Research Assistant in Health Economics / Public Health

NPMS-HHC CIC

National Prospective Monitoring System on Use, Cost and Outcome of HIV Service Provision in
English Hospitals - HIV Health-economics Collaboration Community Interest Company

(NPMS-HHC CIC)

STUDY TITLE Evaluating mHealth technology in HIV to improve Empowerment

and healthcare utilisation: Research and innovation to Generate Evidence for personalised care EmERGE

TITLE OF POST Research Assistant in Health Economics / Public Health

TYPE OF POST Full-time

ANNUAL SALARY The basic salary for someone with an MSc will start at £18,025

(inclusive of London allowance) with an annual review. If the successful candidate with an MSc enrols for a PhD an additional £5,000 will be made available for fees each year

The starting salary of a successful candidate with a PhD will be at £22,250 with an annual review

DURATION OF THE POST Three years full-time, with a 3 month probationary period

START DATE 1^st December 2016

ANNUAL LEAVE 28 days for contracted period

LINEMANAGER Dr Sundhiya Mandalia

RESPONSIBLE TO Dr Eduard Jan Beck

ACCOUNTABLE TO EmERGE Steering Group

PERIOD OF NOTICE One calendar month

BEFORE END OF CONTRACT

Background

The National Prospective Monitoring System on the use, cost and outcome of HIV service provision in UK hospitals - HIV Health-economics Collaboration (NPMS-HHC CIC) has monitored prospectively the effectiveness, efficiency, equity and acceptability of treatment and care since 1996 and professionals at the NPMS-HHC Coordinating and Analytic Centre (CAC) have developed expertise in analyzing the use, cost, outcome and impact of HIV service provision in countries across the world.

The EmERGE study investigates for patients living with stable HIV infection that the introduction of a mHealth intervention provides a cost-effective alternative to more frequent routine HIV outpatient clinic appointments. Enhanced mHealth functions will be explored as part of the co-design process to offer the potential of reducing outpatient appointments and enhancing the management of these stable patients. This is an EU funded study which addresses self-management of health and disease using mHealth applications for disease management and focuses on the following:

National Prospective Monitoring System on Use, Cost and Outcome of HIV Service Provision in
English Hospitals - HIV Health-economics Collaboration Community Interest Company

(NPMS-HHC CIC)

i) The proposed mHealth platform will empower patients living with stable HIV infection to manage their own health and disease by:

using mHealth to inform patients of their key laboratory results (e.g. CD4 counts and viral load results)
using mHealth to personalise healthcare to meet the needs of individual patients, for instance by recording their adherence levels and assessing their frailty status in older people living with HIV, thereby enabling healthcare interactions to be directed to the individual needs of patients

ii) The mHealth platform is likely to result in cost saving for healthcare services by:

reducing the need for face-to-face consultations for people with stable HIV infection
enabling HIV health services to cope with the increasing number of people living with HIV by improving their effectiveness and efficiency and releasing staff to have more time to manage patients with more complex disease who require additional expert input

iii) The mHealth platform will enable the management of people with stable HIV infection outside institutions by:

reducing the need for face-to-face consultations
enabling ‘virtual’ interactions between patients and their HIV care providers

mHealth solutions offer an opportunity to provide alternatives to traditional care that can reduce appointments for stable patients and increase resources to be focused on those living with more complex HIV disease. A key recommendation from a recent review of literature on mHealth for HIV treatment and prevention was the need to provide actionable evidence on how to improve HIV care through incorporation of mHealth solutions, integrating technologies into existing programs.

This project has developed a mHealth platform which will be integrated with clinic ICT systems. This will be used to reduce face-to-face appointments in patients living with stable HIV. The primary intention is to provide the ‘core’ version of the mHealth application to all clinical sites to assist with provision of care in individuals living with stable HIV infection by reducing face-to-face appointments. We will explore the use of enhanced modules for stable patients and the use of ‘core’ and enhanced modules in patients with more complex needs and build these into sub-studies at appropriate clinical sites.

Robust health economic analysis and measurement of healthcare utilisation is integral to the EmERGE project from start to finish in order to accurately evaluate the potential economic benefits of introduction of mHealth technology into routine care.

The project involves 5 clinical sites in 5 European countries. These are:

1) Institute of Tropical Medicine, Antwerp, Belgium

2) Klinika za Infektivne Bolesti Dr Fran Mihaljevic, Zagreb, Croatia

3) Centro Hospitalar de Lisboa central, Lisbon, Portugal

4) Fundacio Privida Clinic per a la Recerca Biomedica, Barcelona, Spain

5) Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

This is an exciting post and is part of an EU collaboration. The post holder will be responsible for coordinating the collection of relevant health economic data from each of the 5 clinical sites and performing analyses identified and agreed by members of the NPMS-HHC CAC and EmERGE Steering Group. This will be done by working in conjunction with the Statistician responsible performing relevant statistical analyses.

National Prospective Monitoring System on Use, Cost and Outcome of HIV Service Provision in
English Hospitals - HIV Health-economics Collaboration Community Interest Company

(NPMS-HHC CIC)

Data collection and analyses

The data to be collected for the work will include:

a) data on the use of services, including number and duration of inpatient stays, number of outpatients and day-ward visits, tests and investigations performed, drugs prescribed and other relevant information

b) data on a variety of primary and secondary outcome measures as defined in the relevant study protocols, clinical stage of HIV and case-severity at the time of service use, including

underlying degree of immunosuppression, presence of opportunistic illnesses or other non-HIV related morbidities

c) calculate unit costs of outpatient, inpatient and dayward care in each clinical sites and transforming these into an average annual cost of HIV care pre- and post-introduction of mHealth

d) data on the acceptability on the services provided and used

Information on the use of hospital inpatient (IP), outpatient (OP) and dayward (DW) services 12 months pre-mHealth and 35 months post-mHealth installation will be obtained from each of the 5 clinical sites. The mean number of IP days, OP and DW visits per patient-year (PPY) will be calculated. The denominator will consist of the total duration of follow up for all patients during a calendar year. Numerators will be calculated by summing the use of IP, OP or DW services and mean use of services PPY will be calculated. The methods used for calculating the mean use of hospital services PPY will be similar to those employed in previous studies^1-4.

