Student blogs

The time for one of the most expected (and feared) courses of the Health Economics, Policy and Management programme finally arrived, and it came with a pandemic! The economic evaluation of healthcare programmes course integrates the knowledge acquired during previous courses in order to dive into the world of cost-effectiveness analyses of health interventions. This was also our first course with distance learning because of the challenging times we are living this 2020.

Schedule:

The course had a duration of 5 weeks. Lectures were conducted mostly on mornings and afternoons were reserved for group assignments. This course contained a considerable amount of time allocated for individual reading and also towards group work. I can say without hesitation that this course has required the greatest amount of time for group meetings so far during the programme, probably due to the challenges and difficulties that distance learning and social distancing bring along.

Course structure and lectures:

The course used online lectures and workshops as the two main teaching methods. The aims for the five weeks were to teach us how to perform and critically assess economic evaluations in healthcare, to calculate costs of health outcomes and different medical interventions, and to understand the basics of decision models in healthcare. The main topics covered in the lectures were:

• Principles and methods for economic evaluation
• The decision rules of cost-effectiveness analysis
• The need for Real World Evidence (RWE) and Real World Data (RWD) for assessing effectiveness and cost-effectiveness of pharmaceuticals
• Monetary valuation of health improvements
• Economic evaluation based on modelling
• Economic evaluation based on clinical trials
• The role of sensitivity and statistical analysis in economic evaluations
• Critical assessment of an economic evaluation
• The role of economic evaluation in the pharmaceutical industry

The director for this course was the head of our programme, professor Niklas Zethraeus, who is a senior researcher at the Medical Management Center and LIME (Learning, Informatics, Management and Ethics) department at KI. Prof Zethraeus has also work experience with the dental and pharmaceutical benefits agency of Sweden.

You can review Prof. Zethraeus work by clicking here: (https://staff.ki.se/people/nikzet)

Distance learning:

Even though this course was our first encounter with distance learning, I must say that we did not miss any lecture, workshop, assignment or activity that was originally planned for campus-based learning. Nonetheless, because of the nature of the course content plus the difficulties that online meetings bring along, it was a challenge for most students to keep the pace and motivation for studying. Fortunately, we managed to push and motivate each other to successfully accomplish all the aims of the course.

“Visits” to TLV and SBU:

On one hand, TLV is the governmental agency of Sweden that takes care of assessing the cost-efectiveness of new pharmaceuticals, medical procedures, medical devices and dental services, in order to determine which of them should be subsidized in the Swedish public health system. For illustration purposes, it is the Swedish equivalent of the Food and Drugs Administration (FDA) in the United States.

On the other hand, SBU is the Swedish Agency for Health Technology Assessment and Assessment of Social Services. This governmental agency takes responsibility for evaluating and communicating evidence on new health technologies and social services.

This course includes a visit to both agencies in order to get orientation and a better understanding of both institutions’ work dynamics, as well as their role in the Swedish healthcare system. Because of the pandemic and social distancing measures in Sweden, a physical visit was not possible. Nonetheless, out programme director organized two special online workshops with top employees of both agencies. We had the opportunity to discuss with them the challenges and opportunities faced in their work, as well as getting a more clear idea of how it would be like to work for a governmental agency of such nature.

Evaluation:

This course was assessed as usual with both individual and group evaluations.

• Group exercises: Our teachers provided us several times with extra exercises after specific lectures. All groups had a deadline for delivering the assignments later on that same day, which definitely helped us to cement the content covered previously in the respective lecture.
• Group evaluation: As expected, this course group evaluation was very time consuming (maybe the distance learning process had something to do with it). We were divided in groups and asked to write a reimbursement application dossier for TLV. Each group performed an economic evaluation for a new (fictitious) treatment for psoriasis. During the process we had to play the roles of applicants and TLV officials, in order to fully understand the two perspectives involved.
• Individual evaluation: This course assessed us at the end with a quite time-consuming (as usual) home exam. The class was given with 24 hours to answer the full evaluation.

Class insights…

Amy Barber (United Kingdom):

Did you find the course challenging?

