EMWA symposium on health economics

In this article, Adam Jacobs provides us with an overview of the 1-day symposium on market access and health economics at the recent European Medical Writers Association event.

The 36th conference of the European Medical Writers Association took place in Manchester on 7th to 11th May 2013. As ever, this was a splendid opportunity for medical writers from all over Europe (and a few hardy souls from further afield) to network with friends and colleagues from the world of medical writing, and take part in a wide variety of training workshops to further their professional development.

An innovation this year was a 1-day symposium during the conference. This was offered as an alternative to the training workshops, and our theme for the day was health economics and market access. We had the wonderful opportunity to listen to various experts in the field give their take on what was happening in the world of health economics, and what role medical writers can play in advancing this increasingly important discipline.


“…the threshold of what is considered cost effective is not a rigid financial boundary…”


The first talk of the day was by Ruth Whittington of Rx Communications. Her talk gave an excellent overview of what health economics is all about: an important start to the day, given that members of the audience had a range of experience in health economics. Some of the audience were experts in the field, for sure, but many others had never worked in the area, and some demystification of all the various buzzwords used by health economists set them up nicely for the talks to come.

Next came Helen Knight from NICE, which we learned has recently been renamed as the National Institute for Health and Care Excellence. Helen gave a helpful overview of what NICE does, and how it makes decisions about whether healthcare innovations (mainly, but certainly not exclusively, new drugs) should be funded, through its process of Health Technology Assessments (HTAs). She described the extensive process of reaching decisions, which has been designed to be as fair and transparent as possible, and incorporates various stages of consultation with stakeholders as well as an appeals process if anyone believes the final decision is unfair. Helen explained that the threshold of what is considered cost effective is not a rigid financial boundary: interventions with a higher cost per QALY than would normally be considered cost effective might be approved if they offer distinctive advantages, such as fulfilling an important unmet medical need or demonstrating real innovation.

The final talk of the morning’s session was by Ruairi O’Donnell from Abacus International. Ruairi also talked about HTAs, but this time from the perspective of those writing them. He gave a great many helpful hints and tips about best practice in preparing HTA documents. Among the things we learned were the importance of keeping in mind what the reviewer needs to know. For example, if any economic modelling has been used, are the models adequately described such that a reviewer would be able to follow the logic? What assumptions were made in those models, and why?


“As life expectancy increases and fertility rates decline, the traditional population pyramid is becoming more of a population muffin…”


After lunch, we heard from Prof Stavros Petrou from the University of Warwick. Stavros was one of the authors on the recently published CHEERS statement, which sets out standards for how health economics evaluations should be reported in the peer-reviewed literature. He took us through the various items in the statement, and gave us the rationale for why they were chosen. The CHEERS statement is absolutely required reading for anyone involved in publishing papers in the health economics field.

Our final talk was from Barbro Westerholm, an experienced health researcher as well as a member of the Swedish parliament. Barbro talked about the growing challenge of health and social care for the elderly. As life expectancy increases and fertility rates decline, the traditional population pyramid is becoming, as Barbro told us, more of a population muffin: the proportion of elderly people to the number of young people able to support them is greatly increasing. This is a good thing, of course – increasing life expectancy is a great tribute to what medical science and better living conditions have achieved – but it does bring real challenges. Barbro described some of the ways in which good care can be given with fewer resources if we apply “work smarter, not harder” principles, including one study in which medicines reviews were able to cut the number of different drugs prescribed to an elderly population from an average of 9 each to less than 3 each. It’s inevitable that people will have to continue working past ages that have been traditionally thought of as retirement age, but this may not be a bad thing: one of the most important things that can lead to a happy and fulfilled old age is constructive interaction with other people, and this can certainly be provided by suitable employment.


“…a common theme that emerged was the crucial importance of close collaboration between health economists and medical writers.”


There was plenty of time during the day for questions and discussion. One subject that was very much discussed was the role of medical writers in communicating health economics information. One of the problems is that health economics can be very complex: some health economics models are full of sophisticated maths and statistics, and any medical writer writing about those models must be sure to understand what has actually happened. While a training in health economics is obviously a good start, no medical writer can hope to understand the details of every economic model, and so a common theme that emerged was the crucial importance of close collaboration between health economists and medical writers. Health economists have important expertise in working with economic models, and medical writers have expertise in communicating complex subjects to non-specialists, but it is rare that either of them could do a good job of this on their own.

All in all, I felt the day had been a great success, and my sentiment seemed to be shared by everyone else I spoke to. I am reasonably confident that the success of this event will lead to a themed 1-day symposium becoming a regular feature of EMWA’s spring meeting, and I am looking forward to finding out what the theme will be for our next spring meeting in Budapest in 2014.



About the author:

Adam is an experienced medical writer and statistician. Before setting up Dianthus Medical in 1999, he worked as a medical writer for both a small contract research organisation and a large medical communication agency. Adam has a PhD in organic chemistry from the University of Cambridge and an MSc in medical statistics from the London School of Hygiene and Tropical Medicine.

He takes an active role in the European Medical Writers Association (EMWA), and was president of the association in 2004-2005. In 2003, he set up EMWA’s ghostwriting task force, as a result of which he was co-author of EMWA’s guidelines on the role of medical writers in peer-reviewed publications. He is a regular workshop leader for EMWA’s training workshops and a columnist in their journal, The Write Stuff, and was among the first few people to be awarded EMWA’s advanced professional development certificate. He is also a fellow of the Institute of Clinical Research and a Chartered Scientist.

In his spare time, he enjoys cooking, gardening, karate, long-distance running, travel, and hill walking (but not usually all at the same time).

He can be contacted via Twitter at @dianthusmed

What role do medical writers play in communicating health economics?