Annual cost PPY estimates for HIV service provision for individual people living with HIV will be produced by linking mean number of IP days, OP visits and DW visits with their respective unit costs. The total annual costs for providing services in each particular clinic will be obtained by adding the average costs for IP stays, OP and DW visits, with annual costs of ART and ‘other’ drugs, and tests and procedures performed, to arrive at the total direct annual costs for treatment and care for people living with HIV in the study. Incremental cost-effectiveness ratios (ICERs) will be calculated using primary and secondary outcome measures respectively and the respective annual costs.

Management of study

The successful candidate will take the lead in collecting the health economic data, including use, cost, outcome and other relevant data, and will work closely with other members of the team especially Dr Mandalia and Dr Beck under the general direction of the EmERGE Steering group.

Responsibilities/specific tasks of the post holder

The successful candidate will be expected to work as a team member with other members of the NPMS-HHCand other relevant professionals involved with EmERGE. Specifically this will involve:

Assist in developing specific questionnaires and tools to be used to collect relevant data and background information, in conjunction with members of the CAC, other relevant professionals and representatives of study sites of the EmERGE study;
Liaise directly with participating centres;

National Prospective Monitoring System on Use, Cost and Outcome of HIV Service Provision in
English Hospitals - HIV Health-economics Collaboration Community Interest Company

(NPMS-HHC CIC)

Collect and review relevant health economic data from each of the 5 clinical sites to calculate unit costs for inpatient, outpatient and dayward care;
If the relevant health economic data are not available or are of dubious quality, to perform a costing exercise;
Ensure that the health economic data collected at source are suitable for successful analyses;
Monitor the quality of data collected by the clinical sites;
Write or amend computer programs for data analysis in conjunction with the statistician and other professionals working on the project;
Quality control data collected from participating clinics;
Maintain the confidentiality of personal and research information collected and held on the database;
Help to write appropriate reports or journal articles and present findings from the analyses to the EmERGE consortium meetings or at other venues;
Feed this information back to the clinical site, working- or steering-groups including making appropriate recommendations if required;
Provide clinical sites with professional advice concerning local data collection requirements;
In conjunction with other colleagues take an active part in organising and preparing information or reports for EmERGE consortium meetings and post-meeting follow ups;
Maintain effective and frequent communication with all members of the NPMS-HHC CAC, especially when costing services on site, as well as with other members of the EmERGE study team;
All tasks to be completed within the time schedule agreed with Drs Beck and Mandalia Undertake other tasks related to the NPMS-HHC CIC as required by Drs Beck or Mandalia falling within an health economics remit.

Qualifications

MSc or PhD in health economics, public health or related discipline
Work experience in the collection and analyses of health economic data

The post will be of particular interest to an enterprising young researcher, who is interested in cutting-edge leading research. This post will involve travel to the five study sites and a substantial amount of processing of large data sets and as such would suit an individual who would like to pursue a career in this area of work.

Experience required

The successful candidate will have:

MSc or PhD in health economics or public health
Have had prior experience of working in the field of HIV or other healthcare settings
Experience in performing costing studies in health or other settings
Computer literacy, in particular proficiency in the use of standard word processing and spreadsheet packages such as MS Word, Excel and PowerPoint

National Prospective Monitoring System on Use, Cost and Outcome of HIV Service Provision in
English Hospitals - HIV Health-economics Collaboration Community Interest Company

(NPMS-HHC CIC)

Experience of one or more of the following statistical packages: SAS, SPSS, EpiInfo, STATA
Programming skills, including complex data set linking
- Experience of routine data collection, various data collection systems and assessment of quality of data from such systems
- A proven record of good verbal and written communication skills
  - Ability to work on their own initiative, appropriate within the context of the project, while keeping other members of the team informed and up to date
  - Good interpersonal and analytical skills with a flexible attitude at working to deadlines as well as deal with issues as they emerge and require immediate attention
  - This job description will be reviewed regularly and revised, if necessary, in consultation with the post holder, to ensure that the post continues to meet the changing needs of the NPMS-HHC CIC
  - Regular review of progress to be discussed with Drs Mandalia and Beck and an annual review of progress ensuring continuous professional development of the successful applicant

References:

1) Beck EJ, Miners A. Effectiveness and efficiency in the delivery of HIV services: economic and related considerations in the effective management of HIV disease. In: Gazzard B, Johnson M, Miles A, eds. Aesculapius medical press. London: Aesculapius Medical Press; 2001:136.

2) Beck EJ, Mandalia S, Gaudreault M, et al. The cost-effectiveness of highly active antiretroviral therapy, Canada 1991-2001. AIDS. 2004;18(18):2411-2418.

3) Badri M, Maartens G, Mandalia S, et al. Cost-effectiveness of highly active antiretroviral therapy in South Africa. PLOS Med. 2006;3(1):e4. doi:10.1371/journal.pmed.0030004.

4) Beck EJ, Mandalia S, Sangha R, Youle M, Brettle R, Gompels M, Johnson M, Pozniak A, Schwenk A, Taylor S, Walsh J, Wilkins E, Williams I and Gazzard B for the NPMS-HHC Steering Group. Lower Healthcare Costs Associated with the Use of a Single-Pill ARV Regimen in the UK, 2004-2008. PLOSONE 2012,7(10): e47376.