services
requested
Q13. Full trial title
Q14. Trial acronym
Q15. Will patient
recruitment be:
Q16. Details of trial
Chief Investigator /
lead applicant
(provide both if
different)
Chief Investigator name
Chief Investigator email
Chief Investigator phone
Lead Applicant (if different)
Lead Applicant email
Lead Applicant phone
Q17. Details of
person collating the
costs
Name
Email
Phone
Q18. Date which
costing is required
by
Click here to enter a date.
Q19. Substantive
employer of the
Chief Investigator
Please specify:
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King’s Health
Economics (KHE)
Professor Sarah
Byford, Director
Tel: 020 7848 0198
Fax: 020 7848 0458
http://www.kcl.ac.uk/cemph
Q20. Please provide
names of any senior
KCTU staff members
who have
provisionally agreed
to be co-applicants
on this grant, if any:
Please specify:
Q21. For non-KCL
lead
applicants/Chief
Investigators,
please provide
names of any other
KCL co-applicants*:
*required to co-ordinate
KCL costs
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