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Plenary Session 05: "Assessing the 'Value for Money' of Acupuncture for Chronic Pain in the UK: Many Challenges and Some Solutions" presented by: Andrea Manca, MSc, PhD

09:15 - 10:00, Regency Ballroom, Terrace Level

Andrea Manca, MSc, PhD 

Professor of Health Economics 
NIHR Career Development Fellow 
Centre for Health Economics 
The University of York, United Kingdom


Presentation Synopsis 

Economic analyses carried out to inform policy making must consider and synthesise all (relevant) evidence relating to the clinical effectiveness, patient-reported outcome measures (PROMs) and costs of the health technologies under scrutiny.  Evidence based medicine says that a quantitative synthesis of the same outcome measure from multiple IPD sources is the gold standard for deriving estimates of treatment effect, a key parameter in any policy evaluation.  Unfortunately, in practice the evidence base is often multifaceted and fragmented, comprising a mix of aggregate (AD) and individual patient level data (IPD). This talk illustrates the methodological challenges encountered (and the solutions devised) by the authors in a recent economic model which assessed the value for money of acupuncture in chronic non-cancer related pain among primary care patients.  

We had access to IPD (>18,000 patients) from 28 high quality Randomised Controlled Trials (RCTs) which evaluated acupuncture (versus either sham acupuncture and/or versus usual care) in three different conditions comprising headache, musculoskeletal pain and osteoarthritis of the knee.  The evidence base was chaotic, with the majority of the RCTs: (a) reporting different condition-specific (e.g. pain VAS, CMS, WOMAC) and generic PROMs (SF12, SF36, only two studies collected EQ-5D), (b) having different follow up durations, (c) failing to compare directly the relevant strategies.  We developed a suite of statistical models for the synthesis of continuous (heterogeneous) outcomes (i.e. change in adjusted pain score, change in EQ-5D), which embedded a series of mapping algorithms to predict individual specific EQ-5D values, and linked these to the patient adjusted standardised pain scores and predicted healthcare resource use.  

This talk will demonstrate the range of methods that can be used to deal with the challenges posed by a complex evidence base, when the purpose is to assess the value for money of competing healthcare strategies.‚Äč



Andrea Manca is Professor of Health Economics and member of the Programme for Economic Evaluation and Health Technology Assessment, part of the Centre for Health Economics at the University of York (UK), where he has been based since 1999.


Andrea is co-editor of the journal Value in Health and senior associate editor of Pharmacoeconomics Italian Research Articles.  His research interests focus on the application and development of statistical methods for the analysis of cost effectiveness and health outcomes data for decision making.  In the past few years, Andrea has developed an active interest and research portfolio relating to the economics of person-centred health care.


He has evaluated drugs, medical devices and other technologies in several clinical areas, including heart disease, oncology, diabetes, chronic pain, gynaecology and obstetrics, COPD, and osteoporosis.  He has more than sixty peer-reviewed publications, and regularly teaches in a series of HTA and health economic evaluation short courses aimed at post-graduates and healthcare professionals in the academia and the medical industry.


Andrea holds a MSc in Health Economics (1998) and a PhD in Economics (2005), both awarded by the University of York.  He received a number of national and international awards in his career, including the Welcome Trust Fellowship in Health Services Research (2004), the BackCare Research Award (2005), the Research Excellence Award for Methodology(2008) by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), and a Career Development Fellowship by the UK National Institute for Health Research (2010).


He is currently a member of the NICE Technology Appraisal Committee, the National Institute of Health Research (NIHR) Doctoral Research Fellowships funding panel, and the National Awareness and Early Diagnosis (NAEDI) Research Workstream scientific committee of the Cancer Research-UK.


Andrea’s contact details, full bio, current research activities and list of publications can be found athttp://www.york.ac.uk/che/staff/research/andreamanca/.