The course was pretty challenging since we were given a lot of independence when doing the group assignment. That was fine though because it mirrors doing that kind of evaluation in real life.

What did you learn from this course?        

We got a good grounding in principles of Health Technology Assessment and how to read an economic evaluation critically.

How was your first experience with distance learning?   

Distance learning was a little tricky especially with the group work. We had to do calculations which would have naturally been done together in a meeting but unfortunately it seems that most groups had to nominate someone to handle the maths. It also meant that lectures were much less interactive naturally.

Camila Felix Fortis (Brazil):

Did you find the course challenging?

It was definitely challenging. The main assignment of the course forced us to be creative and critical in the context of economic evaluations while just starting to learn the concepts. We had to analyse a set of data and convince a public agency in Sweden to support the reimbursement of a drug for the main assignment. We actually framed the reimbursement dossier of the drug according to The Dental and Pharmaceutical Benefits Agency (TLV) guidelines but we had a lot of freedom to make our own judgements on how to analyse and present the data. All this planning involved long online group discussions.

From my perspective, group work is even more challenging in the economics field (to go through the calculations and way of thinking of each team member) compared to a policy or management-related assignment.

Starting the course with sparse previous knowledge through distance learning required much more individual reading and studying. Sometimes this was not enough so we could ask for support of our lecturers. Still, I should say that taking the time to go through the reading material before the lectures was time well spent.

What did you learn from this course?        

I learned how economic evaluation could inform decisions based on the way we value outcomes and costs. After understanding the different economic evaluation methods and the ways of assessing cost-effective interventions, I performed basic economic assessments (how to allocate a fixed budget choosing a set of interventions based on the incremental cost-effectiveness ratio, how to use the willingness to pay approach), learned how data can be collected to perform an economic evaluation (either by conducting it together with an Randomized Controlled Trial, reviewing the literature or collecting Real World Data), how to critically assess it and how to express different kinds of uncertainty (such as parameter and structural uncertainty) surrounding health economic evaluations using sensitivity analyses.

Another important topic was decision models. At first, I was unsure how much modelling could be useful and trustworthy for decision-making. I found in this course that modelling does provide good evidence when soundly conducted and using transparent assumptions. It is frequently unavoidable when we need to combine difference sources of data to compare alternatives or we wish to extrapolate the time horizon of the data. I also increased my knowledge about how HTA and reimbursement decisions are made in different countries (we had great lectures on real-world evidence, medical devices and HTA organizations). The career pathway of people working in the field of health economics (HTA and RWE in governmental agencies and in the pharmaceutical industry) was another highlight for me.

This was clearly a fast-paced introduction course, so I hope to learn the concepts more in depth in the advanced course.

How was your first experience with distance learning?   

Again, challenging is the best word to describe it. Especially at the beginning of the course it was tough to keep track of the content through online lectures, concerning both paying attention and learning the content. Sometimes you are in the process of “trying to formulate the question + writing it down + pressing enter” while the teacher is presenting. You then realize you lost track of what is happening.

When the lecture consisted of mostly hearing the lecturer going through slides, I felt my eyelids heavier than normal. It made a huge difference when we had both the presentation and the presenter on screen. The face of a human being instead of a voice going through slides felt somewhat more engaging. Also, it was trickier for my brain to start “multi-tasking” (checking your e-mail or reading the news while listening to a lecture is tempting but it can make it hard to follow through).

We had different lecturers and I appreciated the efforts on interaction. Some speakers tried different strategies to engage, such as quizzes and “break out rooms” – the class was divided into smaller groups to discuss questions. Additionally, there were lectures that one teacher took the role of paying attention to the chat and take the questions that come up whilst the speaker was presenting. It led to the questions being answered more promptly so we could clarify points “on demand”, mimicking a classroom.    

As expected, another particularly complicated situation was the group work. The assignments required a lot of discussion and I found myself speaking to my colleagues through Zoom mostly everyday.

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Hope you enjoyed the course review! Stay tuned for the last course review of our first year in the programme.

Godspeed,

Julio Sosa.

email: julio.sosa@stud.ki.se

Instagram: @julio.sosam