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Research at York has had a direct impact on national guidance about the use of health technologies in the NHS. It provided methods that are used to assess whether a technology is expected to be a cost-effective use of NHS resources, how uncertain this assessment is likely to be and whether additional evidence is sufficiently valuable to recommend further research to support its widespread use. It has had an impact on the technologies available in the NHS and the evidence available to support their use: improving patient outcomes; saving NHS resources and strengthening the evidence base for clinical practice. It gives an explicit signal and incentive to manufacturers; informing development decisions and the type of evidence collected. It has had an international impact on how the adequacy of evidence is judged and research is prioritised; particularly in recent reforms in the United States (US) where the principles of this value of information (VOI) analysis are informing the prioritisation of $3.8bn for `comparative effectiveness research'. It has also informed the methods used in low and middle income countries, especially national agencies in health care systems in South East Asia and South America, as well as global funding bodies.
A team at the University of Liverpool has undertaken research that has informed practice and policy worldwide in the management of patients presenting with newly diagnosed epilepsy, which has achieved international impact on health. Seizures are common and 3-5% of the population will be given a diagnosis of epilepsy during their lifetime. Decisions about when to start treatment, and if so with which drug are crucial and can have a significant effect on outcomes for the individual and have significant economic consequences for society. The research includes the undertaking and analysis of data from randomised controlled trials. The data analysis is based on the statistical research initiated by Dr Paula Williamson while in the Department of Mathematical Sciences at the University of Liverpool between 1996 and 2000. The research identified the most appropriate first line treatments for patients with newly diagnosed epilepsy, addressing both clinical and cost effectiveness. This work has underpinned national policy and triggered the most recent update of the NICE (National Institute for Clinical Excellence) epilepsy guidelines in 2012.
A programme of methodological research undertaken by the University of York has shaped the economic evaluation methods used by the National Institute for Health and Care Excellence (NICE) since its inception, to assess the cost-effectiveness of healthcare interventions. Therefore the methods developed by York underpin many of the healthcare decisions by NICE on which new and existing interventions and programmes should be funded and used in the NHS. The methods used by NICE have also had a major influence on the approach taken to technology assessment internationally and so York's underpinning research has had wide impact beyond the UK.
About 800,000 people are living with Alzheimer's disease in the UK today, at a cost of about £23 Billion/annum. Researchers in Exeter produced a report in 2010 about the effectiveness and cost- effectiveness of available drugs, which formed the basis for revised NICE guidelines (2011), recommending more widespread drug usage. 2012 NHS data showed a big increase in drug prescribing since 2010. We estimate that if the 110,000 people with untreated mild disease at the time of the report are now being treated, there would be an average delay in time to admission to care of 13,000 person years.
The World Health Organization (WHO) estimate 3.3 billion people are at risk of malaria, with 219 million cases and over half a million deaths annually. The Liverpool School of Tropical Medicine (LSTM) has applied new methods of research synthesis to malaria, and the results of this work have directly influenced important global decisions on malaria policies, including the adoption of new antimalarial drugs. In this case study, we report on the influence of the LSTM on malaria control over the last 15 years by preparing rigorous, up-to-date, timely systematic reviews on malaria. This work has also contributed to substantive improvements in the methodological rigor and transparency of the WHO malaria policy group in evidence-based policy formulation and guideline development.
In a series of papers published from 1999 on, Aitken (Maxwell Institute) and collaborators applied Bayesian statistics to develop a methodology for the quantification of judicial evidence derived from forensic analyses. They proposed and implemented procedures for (i) determining the optimal size of samples that should be taken from potentially incriminating material (such as drugs seized); and (ii) the estimation of likelihood ratios characterising evidence provided by multivariate hierarchical data (such as the chemical composition of crime-scene samples). Their procedures have been recommended in international guideline documents (including a 2009 publication by the United Nations Office on Drugs and Crime) and have been routinely used by forensic science laboratories worldwide since 2008. The research has therefore had an impact on the administration of justice, leading to a better use of evidence and accompanying judicial and economic benefits. Examples are given from laboratories in Australia, Sweden and The Netherlands.
The National Institute for health Care Excellence (NICE) in England and Wales makes timely and equitable decisions regarding the use of health technologies (medical devices and pharmaceuticals) within the NHS in order to improve patient care. Such decisions are reliant on Health Technology Assessment (HTA) — the processes of evidence generation and synthesis, and the methods that underpin these. Methods pioneered and developed at Leicester over the last 15 years are now used routinely in HTA both by NICE and the pharmaceutical industry and healthcare consultancy companies who make submissions to NICE. Internationally, these methods are also now being adopted in the US by Agency for Healthcare Research and Quality (AHRQ), as well as in rapidly developing countries such as Brazil and Colombia.
Professor Irving Kirsch has conducted a meta-analysis of both published and unpublished clinical trials of antidepressants (Kirsch et al., 2008). This analysis demonstrates that the effects of antidepressants are mostly placebo effects except with extremely severe depression. The analysis opened an international debate on antidepressant efficacy, influenced NICE guidelines for the treatment of depression (NICE, 2010), and led the scientific committee of the European Medicines Agency to reconsider its own approval of antidepressants (Broich, 2009). It also informed public opinion through widespread media coverage, and produced intentions to change prescribing habits among 44% of surveyed UK doctors. Public awareness of Kirsch's work is such that a class action has been taken against Pfizer, a large pharmaceutical company, and the Vatican has convened an international study meeting (14-15 June, 2013) to produce new recommendations for the treatment of depression.
Our research has been applied directly by Aviva plc. to develop improved products in the general insurance market (e.g. household and car) and in the more specialised area of enhanced pension annuities. As a result, Aviva has become more competitive in these markets and customers are enjoying better value for money. In the case of enhanced annuities, the benefits are in the form of higher pension income for those accurately identified as facing shortened life expectancies. Aviva is the largest insurance company in the UK and the sixth largest in the world.
Professor Hutton's research considers the biasing effect of selection of data due to consent procedures or selective reporting, and its consequences for the validity of conclusions and reliability of results. This research has had impacts on patients directly; on health and legal professionals by informing and influencing national and international guidelines for the treatment of epilepsy used by healthcare professionals and practitioners; and has provided expert evidence to legal professionals for the conclusion of civil litigations and a General Medical Council professional misconduct trial. Hutton's research also informs ethical debate associated with the validity and robustness of study results. This work has determined guidelines for ethical conduct of research, and requirements for publications, which are significant for all biomedical researchers.