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Economics-Epidemiology Collaboration

Learn about the importance of collaboration in economics-epidemiology studies, with examples from the work of James G. Kahn, MD, MPH. Discover funding and timing considerations, challenges, and useful practices for successful collaboration. Contact jgkahn@ucsf.edu for more information.

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Economics-Epidemiology Collaboration

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  1. Economics-Epidemiology Collaboration James G. Kahn, MD, MPH Professor of Health Policy, Epidemiology, & Global Health University of California, San Francisco

  2. Overview • Why collaborate? • Examples from my work • Funding & timing • Challenges • Useful practices

  3. Why collaborate? • Regardless of timing - amplify impact of epidemiologic study • Descriptive & interventional • If prospective: • Influence epidemiologic design as member of team • Fully explore and refine economic question(s) • Better measurement of: • costs - for program (concurrent costing, time and motion) and household (interviews) • health events and associated medical utilization • Accelerate economics results

  4. Collaboration examples from my work • PETRA PMTCT studies, via UNAIDS (coordinating unit) • Tororo HBAC (Home-Based AIDS Care), with CDC Kenya • Community Integrated Prevention Campaign, with Vestergaard Frandsen & Kenya partners • SEARCH and related studies of ART expansion in Uganda and Kenya, with UCSF AIDS Program • HOPE – keeping IDUs in ART care (U.S.), NIDA-funded research, U. of Miami

  5. Funding and timing of economics portion • Part of original award: more timely, can strengthen initial proposal, but often limited amount, may be questioned prior to efficacy data. • Supplement to original award: Can occur once efficacy known, larger amount, but missed chance for parallel data collection. • Separate flexible economics funding: wonderful if possible.

  6. Challenges • Education on economics • terms & concepts (egeconomic vs financial costs, time and motion, sensitivity analyses, ICERs), • methods (eg survey approaches, forest / trees) • Education on epidemiology • My perspective as MD/epidemiologist is atypical … health economists might require more assistance on epidemiology • Occasional temptation to: • treat preliminary favorable results (which may have order-of-magnitude errors) as meaningful • tweak decisions eg on program implementation to low cost • treat high (unattractive) final ICERs as inconsequential

  7. Useful collaboration practices • Participatein protocol & operational manual development, and work with data & statistics teams. • Lots of team and economics meetings, and joint travel to the field. • Hire dedicated economics RA(s), on site and at home (within constraints) – for expertise and focus. Use an economics knowledge / skills testto assess candidates. • Specify reasonable expectations & priorities given available resources. • Repeatedly describe and illustrate economics … develop facility to clearly explain key concepts, methods, and results (oral and written) • Sensitivity analyses (more than usual) for persistently divergent or uncertain program costing visions

  8. Products • Presentations at team meetings • Abstracts & talks at professional meetings • Papers – nothing compares for formality, comprehensiveness, shared ownership, finality. • Collective scrutiny of methods, findings, conclusions. • Creation of common voice. • Sometimes intense process, always excellent resolution and product.

  9. Contact jgkahn@ucsf.edu

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