Estimation and subsequent use of health state utilities in cost-effectiveness models

The use of utilities is a key component of conducting economic evaluation to inform resource allocation decision making, specifically related to allocative efficiency based on quality-adjusted life years (QALYs). This work will have important implications for decision-making in England and internationally including the National Institute for Health and Care Excellence (NICE), who perform economic evaluations via their influential technology appraisal programme and influence guidelines internationally. Furthermore, this research will build on published International Society for PharmacoEconomics and Outcomes Research (ISPOR) good practice guidance on the identification, review, and use of health state utilities in cost-effectiveness models: https://doi.org/10.1016/j.jval.2019.01.004.

This project will explore innovative methods for the incorporation of utilities within health economic models to inform decision-making. Several factors may influence estimated and secondary use of utility values for a given disease or condition, including capturing and/or accounting for multi-morbidity, the impact of ageing, and adverse events. Appropriately accounting for these factors is important as the choice of utility values can influence estimates of cost-effectiveness and hence a decision-maker’s choice to invest in a new intervention.

This PhD builds upon the ISPOR taskforce, focusing on unresolved questions. For example, how best to simultaneously incorporate the effects of both ageing and co-morbidities over the modelling time horizon; considerations include:

– approaches for combining utilities (e.g. additive, multiplicative, or if an alternative approach is required) while avoiding double counting;

– time-dependent and varying adjustments when estimating utilities and when included in economic models (e.g. within and across cycle periods and model time horizon);

– potential bias within estimated results due to choice of method;

– appropriate evidence sources for general population utility values (e.g. anchoring age-specific utility estimates).

This project will include a systematic literature review of existing approaches for adjusting utility values for ageing and co-morbidities, which may suggest the need for the development of new conceptual and practical approaches. The identified methods shall be tested in exemplar case-studies to examine their impact on cost-effectiveness estimates, while also exploring if heterogeneous factors influence estimates (e.g. average age, disease severity, and number of comorbidities). New analyses of existing datasets may be explored, for example to derive reference utility values.

This research will provide important contributions to health economic evaluation which is of relevance to a range of stakeholders associated with health technology assessment. The successful candidate will be supervised by two members of University of Sheffield staff (with the potential for a third supervisor), who collectively have expertise in the identification and estimation of utilities values, the development of health economic models, and the application of utility values in models. Additional input will come from OpenHealth (www.openhealthgroup.com) who are part funding this PhD opportunity.

Entry Requirements:

– 2:1 (honours) undergraduate degree in a numerate subject such as health economics, economics, econometrics, operational research, mathematics, or statistics.

– Must have completed, or on the way to completing, a master’s degree at merit or distinction (or a non-UK equivalent) in a relevant subject

How to apply:

Please complete a University Postgraduate Research Application form available here: https://www.sheffield.ac.uk/postgraduate/phd/apply/applying. 

Please clearly state the prospective main supervisor in the respective box and select ‘School of Medicine and Population Health: Population Health’ as the department.

Proposed start date:

October 2024