Health, Work and Society: Improving Health Economic Evaluations

Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers). Existing health economic evaluations have largely ignored patient and caregiver work productivity costs mainly due to the limitations in current measurement methods.

My program of research will focus on the development of methods that will provide accurate estimates of patient and caregiver work productivity costs. These methods will then be applied and tested in an economic evaluation of new treatments for recurrent Clostridium difficile infection. Ultimately, my research findings will help improve health economic evaluations for other diseases, leading to better healthcare decision making in BC, Canada and beyond.

Exploring Novel Approaches to Reduce the Prevalence of Depression

Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.

Recent analyses, however, suggest that the prevalence and burden of depression has remained the same in the last two decades, in spite of the intensified efforts to improve access to mental health services. This is mainly because not enough efforts have been spent on providing treatments that are adequate, appropriate, and equitable, and also because of the lack of investments on prevention.

In my research program, I propose to:

  1. study treatment patterns that are adequate and that work for specific group of people at specific times
  2. examine complex combinations of social factors that influence access to mental health services, and
  3. identify community-based activities that promote mental wellness and resilience. The program of research has the potential to generate recommendations at the individual, health system, and community level that can be implemented to reduce the prevalence and burden of depression over time.

Implementation of Shared Decision Making to Improve Person- and Family-Centred Care

The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.

To advance the science of implementing evidence into policy and practice, I will implement and assess evidence-based SDM tools in routine primary care, focusing on maternal health.

Key objectives include to:

  • Investigate factors contributing to successful implementation of SDM tools in routine care,
  • Adapt, implement, and assess health care professional training to support uptake of SDM,
  • Investigate how documentary film can work as a method of knowledge translation to support patients' informed choices, and
  • Evaluate partnerships between researchers and policy makers to catalyze the implementation of SDM.

This research will be used to advance person- and family-centred care in maternal health and in primary care more broadly.

The cost effectiveness of personalized medicine: Using a biomarker-driven treatment strategy for Rheumatoid Arthritis

Rheumatoid arthritis is a common lifelong disease. People with the disease suffer swelling and pain as the disease damages their joints. This leads to disabilities that can affect their ability to do day to day tasks in their personal and work lives.

The best way to slow down the damage caused by the disease is to treat it early. There are many different treatments available, but there are many people for whom each of these treatments does not work. New tests are being developed in laboratories to try and understand which treatments are likely to work for each person with the disease. These tests offer the hope that only the people who are likely to benefit from a treatment will be treated, saving money, and giving patients effective treatment earlier. What is not known is whether these tests can actually improve patient outcomes and save costs in real life.

This study plans to estimate the value to patients and the health system of paying for additional tests to determine which treatments people are given and when.