I am a health economist with an interest in health technology assessment. My research is focused upon developing appropriate methods for the economic evaluation of health technologies.
I hold an MA in economics conferred by the University of Cambridge, an MSc in health economics from the University of York and a PhD in medicine from the University of Alberta.
Prior to joining the School of Public Health, I was a senior research associate within Christopher McCabe's health economics research group at the University of Alberta. I have also previously held research positions within the Toronto Health Economics and Technology Assessment Collaborative at the University of Toronto, and the Centre for Health Economics at the University of York.
My research interests are described in more detail under the Scholarly Activities tab above.
During Winter 2017, I am teaching the following:
Institute for Health Economics (IHE) "Evidence into Practice" Luncheon Series
This is a series of health economics training sessions organized by the Institute of Health Economics (IHE) in partnership with Alberta Health. I am teaching the following sessions:
- 16 Jan. 2017: "Advanced Methods in Economic Evaluation: Value of Perfect Information and Probabilistic Sensitivity Analysis" (slides available here; video available here)
- 23 Jan. 2017: "Systematic Reviews of Economic Literature & Quality Assessment Instruments" (slides available here)
- 10 Feb. 2017: "Outcome Measurement for Economic Evaluations" (slides will be posted following the session)
During Spring 2017, I will be teaching the following:
During Winter 2018, I will be teaching the following:
During Fall 2016, I taught the following:
I am the lead author of an article in the February 2017 issue of Medical Decision Making, titled "Determinants of Change in the Cost-effectiveness Threshold".
I am the lead author of a critique of the discounting recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine, which has been published as the Leading Article in the January 2017 issue of PharmacoEconomics.
I have worked on health technology assessments for several decision makers, including the UK’s National Institute for Health and Care Excellence (NICE), the Ontario Ministry of Health and Long-Term Care, and Alberta Health Services. In doing so I have developed models to evaluate the cost-effectiveness of a variety of different health technologies and interventions.
The first was an integrated evidence synthesis and value of information analysis of methods to identify postnatal depression in primary care; I was the lead author of the economic analysis conducted as part of this project, which was subsequently published in the British Medical Journal (BMJ).
The third was a systematic review and economic assessment of Sugammadex for the reversal of muscle relaxation in general anaesthesia, which was later summarized in two separate papers published in the British Journal of Anaesthesia (BJA).
Also at York, I was a member of the evidence review group (ERG) that reviewed two models submitted to NICE under its single technology appraisal (STA) process: Alitretinoin for the treatment of severe chronic hand eczema; and Topotecan for the treatment of recurrent and stage IVB carcinoma of the cervix. I subsequently coauthored a paper that summarized the ERG's review of Alitretinoin and critiqued NICE's STA process.
While at the University of Toronto, I led an economic evaluation of the 21-gene assay (Oncotype DX) for guiding adjuvant chemotherapy decisions in early breast cancer, and I collaborated with researchers from the University for Health Sciences in Austria who rebuilt the cohort state-transition model used for this evaluation as a discrete event simulation model in order to conduct a cross-model validation.
I also contributed towards economic evaluations of support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery, early prevention of pressure ulcers among elderly patients admitted through emergency departments, alternative repositioning schedules for nursing facility residents at moderate and high risk for pressure ulcer development, and enhanced multi-disciplinary teams for the treatment of pressure ulcers in long term care facilities.
While at the University of Alberta, I coauthored an economic evaluation of Prosigna and Oncotype DX for guiding adjuvant chemotherapy treatment in Alberta. I have also provided expert advice on economic evaluations to public agencies and non-profit institutions: I have reviewed models submitted to the Canadian Agency for Drugs and Technologies in Health (CADTH) and the International Centre for Infectious Diseases, and I was a member of the Guideline Expert Panel for a study sponsored by the Financial Services Commission of Ontario to develop a "Minor Injury Treatment Protocol" to aid in the recovery from common traffic injuries.
I have published methodological research across several topics in health technology assessment, including the appropriate means for considering societal time preferences, the estimation of cost-effectiveness thresholds for reimbursement decision making, and the integration of social values within the methods used for the economic evaluation of health technologies.
I am particularly interested in the discounting of expected future costs and health outcomes in economic evaluations of health technologies. Shortly after completing my MSc, I coauthored a paper that addressed a long-running dispute over the merits of differential discounting; this paper brought together leading authors from both sides of the debate to reach a consensus position.I was the lead author of a paper written with Karl Claxton that proposed a novel means for deriving the social rate of time preference for health.
After NICE updated its methods guidance for economic evaluations to allow for selective discounting, I collaborated with James O'Mahony to publish a critique of NICE's methods. I subsequently contributed a chapter on "Time Preference and Discounting" to the Encyclopedia of Health Economics, edited by Anthony J Culyer.
In 2016, I was the lead author of a report on discounting and time preference that informed the process for updating the guidelines adopted by Canadian Agency for Drugs and Technologies in Health (CADTH) for the economic evaluation of health technologies in Canada.
Most recently, I was the lead author of a critique of the discounting guidance issued by the Second Panel on Cost-Effectiveness in Health and Medicine, which pointed out fundamental errors in the panel's work. My current research concerns the merits of discount rates that vary over the time horizon of an analysis.
I also have an interest in methods for the estimation of cost-effectiveness thresholds. I co-authored a commentary on a novel method proposed by Eckermann and Pekarsky for deriving optimal thresholds, and I was recently lead author on a paper that explored the various determinants of the threshold and considered how the threshold might vary over time.
My current research concerns the appropriate methods for estimating cost-effectiveness thresholds for the provincial health care systems in Canada.
Finally, I am interested in how social values can be integrated within the methods used for economic evaluations of health technologies. The title of my doctoral thesis was "Opportunity cost and social values in health care resource allocation". Two chapters have been published from this thesis: the first reported a scoping review of social value arguments in the orphan drugs literature and proposed a value-based decision framework for the reimbursement of orphan drugs; the second highlighted some inconsistencies in NICE's consideration of social values in its methods for the economic evaluation of health technologies.
I am currently working on a survey of Canadian social values regarding personalized medicine, as part of the PACEOMICS research project at the University of Alberta.