PhD Studentship
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
[sursa beasiswa]
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