Developing methodology for economic evaluation of a strategy to reduce the burden of multimorbidity in patients in Malawi and Tanzania

Sub-Saharan Africa suffers from an interplay of high rates of infectious disease and rising prevalence of non-communicable diseases, resulting in multimorbidity. Importantly, HIV (and anti-retroviral treatment) can accelerate non-communicable disease. Patients frequently delay seeking treatment until they are severely ill and require emergency management. Hospital care then predominantly focuses on the primary presenting problem, overlooking multimorbidity, resulting in more frequent hospital admissions; higher health system and patient costs; additional disability and, death.

This PhD project will be embedded within an overall project (called Multilink) which aims to design and test a package of health systems interventions to identify patients suffering from multimorbidity during emergency assessment in sub-Saharan African hospitals and improve their health outcomes. The intervention is being developed prior to commencement of the PhD project and is likely to focus on enhanced testing protocols for acutely ill patients in hospital to identify multimorbidity, as well as better links to support via outpatient clinics after they are discharged.

We will recruit approximately 2800 patients in twenty hospitals in Malawi and Tanzania to a cluster randomised trial designed to evaluate the impact of the intervention. The candidate will conduct a sophisticated with-in trial cost-utility and cost-effectiveness analysis as an integral part of the overall evaluation (which also involves qualitative process evaluation). Evidence of the impact, cost-utility and cost-effectiveness will provide national policymakers with rigorous evidence and inform strategies to reduce the burden of multimorbidity and contribute to the sustainable development goals.

As well as the data from the randomised trial, the PhD candidate will have access to data from a preparatory cohort study conducted in Malawi and Tanzania between 2021-2022. This data will include multimorbidity prevalence; patient and health system costs treatment seeking and treatment costs; clinical and health related quality of life outcomes (EQ-5D) and qualitative information on health worker behaviour and health system constraints. This rich dataset will facilitate development and application of statistical methodology for modelling joint-outcomes and multimorbidity (by the candidate) which will be incorporated into the within-trial economic evaluation that s/he will produce.

Where does the project lie on the Translational Pathway?

T3 Evidence into Practice

Expected Outputs

A full health economic analysis of the project intervention for identifying multimorbidity, and for improving linkage to care. This is expected to be a high-impact publication, and if the results are favourable, a high impact intervention. The economic evaluation will be key in persuading stakeholders of the potential for broader implementation.

Training Opportunities

Large investigator network in multiple disciplines, and “being part of the team”, leading to developing the student’s own collaborations

Potential to present results to appropriate conferences

Ad hoc training in specific methodologies needed to complete the project

Skills Required

  • Strong quantitative data analysis skills
  • Understanding and ideally experience of conducting economic evaluations, preferably in a low-income country context
  • Ability to work across and between disciplines
  • Commitment to conducting rigorous, excellent research

Willingness and ability to work independently and the confidence to ask for help and support as needed

Key Publications associated with this project

Guthrie B, Thompson A, Dumbreck S, et al. Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling. Southampton (UK): NIHR Journals Library;

A cross-sectional and spatial analysis of the prevalence of multimorbidity and its association with socioeconomic disadvantage in South Africa: A comparison between 2008 and 2012

Academy of Medical Sciences. Multimorbidity: a priority for global health research, 2018.

Economic evaluation of a short, all-oral bedaquiline-containing regimen for the treatment of rifampicin-resistant tuberculosis from the STREAM trial. Rosu et al (2020)

Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d’Ivoire: a two-armed cluster randomized controlled trial (2021)

Now Accepting Applications 

CLOSING DATE FOR APPLICATIONS: Application Portal closes: Wednesday 9th February 2022 (12:00 noon UK time)

Shortlisting complete by: End Feb/early March 2022

Interviews by: Late March/early April 2022

For more information on Eligibility, funding and how to apply please visit the MRC DTP/CASE pages