Valuation of severe health states

We are offering up to two fully-funded, full-time, 3.5 year PhD studentships in Health Economics. We will provide the successful student with the opportunity to study in an area of health economics of direct relevance to the work of the Policy Research Unit (PRU). You will be based in the section of Health Economics and Decision Science (HEDS) which is part of the School of Health and Related Research (ScHARR), at the University of Sheffield.
You will be supervised by a team from within the PRU in conjunction with others from ScHARR. The supervisory team will be selected to reflect the research interests and expertise necessary, according to the chosen PhD topic. We will also involve advisors from the Department of Health and Social Care as part of your supervisory team.

Economic evaluation combines information on costs and benefits to inform the allocation of scarce health care resources. One of the most commonly used methods is to estimate the incremental cost per Quality Adjusted Life Year (QALY) of new health technologies. Life years gained are assigned a value on a scale anchored to one at full health and zero as equivalent to being dead which reflects the preferences associated with different levels of health. Common methods used to elicit these preferences (such as time-trade off, standard gamble or discrete choice experiments) allow states to be valued as worse than dead (SWD). However, the methods applied to enable this (both during the elicitation stage and at the data analysis stage) have been subject to criticism (Robinson and Spencer 2006). Negative health state values impact on the mean values for health states, and the scale can impact upon the relative cost effectiveness of life saving and life enhancing interventions (Roudijk et al, 2018). There have been calls for greater theoretical and empirical investigation into the issue of how to interpret scores for states rated as worse than dead since the initial valuation of instrument recommended by NICE for estimating the cost per QALY of new interventions, the EQ-5D (e.g. Dolan and Roberts, 2002). However, many uncertainties still remain and different elicitation methods can generate quite different results for SWD (Xie et al, 2016).

This PhD will contribute to methods development for eliciting social values for SWD. It will adopt a mixed methods approach, with a primary aim of understand how confident we can be that methods can elicit cardinal values for SWD. The student will initially conduct a review of theoretical and empirical work conducted internationally on eliciting SWD. This will include normative work on the implications and justification for the QALY scale (including censoring the negative values to -1); qualitative work (such as cognitive debriefing and think aloud studies) conducted alongside preference elicitation tasks, and international work that considers cultural differences that impact upon the elicitation tasks in relation to valuing very poor states.

Primary qualitative work will explore people’s thought processes when answering questions around valuation of SWD – such as how they feel about being asked to compare two very poor outcomes versus comparing two moderate outcomes. A degree of flexibility will be maintained to respond to particular issues arising from the literature review, and current/on-going relevant empirical work.
Secondary analysis will make use of existing preference elicitation data including publically available data (e.g. EQ-5D-3L data), and ScHARR held data (e.g. E-QALY and SF-6D valuation data) and will look for evidence within the data to establish the robustness of the valuations of SWD (e.g. do they correlate with a score generated by a simple scoring often known as the ‘misery score’).

The proposed start date for the project is 1 January 2020, at the latest.

Entry Requirements:
Candidates must have a first or upper second class honors degree, and a Merit at masters or significant research experience.

How to apply:
Please complete a University Postgraduate Research Application form available here: www.shef.ac.uk/postgraduate/research/apply
Please clearly state the title of the studentship, the prospective main supervisor and select ScHARR as the department.
You will also need to include:
• a covering letter explaining why you wish to apply for this studentship.
• a copy of your CV.