Inter-country Differences in the Effectiveness of Medical
Interventions: a Study using "Panoramic" Meta-analysis
Department of Public Health and Epidemiology
Applications are invited for a PhD studentship funded for three years
by the MATCH collaboration at the University of Birmingham, Department
of Public Health and Epidemiology. (Annual stipend: £12,600).
First supervisor: Dr Russell Bowater
Second supervisor: Mr Alan Girling
Start date: September 2007 or as soon as possible thereafter.
Closing date for applications: 14th September 2007.
Project outline
Differences between the results of clinical trials or observational
studies conducted in different countries (e.g. UK and USA) are often
considered to be of great importance by regulators and reimbursement
agencies. The expectation of such differences may prevent changes in
clinical practice in a particular country despite quite conclusive
evidence from other countries that a certain clinical intervention is
beneficial. For example, the US Food and Drug Administration (FDA)
generally does not give licences to new treatments on the basis of
evidence from clinical trials that have been conducted outside the
USA.
Research methods will include systematic review and statistical
analysis of the results. Training in these methods will be available.
In the first instance it is anticipated that systematic searches will
be made for pre-existing reviews, rather than conducting systematic
reviews over individual RCTs. Within-country estimates of
effectiveness of different interventions can then be used as the basis
for a "panoramic" meta-analysis by intervention and country. Panoramic
meta-analysis was first developed to investigate generic hypotheses
that apply to groups of diseases and interventions. (See Bowater,
Stirling and Lilford [1]). Here it will be used to investigate whether
there are certain types of intervention whose outcomes appear not to
be affected by the country in which they are carried out - i.e. whose
outcomes are "transferable between countries". A strong case could
then be made for approving a new intervention of this type in a
particular country using studies performed outside the country
concerned. Further, it may be possible to identify groups of related
clinical interventions that exhibit similar inter-country differences
in their effectiveness. This information will then be used to quantify
the uncertainty surrounding the results of a clinical study when these
are applied in a different country. In some cases, explicit adjustment
of results may be possible. A health-economic perspective may be taken
to support the regulatory and reimbursement implications of the work.
Research environment: The studentship will be based in Professor
Lilford's research group (17 full-time members) in the Department of
Public Health and Epidemiology. He currently holds grants from EPSRC,
the HTA programme, the Department of Health, the European Union and
the Health Foundation. The expertise within the group includes
Clinical Trials, Patient Safety, Health Economics, Systematic Reviews,
Research Methodology and Statistics.
Candidate profile: The successful candidate will have a first degree
or masters degree in a subject with a strong quantitative component
and a strong interest in pursuing epidemiological research. Prior
experience in meta-analysis is not required though some basic training
in statistical methods is highly desirable.
Reference
[1] Bowater, R. J., Stirling, S. A. and Lilford, R. J. (2007). Is
antibiotic prophylaxis in surgery a generally effective treatment?
Testing a generic hypothesis over a set of meta-analyses. (Available
on request from Dr Bowater)
Applications to:
Dr Russell Bowater (PCRTempUser45@adf.bham.ac.uk), or
Mr Alan Girling (A.J.Girling@bham.ac.uk)
Dept of Public Health and Epidemiology,
Public Health Building,
University of Birmingham,
Birmingham B15 2TT
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