Economic analysis alongside randomised control trials & implementation studies

Overview

Economic analysis alongside randomised control trials & implementation studies

CHE staff are engaged in current and planned future projects to undertake economic analyses using data from randomised controlled trials and implementation studies conducted in low- and middle-income countries (LMICs), particularly in eastern and southern Africa.

In particular, CHE has a longstanding relationship with the Medical Research Council Clinical Trials Unit (MRC CTU) which manages and conducts a number of leading clinical trials and demonstration projects in disease areas such as adult and paediatric HIV treatment, tuberculosis and emergency care interventions.

Example publication:

  • Waddell KM, Kagame K, Ndamira A, Twinamasiko A, Picton SV, Simmons IG, Revill P, Johnston T, Newton R. Improving survival of retinoblastoma in Uganda. British Journal of Ophthalmology 2015;99(7):937-942Download from bjo

Lablite & ARROW: Young Lives

Lablite project

The Lablite project was a collaboration between CHE, the Medical Research Council Clinical Trial Unit (MRC CTU), infectious disease modellers from HIV Epidemiology and Biostatistics at University College London, and clinical research institutes in Uganda, Malawi and Zimbabwe. 

The project involved two streams - clinical demonstration projects of decentralised antiretroviral therapy (ART) based upon minimal use of laboratory monitoring and modelling/economic evaluation work to evaluate a full range of policy alternatives.

ARROW: Young Lives project

The ARROW: Young Lives project was similar to Lablite but involved the evaluation of HIV treatment alternatives for children and adolescents using data from patients in a clinical trial undertaken in Uganda and Zimbabwe.

Both projects involved the development and use of novel economic evaluation methods such as mathematical modelling, mathematical programming and value of implementation and information analyses.

They also included the collection and analysis of data directly from patients to better understand the fuller effects of alternatives including those related to informal care, indirect/productivity effects and equity concerns.


Research staff involved: Paul Revill, Susan Griffin, Simon Walker (TEEHTA team).

Example publications:

  • Revill P, Walker S, Mabugu T, Nathoo KJ, Mugyenyi P, Kekitinwa A, Munderi P, Bwakura-Dangarembizi M, Musiime V, Bakeera-Kitaka S, Nahirya-Ntege P, Walker AS, Sculpher M, Gibb DM. Opportunities for improving the efficiency of paediatric HIV treatment programmes. AIDS 2015;29(2):201-210.
  • Chan AK, Ford D, Namata H, Muzambi M, Nkhata MJ, Abongomera G, Mambule I, South A, Revill P  et al and the Lablite Team. The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. BMC Health Services Research 2014;14:352.
  • Mabugu T, Revill P, Van den Berg B. The methodological challenges for the estimation of quality of life in children for use in economic evaluation in low income countries. Value in Health Regional Issues2013;2(2):231-239.
  • Ryan M, Griffin S et al. The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. AIDS 2008;22(6):749-757. Download from AIDS

MRC CTU Trials

BREATHER

BREATHER is a multi-national study run by the Medical Research Council Clinical Trial Unit (MRC CTU) and funded by the NIHR Health Technology Assessment Programme (UK Deptartment of Health) in the UK and Ireland and the PENTA Foundation in other participating countries (Argentina, Belgium, Denmark, Germany, Spain, Thailand, Uganda, the Ukraine and the USA). 

It is a randomised trial comparing two different ways for children and young people with HIV to take antiretroviral medicines when one of their treatments is a medicine called efavirenz: taking the medicines during the week for five days and then having a break and not taking medicines for two days at the weekend (i.e. Short Cycle Therapy or SCT) versus taking the medicines every day (as is usual).

CHE is contributing to this work by conducting an economic evaluation alongside the trial to assess the cost-effectiveness of SCT compared to continuous care. We are using a multilevel modelling approach to account for the fact that patient-level resource use and health outcomes data were collected in different geographical locations. This also enables us to evaluate the generalisability of the results between countries. 

We are assessing cost-effectiveness according to the incremental net monetary benefit (NMB) estimated with country-specific thresholds. The results will provide country-specific guidance on the adoption of SCT in children and young people.

Further information can be found here: BREATHER MRC UCL homepage


CHAPAS-3

The CHAPAS-3 study is funded by a number of international development organisations, including: the European Developing Countries Clinical Trials Partnership (EDCTP), UK Medical Research Council (MRC UK), UK Department for International Development (DFID), the Ministerio de Sanidad y Consumo, Spain, and the Health Research Board, Ireland.  

The study is taking place in Uganda, exploring the effectiveness of the new antiretroviral Fixed Dose Combination (FDC) and single drugs in HIV infected children in Africa, as well as how effective different drug combinations work in treating HIV. It is also evaluating pharmacokinetic effects, the cost-effectiveness of the different antiretroviral regimes, and the adherence and acceptability of the drugs.

The results of the study will be used in the WHO 2015 Guidelines recommending abacavir first-line for HIV-infected children.

Further information can be found here: CHAPAS-3 MRC UCL homepage.


Research staff involved: Paul RevillJessica Ochalek (TEEHTA team).