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NDORMS DPhil & MSc by Research

OUTLINE OF RESEARCH PROPOSAL

About 25% of patients with rheumatoid arthritis (RA) require a knee or hip replacement. However, there is controversy around the risks and benefits of total knee (TKA) or hip (THA) arthroplasty for RA patients.

New biologic therapies are effective modulators of inflammation and immunity in RA. Biologics have been shown to reduce clinical measures of joint damage (erosion and joint space narrowing), but have not yet been proven to reduce TKA/THA rates. This has potentially significant implications for cost-effectiveness modelling, as the current models used by NICE guidelines assume no effect of biologics on the need for TKA/THA.

You will review the literature on the costs and outcomes of total joint arthroplasty (TJA) on RA patients as well as on the cost-effectiveness of biologics for RA. Through these you will gather a general understanding of the strengths and limitations of the models employed as well as the methods and data sources used, and assess their quality as potential modelling methods, structures and parameters for a subsequent cost-utility analysis.

Using large routinely collected primary (CPRD) and secondary care (HES) datasets, you will estimate the primary and secondary care costs of treating RA patients in the NHS before and after a TJA. You will also explore disease-specific and health-related quality of life outcomes data available and potentially work on producing estimates to feed an economic model. RA-specific estimates of costs and utility indexes related to TJA will be obtained from these datasets including primary care visits, prescriptions, referrals, and hospitalizations in the patient population for at least two years before and after arthroplasty.

As the current Birmingham Rheumatoid Arthritis Model (BRAM) assumes no effect of biologics on the need for arthroplasty, you will make the appropriate adjustments to populate and run the BRAM model with effectiveness estimates obtained from an ongoing study on the association between the use of biologics and the need for TJA in order to assess the cost-effectiveness of using biologics to prevent TJA in RA.

You will conduct a full economic evaluation following current guidelines showing solid justifications for the target population, subgroups, study perspective, time horizon, choice of outcome, methods for the estimation of resources, costs and outcome measures, sources of data, choice of model and analytic methods.

You will conduct the economic evaluation fully accounting for parameter and other sources of uncertainty and draw policy relevant conclusions. In addition, novel methods for the analysis of costs using large routinely collected datasets will be explored as you apply alternative methods to the above big healthcare data to describe and compare the NHS costs and health utility outcomes of TJA amongst patients with different types of arthritis such as RA, osteoarthritis, ankylosing spondylitis, and crystal arthritis.

THEMES

  • Epidemiology 
  • Health Economics
  • Rheumatoid Arthritis
  • Big healthcare data

FURTHER INFORMATION

Dr Rafael Pinedo Villanueva
Rafael.pinedo@ndorms.ox.ac.uk

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