Bayesian Economic Evaluation:
A Multidisciplinary Future
George Sarna
17 December 2002
Summary
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MRC - mission/principles
Scientific challenges
Links with other organisations
MRC support - health economics/statistics
What we have tried and what has failed
What should we be doing to develop this
field?
MRC Background
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Set up in 1914
1 of 6 Research Councils
Funded by Government (£350m pa)
Research - Investigator initiated
Support high quality research with aim of maintaining
& improving human health
Train skilled people
Advance & disseminate knowledge & technology to
meet national needs for health, quality of life &
economic competitiveness
Principles
 Will support good work in all sectors of
medical research
 Excellence is key
 Proposals from all areas compete for funding
available
 Do not as a rule earmark funds for particular
topics though good proposals in strategic
areas may receive priority
Biomedical Research
Post-genome
Health of the Public
“continuum”
Challenges Ahead
Individual
Animal
Organ
Understanding
Health & Disease
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prevention
diagnosis
treatment
Cell
Genome
Environment
Families
Population
Science & Policy
 Data integration
 New diagnostics
 Translation
 Multidisciplinary working
 Forging Partnerships
 Training and retaining
researchers
 Engaging the public
Short versus long term funding
Short term versus long term gross research spend (2000/01) - £m
300
250
Research spend (£m)
200
Long term
150
Short term
100
50
0
BHF
Wellcome Trust
BBSRC
CRC
Other AMRC
MRC
Health Services and Public Health
MRC Spend on People & Population Studies
MRC & Clinical Trials
PARTNERSHIPS
MRC
HDs
NICE
HTA
HDA
SDO
NEAT
Methodology Panel
Gvn - DfID, MoD etc
Charities
INDUSTRY
MRC Support
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Clinical Trials - 120 ongoing trials
 Justification for inclusion/exclusion of health
economics in applications; planned analyses
 Burden of disease, present and future resource
implications for NHS/economy
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MRC Biostatistics Unit (Cambridge)
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MRC Health Services Research Collaboration
(Bristol)
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MRC Clinical Trials Unit (London)
Multicentre Aneurysm Screening Study
(MASS - BMJ + Lancet 16 Nov 2002)
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MRC/DH funded study - Alan Scott
 Clinical analysis + cost effectiveness study
 6800 deaths in England + Wales in 2000; 2.1 %
of all deaths in men older than 65
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Screening study - ultrasound scans
 RCT of 67800 men aged 65-74 (1997-1999)
 Randomised to receive scan or not
 Primary outcome was mortality related to abdominal
aortic aneurysm
Multicentre Aneurysm Screening Study
(MASS - BMJ + Lancet 16 Nov 2002)
Clinical analysis
 Deaths - 65 (intervention) cf 113 (control)
 Risk reduction - 53%
Costs
 Additional cost of screening - £2.2m
 Cost per life year gained - £28k (4 year followup) and ?? £8k (over 10 years)
 Both within perceived NHS threshold
Policy/Practice???
What we have tried/failed
Capacity building
 HSR/Public Health Fellowships
 MSc courses - medical statistics
Failed
 Health economics: discipline hopping
scheme
Career Path and Eligibility for
Funding Schemes
PhD training
Postdoctoral
Period
NON-CLINICAL
______ Research Studentship ________
CLINICAL
Clinical Training Fellowship
______ Research Assistant on Grant ___ Research Assistant on Grant
______ Research Fellowship
______ Career Development Award ____ Clinician Scientist Fellowship
______ Senior Fellowship ____________ Senior Fellowship
University/
Clinical Appointment
OR
MRC Senior Fellow
(Clinical or NonClinical)
* Career Establishment Grant
* Co-ordinated Grants Scheme
- Centre Grant
- Co-operative Grant
- Development Grant
* Innovation Grant
Strategic Project Grant
Programme Grant
MRC Readership/Professorship
Models for Co-ops(1)
M
E
M
CORE
status only
Infrastructure
Resource
C
XBG
C
MAB
Funders’ perspective - What next?
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Emerging issues?
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What is urgent?
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What (else) is needed in terms of
infrastructure/resources - ?UK wide
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Feedback to funders - advice to applicants
The Medical Research Council
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Web Page: www.mrc.ac.uk
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Email:
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Telephone 020 7636 5422
george.sarna@ headoffice.mrc.ac.uk
Health Services Research (HSR)
The investigation of the health needs
of the community and the efficiency
and effectiveness of the provision of
services to meet those needs
Trials
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Importance of the Question
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Burden of ill health - NHS, Community, Family?
The right question: clinical, timely, feasible?
Prior knowledge & evidence - systematic reviews?
Impact? Generalisable? Particularisable?
Design
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Will the design answer the question?
Feasible? Pilot / preliminary data? Staging?
Outcome measures?
Effect sizes? Sampling size and strategy
Bias? Randomisation - 3rd party?
Council Board, Panel and Group Structure
Innovation
Grant
Panel
Council
Career
Establishment
Grants
Panel
Strategy Development
Group
Molecular and Cellular
Medicine Board
Awards Advisory
Group
Physiological Medicine
and Infections Board
Neurosciences and Health Services and
Mental Health Board Public Health Board
CrossBoard
Group
MRC Advisory Board
Investigator Initiated Funding
Schemes for Research
.
Programme Grants
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To support both focussed and more broadly based long term programmes of
research.
Co-operative Group Grants
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To establish or bring together critical research mass, in ways which add value to
individual research projects and improve the productivity of research
environments.
Development Grants – for Co-operative Groups
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To help get to the point where they can make competitive applications for
funding under the Co-operative Group Grants scheme.
Career Establishment Grants
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To provide 5yrssupport for scientists recently appointed to University academic
posts to help them to establish themselves as independent research workers
capable of winning support in open competition.
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Strategic Grants
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To support work which makes a specific contribution to MRC’s strategy
Models for Co-ops (2)
C
SF
C
CORE
status only
Infrastructure
Resource
SPG
RCT
Understanding and Treating Brain Disease
e.g. bipolar disorder
Individual
cognitive behavioural therapy
e.g. schizophrenia
e.g. Parkinson’s
Brain
antipsychotics
couple
therapy
Cell
L-Dopa,
stem cells
public
health
gene therapy
Genome
e.g. Huntington’s
Families
Population
parenting
Environment
e.g. antisocial behaviour
e.g. depression
e.g. risk behaviour
Finance
Intramural versus extramural gross research spend (2000/01) - £m
350
300
Research spend (£m)
250
200
Intramural
Extramural
150
100
50
0
BHF
Wellcome Trust
BBSRC
MRC
CRC
MRC Corporate Policies & Influences
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The following represent important elements in the way the MRC
has pursued its mission and national responsibilities to date:
 Investing in the best science, across the whole field relevant
to human health;
 Responding to, and balancing the needs of, all stakeholders;
 Meeting national (health and policy) needs; providing longterm support and critical mass;
 Building capacity (through people and in fields of research,
eg Health Services Research);
 Funding national infrastructures (eg Mary Lyon, Biobank) and
national facilities (eg HGMP) in response to investigator
demand.
People
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MRC - principles
Key scientific challenges ahead
Links with other organisations; 'boundaries'
MRC support - health economics; statistics
How to get support
What we have tried and what failed
What should the MRC be doing?