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Evaluation: clinical and economic evidence to inform decision-making

Research theme leads

Engineer futuristic screen


About this theme

We provide methodological expertise in clinical epidemiology, economic evaluation and infectious disease modelling, and use disease transmission and economic models to provide evidence on impact and cost-effectiveness of different interventions. Where empirical evidence is weak and models are uncertain, we develop new studies that strengthen clincial and epidemiological data on key factors, such as morbidity, quality of life, carriage and mixing patterns. We also oversee the evaluation of interventions in response to PHE's urgent requests and support development of methodologies for evaluating health protection interventions.

Objectives

Short-term objectives include:

  • contribute to an HPRU network on economic modelling and facilitate training of PHE staff, including linkage to the new ECDC modelling unit jointly hosted at University of Bristol; 
  • co-produce a programme of work with PHE, including urgent needs for evaluation;
  • develop and pilot methods of enhanced data collection on disease burden, quality of life and mixingpatterns for vaccine-preventable infections; 
  • evaluate selective immunisation of high-risk groups and vulnerable under-served populations, e.g. older adults with pneumococcal, flu and shingles vaccines and vaccination of MSM and migrant populations;
  • collaborate with the HPRU in Blood-borne & Sexually Transmitted Infections (HPRU BB&STI) on evaluating Hepatitis B and Hepatitis C case-finding interventions and elimination strategies;
  • develop and use STI transmission models to evaluate the impact of STI vaccination and other interventions, including the optimisation of STI screening interventions among men who have sex with men (MSM) on HIV pre-exposure prophylaxis, while incorporating behavioural effects (with HPRU BB&STI).
  • collaborate with the HPRUs on Modelling and BB&STI to evaluate the national chlamydia screening programme.

Longer term objectives are to:

  • establish a Site of Excellence in Epidemiology Research (SEER) with PHE and industry partners; 
  • collaborate with HPRU colleagues on methods to expand the use of routine surveillance data for evaluation through incorporating Multi Parameter Evidence Synthesis with disease transmission models;
  • use modelling and economic evaluations to prioritise the importance of behaviour change interventions alongside other interventions;
  • support and lead external grant applications;
  • continue to provide clinical, epidemiological, infectious disease and economic modelling expertise to evaluations of interventions;
  • develop cases studies that show how modelling and economic evaluation can include diverse populations and assess impact of interventions on health inequalities;
  • demonstrate how our work has strengthened clinical information, disease surveillance and health protection priorities.

Key projects and outputs

Viral hepatitis case-finding, prevention, and elimination: There has been an expansion in novel Hepatitis C care pathways. We will collaborate with HPRU BB&STI on studies to estimate the cost-effectiveness of novel Hepatitis C and Hepatitis B case-finding pathways – such as through pharmacies, homeless services, prison and A&E.

Clinical epidemiology: The true burden of some diseases and therefore the effectiveness and cost-effectiveness of vaccines and other interventions to prevent them may be under-estimated (due to underreporting milder disease, limitations of surveillance, and insufficient quality of life data). We will design and pilot a prospective surveillance study to determine the clinical burden in hospital and the community for selected vaccine-preventable infections – starting with Lower Respiratory Tract Infections due to Streptococcus pneumoniae and Respiratory Syncytial Virus, and diarrheal illness in adults attributable to Clostridium difficile.

Vaccines, disease prevention and antimicrobial resistance (AMR): A gonorrhoea vaccine could be important for addressing the challenge of AMR, both directly through reducing disease transmission and indirectly by reducing the use of antibiotics. Recently a vaccine for Neisseria meningitidis was shown to have effectiveness against Neisseria gonorrhoea in clinical trials. Collaborating with an industry partner we will use dynamic mathematical models to assess the public health impact of this vaccine in the UK.

Research examples

A comparison of the cost of different methods of re-testing chlamydia positive individuals in England

Analysis of the potential for point-of-care tests to enable individualised treatment of infections caused by antimicrobial resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study

Cost-effectiveness of different interventions to improve the testing and linkage to care for people with Hepatitis C

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

 Research team

Bristol Infectious Disease Dynamics Group

 Find out more about the University of Bristol Infectious Disease Dynamics research group.