The health economics of medicines is a new theme in the Division and is led by Rachel Elliott. She is a pharmacist with a PhD in economics and focuses on the economic impact of medicines in the real world through the refinement of methodologies for economic research around medicines use, through empirical application.
Methods for the selection of medicines from multiple alternative strategies:
The economic impact of interventions to improve medicines safety and medicines use by patients:
Selection of Acceptable Anaesthetics in Adult & Paediatric Day Surgery
Primary head-to-head comparisons of day case anaesthesia in both adults and children (DH; with Manchester and Wirral) was the largest study carried out to date in this therapeutic field. Methods used were head to head randomised controlled trials, observational data collection, probabilistic economic analysis.
Key Publications
Elliott RA, Davies LM, Payne K, Moore JK, Harper NJN. Costing day case anesthesia: obtaining accurate patient-based costs for adults and children. International Journal of Technology Assessment in Health Care 2004; 20; 552-561.
Payne K, Elliott RA, Moore JK, Bennett J, Lawrence G. Day case anaesthesia: what would the patient prefer? Clinician in Management 2004; 12: 133-139.
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Selection of Safe NSAID Strategies in Chronic Analgesic Use
A recent notable project in the theme of medicines safety and efficiency modelled NSAIDs and COX-2 inhibitors in long term use, research urgently required as published trial data do not provide head-to-head comparisons.
This study used indirect comparison meta-analysis, synthesis of cost, cost effectiveness and net benefit data (principally non-parametric bootstrapping, regression and simulation techniques, probabilistic and Bayesian economic analysis techniques).
Key Publications
Hooper L, Brown TJ, Elliott RA, Payne K, Roberts C, Symmons D. Relative effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review. British Medical Journal 2004; 329: 948-952.
Elliott RA, Hooper L, Payne K, Brown TJ, Roberts C, Symmons D. Preventing non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: are older strategies more cost effective in the general population? Rheumatology 2006; 45: 606-613. [Subsequently abstracted and featured in: Research Highlights: Economic analysis of gastroprotective treatments in patients with chronic arthritis. Nature Clinical Practice Rheumatology(2006) 2, 406 doi:10.1038/ncprheum0241].
Brown TJ, Hooper L, Elliott RA, Payne K, Webb R, Roberts C, Rostom A, Symmons D. A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review with economic modelling. Health Technology Assessment 2006; 10: (38) 1-202.
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Prevention of Osteoporosis in JIA
Use of economic models to explain medicines-taking behaviour, quantify patient preferences for different medicines, and systems for medicines delivery.
Key Publications
Elliott R, Tully M. AL-Sharhan F. Eliciting patient preferences for day surgery anaesthesia. Journal of Social and Administrative Pharmacy 2000; 17: 194-201.
Payne K, Elliott RA, Moore JK, Bennett J, Lawrence G. Day case anaesthesia: what would the patient prefer? Clinician in Management 2004; 12: 133-139.
Payne K, Elliott RA. Using discrete choice experiments to value preferences for pharmacy services. International Journal of Pharmacy Practice 2005; 13:1-12.
Seston E, Elliott RA, Noyce PR, Payne K. Women’s preferences for the provision of emergency hormonal contraception services: Results of a stated preference discrete choice experiment. Pharmacy World and Science January 2007. http://dx.doi.org/10.1007/s11096-006-9068-9.
Gidman WK, Elliott RA, Payne K. Parents’ preferences for attributes of child day case surgery provision: applying the discrete choice and graded pairs preference elicitation methods. Paediatric Anaesthesia 2007.
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Measuring True Resource Consumption of Medicines Use
Key Publications
Elliott R. An analysis of the drug costs for the management of chemotherapy-related side effects in advanced colorectal cancer. Journal of Oncology Pharmacy Practice 1996; 2: 186-190.
Al-Ageel S, Elliott R, Noyce P. Obtaining accurate patient-specific peri-operative anaesthetic costs in orthopaedic anaesthesia. International Journal of Pharmacy Practice 2001: 9 (suppl): R8.
Payne K, Elliott RA, Davies LM. Estimating the semi-fixed costs of a day-case episode. Value in Health 2001; 4: 466.
Elliott RA, Davies LM, Payne K, Moore JK, Harper NJN. Costing day case anesthesia: obtaining accurate patient-based costs for adults and children. International Journal of Technology Assessment in Health Care 2004; 20; 552-561.
Elliott RA, Thornton J, Webb AK, Dodd M, Tully M. Comparing costs of home versus hospital-based treatment of infections in adults in a specialist cystic fibrosis centre. International Journal of Technology Assessment in Health Care 2005; 21: 506-10.
Thornton J, Lunt M, Ashcroft DM, Baildam E, Foster H, Davidson J, Gardner-Medwin J, Beresford M, Symmons D, Thomson W, Elliott RA. Costing juvenile idiopathic arthritis: examining patient-based costs during the first year after diagnosis. Submitted to Rheumatology, June 2007.
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PINCER stands for a cluster randomised trial to determine the effectiveness, costs/benefits and acceptability of a pharmacist-led, IT-based intervention compared with simple feedback in reducing clinically important instances of potentially hazardous prescribing and medicines management in general practice.
