Working with health economists
A medical writer becomes useful to a health economist by knowing who economists are and how they see writers, admitting what the writer does not know, learning the concepts before the first conversation, checking a model that may still be changing, serving as a sounding board for the model's clinical assumptions and bringing publication practice to the work.
Who health economists are
Understanding the history of health economics can make working with health economists more effective.
In its early days health economics was taught as an adjunct to other studies, such as health policy, statistics or epidemiology courses, and the first health economists in pharmaceutical and device companies were typically statisticians or people from other disciplines with an interest in the subject. In pharmaceutical and device affiliate companies the work may still be done by medical or even marketing directors. Academic departments of health economics began appearing in universities in the early 1980s but were not widely available to students until the 1990s. In 2013 there were still more health economics jobs than experienced people to fill them, a familiar lament among heads of health economics departments in the commercial sector.
One health economist grants that the caricature of health economists as nerdy men with poor social skills locked away in darkened rooms to focus solely on technical matters may have some foundation, perhaps particularly in academia, but holds that those who work in and for the pharmaceutical and device industries are very much in touch with the real world. Health economics demands a combination of scientific rigour and commercial acumen.
How health economists see medical writers
In one practitioner's experience over 20 years, many health economists perceive medical writers as incompetent in health economics writing, and writers need to abolish that perception, so they must develop an understanding of cost-effectiveness, cost-utility and other health economic concepts. To be accepted as a useful member of the publications team, a writer needs a good understanding of health economic terms and concepts and must also adapt to and understand health economists and their needs.
Well-trained health economists have rarely entered their profession to be skilled communicators. Someone whose passion is health economic modelling, or who has a background in statistics or epidemiology, tends to believe that nobody can understand their research as well as they can, and so is likely to look on medical writers with doubt and even derision. The complex statistics behind mixed treatment or indirect comparisons, and the more complicated analyses developed every year, may justify that scepticism. The negative perception is also widespread among researchers in health economics agencies, who often use their most junior health economists as writers instead, with predictably dismal effect. Similarly, the number of assumptions that may have to be made to derive health economics data may cause a clinically trained medical writer to assign health economics to fantasy land, the underlying issue being that health economics data are often hard to obtain.
Admitting gaps in health economics knowledge
In one practitioner's experience, many health economists have had bad experiences with medical writers on global publications teams who may have been very experienced in the therapeutic field but less so in health economics. Good knowledge of the disease area and the available therapies is very important but not enough. Admitting not being an expert in health economic analyses is much better than trying to bluff. Showing some background reading and an effort to understand will help, especially where the writer's questions about the data package they receive are relevant.
Unlike with clinical trial data, one health economics study design cannot be assumed to be the same as another.
Learning the basics before the first conversation
A writer who wants to succeed in this field must put a great deal of their own time into mastering the basics of health economics. A glossary of health economic terms is a good starting point, Wikipedia is useful, and introductory texts are on the market, though many of them are written for would-be health economists. In 2013 the International Society for Pharmacoeconomics and Outcomes Research had a great deal of free resource material on its website and also offered books, courses and workshops.
These resources are only a starting point, and three tactics may help an inexperienced writer understand a health economist's explanation of their study:
- Get a chance to review the data and the study protocol, if there is one, before discussing the study with the health economist.
- Look up similar studies in the field on PubMed and become familiar with the types of information included and the key points the manuscript or document should cover.
- Use a checklist to make sure of knowing the key components of a health economic study, such as perspective, design, data sources and analyses done, and so any gaps in the information supplied, and look at the CHEERS guidelines for health economic research to help identify sensible questions to ask the researcher about study limitations or missing information, which is very important because not all health economic data packages are complete at project initiation.
A model that may still be changing
A data package may not make it obvious that the model behind it may still be changing as information is added or as parameters and functionality are altered. Health economics modellers commonly tweak their models continuously to see the effect on the results and so improve their understanding of what drives the outcomes. So the printed report in the data package may not come from the last version of the model, and the writer needs to check frequently during the production of publications whether they have the final dataset. The writer should also check the following:
- Where the health economist built the modelling study in Excel, ask for the working model and check that it is the latest version.
- Where the report comes from other software, such as TreeAge or Arena, check the date on it to make sure it is the most recent.
- Check that the sensitivity analyses are part of the report, because they are needed for the publication: few models or analyses are accepted for publication without them.
The writer as a sounding board for clinical assumptions
The writer who has researched and written a submission's clinical section is usually the team member with the most knowledge of the disease and its treatment, and so can be an important sounding board while the health economists develop their modelling assumptions and inputs, although validation of the modelling approach by clinical experts is also key. Frequent cross-talk between the writing and modelling teams helps both optimise the submission and can avert problems such as the modelling team using an assumption that is open to clinical challenge. The writer needs to be able to spot when an argument in the economic section is incompatible with one in the clinical section, or the reverse, so that conflicts can be resolved early.
Publication policies and processes
Publication policies and ethics are not important to a health economist until someone spends time educating them about it. Health economists often come from academic backgrounds and will have published a few articles already, usually with their research supervisor as lead author, so they think publication processes are an open book and that there is little a writer can teach them about it. Health economics departments can be problematic about timelines, review stages, authors and other parts of the publication process, as a publications manager in a pharmaceutical company may be aware.
Being familiar with the health economist's company publications policy and processes, and making them as easy for the client as possible, endears the writer to them and may overcome their reaction to any naive questions the writer asks about their work. Scare tactics about ghost authorship and bad publicity may also help.