Developing Methods of Precision Medicine in the Psychological Treatment of Depression - Health Services Research, PhD (GW4 BioMed MRC DTP)

About the award
Supervisory Team: Prof David Richards (Lead)
Prof Rod Taylor, Dr David Kessler, Dr Fiona Warren
Location: Exeter, Medical School

Project
This project will:

a) review, develop and apply novel algorithmic approaches, including PAI, to prescribing psychological therapies for depression;

b) review and develop clinical trials designs to prepare trials of precision medicine in depression.

It is driven by meta-analyses that show little difference between approaches, all achieving barely moderate effect sizes (g = 0.4). However, retrospective trial analyses by DeRubeis at Penn State Uni., USA, have demonstrated the possibility of calculating a precision medicine prescriptive algorithm – the Patient Advantage Index (PAI) – to differentiate and predict patient response to different treatments, with the potential to double effect sizes and recovery rates by allocating patients to treatments based on PAI scores. We envisage four work stages:

1. A review of the prescriptive value of different statistical approaches to precision medicine and the evidence for their clinical application.

2. Developing methods identified in (1) further, using our NIHR HTA COBRA trial dataset (n=440) to test their predictive utility.

3. Refinement of PAI and other models through an individual patient data (IPD) meta-analysis to obtain PAI’s and other predictive algorithms from other available trial datasets of several thousand patients on psychological therapy for depression.

4. Production of recommendations for the design of the next generation of clinical trials using precision medicine approaches for psychological therapies in depression.

Significance, originality, feasibility and degree of challenge: this studentship will for the first time internationally apply precision medicine approaches to psychological therapy datasets and prepare the ground for prospective randomised clinical trials of prescriptive approaches; we have access to multiple psychological therapy trial datasets and are already collaborating with the DeRubeis lab; the work uses novel statistical techniques and is challenging per se and in its application across multiple datasets with multiple treatment comparisons.

Research training: Research training will combine the two methodological cornerstones of precision medicine: statistical analysis methods and innovative clinical trial design. The Exeter base is the IHR campus where academic health statistics and clinical trials teams are co-located providing maximum exposure to joint expertise. In the initial phase of the PhD, the student will attend the four taught modules of our MSc in Applied Health Services Research to facilitate transition from their discipline background to that of HSR. The student will spend time at Rob DeRubeis’ lab at Penn State to fine-tune their expertise in state of the art statistical methods. Later, the student will have a placement at NICE in London or Manchester to gain a first-hand appreciation of the policy application of precision medicine. As Director of Exeter CTU, Taylor has excellent links with his fellow UK CTU Directors to facilitate brief periods of student placement in these CTUs to broaden their experience of clinical trials. The student will have access to IHR and Bristol research groups including operational and behaviour change research into the effectiveness, cost-effectiveness and implementation of health interventions for NIHR, NICE and national policy makers.

Start date: October 2018

Most studentships will be 3.5 years full time or up to 7 years part-time, and can be longer where additional training is undertaken.


How to apply
APPLICATIONS OPEN ON 25 SEPTEMBER AND CLOSE AT 17:00 ON 24 NOVEMBER 2017.

IMPORTANT: In order to apply for this project, you should apply using the DTP’s online application form. More information on the application process may be found here: http://www.gw4biomed.ac.uk/projects-2/for-students/

You do NOT need to apply to the University of Exeter at this stage – only those applicants who are successful in obtaining an offer of funding from the DTP will be required to submit an application to study at Exeter.