(Funded by Patient Safety Research Programme with Manchester, Edinburgh, Principal Investigator: Prof Tony Avery)
The study is ongoing. Rachel Elliott is leading the economic analysis. The principal objectives of this part of PINCER are to:
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Identify and value the resource use associated with the interventions used in the trial.
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Identify and value the impact on patients of the interventions.
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Identify and value the resource use associated with reduced instances of potentially hazardous prescribing ("error") in primary care.
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Assess the relative value for money of the interventions.
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TARGET
Target logo
TPMT: Azathioprine Response to Genotyping and Enzyme Testing (TARGET) trial with colleagues in CIGMR (Prof Bill Ollier), Nowgen (Dr Katherine Payne), Pharmacy (Prof Brian Houston, Dr Julie Andrews, Dr Rachel Elliott), Medicine (Prof David Ray, Prof Chris Griffiths, Dr Jon Shaffer, Dr Ian Bruce, Dr Kay Poulton) and statistics (Dr Steve Roberts) we are conducting a randomised controlled trial to establish the effect of using a pharmacogenetic test to reduce adverse drug reactions. This is a multi-centre multidiciplinary trial to develop effective pharmacogenetic testing in clinical practice. (Funded by DH, with Manchester, Principal Investigator: Prof Bill Ollier)
The study is ongoing. Rachel Elliott is contributing to the economic analysis.
Dissemination to date:
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Best poster British Pharmaceutical Conference 2006 Fargher EA, and TARGET team.
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Best poster CMMC R&D Conference 2007 Fargher EA, and TARGET team.
Fargher E, Tricker K, Newman W, Elliott R, Roberts SA, Shaffer JL, Bruce I, Payne K. Current use of pharmacogenetic testing: A national survey of thiopurine methyltransferase (TPMT) testing prior to azathioprine prescription. Journal of Clinical Pharmacy and Therapeutics 2007; 32: 187-195.
Exploring the use of discrete choice experiements to elicit peoples' preferences for a pharmacogenetic test. Emily Fargher, Rachel Elliott, Julie Ratcliffe, Karen Tricker, Wiulliam Newman, Katherine Payne. Economics of Genetic Technologies Seminar Series, Nov 2006, University of Oxford.
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Hello, it's the Pharmacist Calling
This completed "proof of concept" study aimed to assess the cost effectiveness of pharmacists giving advice via telephone, to patients receiving a new medicine for a chronic condition in England (with London, Brighton, Principal Investigator: Prof Nick Barber).
The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control, (23% vs 34% p=0.021). The intervention was dominant (less costly and more effective).
Prizes
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Pfizer Best Practice Awards 2003 (finalist) with Barber N, Horne J, Clifford S, Darracott S.
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Pharmaceutical Care Awards 2003 (runner-up) with Barber N, Horne J, Clifford S, Darracott S.
Key Publications
Clifford S, Barber N, Elliott RA, Hartley E, Horne R. Patient-centred advice is effective in improving adherence to medicines. Pharmacy World and Science 2006; 28: 165-170. http://dx.doi.org/10.1007/s11096-006-9026-6.
Elliott RA, Clifford S, Barber N, Hartley E, Horne R. The cost effectiveness of a pharmacy advisory service to improve adherence to medicines. Pharmacy World and Science 2007 in print.
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Home-Based Management of CF Respiratory Infections
This University of Manchester funded PhD project was completed by Judith Thornton, supervised by Rachel Elliott and Mary Tully (Manchester) in collaboration with Kevin Webb and Mary Dodd (Manchester Adult CF Unit, Wythenshawe Hospital).
This study is the largest of its kind, and shows that home management of CF respiratory infections is cheaper than hospital-based, but is associated with poorer patient outcomes.
Key Publications
Thornton J, Elliott RA, Tully M, Webb K, Dodd M. Long-term clinical outcome of home and hospital intravenous antibiotic treatment in adults with cystic fibrosis. Thorax 2004; 59: 242-246.
Elliott RA, Thornton J, Webb AK, Dodd M, Tully M. Comparing costs of home versus hospital-based treatment of infections in adults in a specialist cystic fibrosis centre. International Journal of Technology Assessment in Health Care 2005; 21: 506-10.
Thornton J, Elliott RA, Tully M, Webb K, Dodd M. Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: a comparative study of hospital and home-based care. Journal of Cystic Fibrosis 2005;4: 239-247.
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Selection of an MRSA Prophylaxis Strategy in Surgery
An ongoing DH funded project is a systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery (PI: Prof Mark Sculpher, York).
Our overall objective was to determine whether there is a level of MRSA prevalence at which a switch from non-glycopeptide to glycopeptide antibiotics for routine prophylaxis is indicated in surgical environments with a high risk of MRSA infection.
An indicative decision analytic model has been developed to compare vancomycin with a cephalosporin and with a combination of vancomycin and cephalosporin, using hip arthroplasty as an exemplar.
Key Publications
Cranny G, Elliott RA, Weatherly H, Chambers D, Hawkins N, Myers L, Sculpher M, Eastwood A. A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery. NHS HTA R&D Programme, DoH, London, 2006.
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