Entering health economics writing
Health economics, outcomes research and market access form a field that medical writers are increasingly asked to work in. Its research shapes healthcare decisions and is often poorly communicated, most of it takes place in commercial settings, much of the companies' writing in it is outsourced, it asks for skills beyond writing, writers enter it with and without a science background, and its projects are among the most challenging a medical writer meets.
Why the field needs writers
Health economics and outcomes research was by 2013 becoming increasingly important for healthcare decisions and policies. Its data were permeating healthcare delivery at primary level, with budget impact analyses used by most fund holders and many therapeutic guidelines influenced by health economic study results, so medical writers need to understand health economic concepts and study methods in order to support effective communication of the research. Knowledge of the basics of health economics was becoming increasingly important for medical writers as companies sought to communicate the economic value of their products. Increasingly, medical writers were being asked to work with health economics and outcomes research information. Health economics and outcomes research analyses were in 2013 an increasingly common component of clinical research and an emerging area of specialisation in medical writing.
Health economics research is often poorly communicated, and medical writers can make a great deal of difference in this increasingly important area. Effectively communicating the results of economic evaluation is of enormous clinical importance.
One health economist sees health economics and market access as an area where medical writers can add real value. In his account the majority of health economics, like medical writing, takes place in the commercial setting and not in academia, and economists need help getting their work into top-tier clinical journals rather than backwater technical journals. Even health economists have rapidly come to understand the value of good communication. Global acceptance of health technology assessment as the gold standard reimbursement framework has led to the emergence of market access as a distinct standalone discipline, and a good market access professional understands the need to present complex concepts simply and concisely, within an overall communication strategy, to make a convincing case for the clinical and economic value of a product, with skills similar to those a good medical writer needs.
About half of the attendees of EMWA's spring 2013 conference came to its full-day symposium on writing for health economics and market access. Both the symposium and a workshop on health economics at the conference were very well attended, with a high level of engagement, and to the health economist who taught the workshop the medical writing community represented there seemed well aware that its input in the field is much needed.
Health economics and outcomes research was in 2017 a growing field with opportunities for "smart, adaptable writers, regardless of your experience in HEOR," in the words of one writer in the field. There are many ways for writers to help disseminate its evidence. Products will not succeed unless their value is demonstrated, and writers use the evidence to effectively communicate the value of health care interventions to payers, health care decision makers and patients, and must help scientists clearly communicate research findings. Opportunities to inform stakeholders, through manuscripts, posters, abstracts, dossiers and other documents, exist along the entire product life cycle.
Growth of the field and where the work is done
The field had visibly expanded in the United States by 2013. Numerous journals devoted to the health economics literature had emerged, aimed at managed care plan executives, pharmacy benefit and formulary managers, government officials and other key decision-makers, among them Health Economics, the Journal of Health Economics, the Journal of Managed Care Pharmacy and Value in Health. It was becoming common for pharmaceutical, device and health insurance companies to have internal health economics and outcomes research departments, but typically a substantial proportion of the writing and other professional work of those companies was outsourced. Academia generated a huge number of analyses, most often through programmes affiliated with pharmacy or public health. The growth in related medical writing was quite steady: a PubMed count of publications carrying cost-effectiveness in the title rose from 139 in 1992 to 1,045 in 2012.
Writing and editing work in the field
In 2017 writers in the field worked on dossiers, publications, value messaging and objection handlers, and editors on dossiers, publications, slide decks and reports. The writing and editing roles in the field in 2018 were dossiers, publications, value messaging, slide decks, objection handlers, reports, study reports and modelling reports.
Skills the work asks for
Most medical writers are likely to be exposed to health economics and outcomes research concepts as part of their professional work, so it is important for them to be familiar with those concepts and the field's terminology. Many medical writers have the underlying skills to incorporate the concepts into their work but need more background to do so comfortably.
Health economics writers almost always bring value beyond writing skills to a project, and one writer with seven years in the field names three skills such a writer should have beyond writing.
- The first and most important is a willingness to work directly with numbers: such writers are often handed raw data, or data that has to be reviewed closely, double-checked and formatted before any writing begins.
- The second is understanding the primary study data in full, which it is not unusual for such a writer to have to do, because compared with analyses of clinical trials these analyses are likely to have fewer authors who comprehend the mathematical aspects of the work.
- The third is a concise writing style, because preparing an economic analysis for publication carries the documented additional challenge of reporting cost-related items in the methods section that a purely clinical study would not have to report.
Routes into the field
Opportunities exist for writers with and without a science, medical or economics background. One health economics writer came from science: her science background first prepared her for a career in pharmacy, and while working in a clinical setting she learned medical writing and freelanced until she took her post writing in the field. She arrived in the field through a PharmD, work as a pharmacist and a medical writing fellowship. Another, with a liberal arts background, was the first non-scientist hired as a writer at her company. Although she had no professional medical writing experience, her application included an HPV vaccination proposal she had written as an undergraduate, to show a long-standing interest in medical writing; she had worked as an editorial assistant and interned at the National Cancer Institute, and at the company she began by editing and proofreading before moving to writing. One writer arrived in the field through an English degree and exposure to science as an intern at the National Cancer Institute.
Preparing to enter the field
Two writers in the field advise a writer breaking into it to show how their skills translate into the work and how they can meet the client's needs, and to know the audience for each project. Their further tips, set out for freelances and for writers with a non-technical background, are to leverage one's skill set in manuscript writing, editing, slide decks, reports and journal selection; to assess one's skills, learning or brushing up on statistics, promoting one's Microsoft Word skills and scientific background knowledge; to know the audience, among them health care decision makers, global and national, health technology assessment bodies and patients; not to take liberal arts skills for granted, such as audience analysis, the big picture, writing mechanics, organising ideas and insight into non-expert audiences; to know the resources, among them the website of the International Society for Pharmacoeconomics and Outcomes Research, the Academy of Managed Care Pharmacy format and healtheconomics.com; to attend American Medical Writers Association workshops; and to focus on one's "highest and best use". Writers with a medical background can leverage their existing skills to break into the field. Writers without one can also bring valuable assets to it, including expertise with Microsoft Word, insight into non-expert audiences, strong writing mechanics and an ability to organise ideas, and one health economics writer recommends that they enhance their medical knowledge by brushing up on statistics, learning about different health audiences and taking American Medical Writers Association workshops.
Educational resources can help those interested in professional development in the field: in 2018 the Professional Society for Health Economics and Outcomes Research offered short courses, the Academy of Managed Care Pharmacy held two national meetings a year involving education in the pharmacy space, and HealthEconomics.com provided education and research related to the field. These resources, together with the writer's existing writing skills, may help interested writers find opportunities in the field.
What the field gives back
A medical writer who makes the effort to understand health economics can reap a number of rewards, in one medical writer's account: being constantly in demand as one of the elite, and being privy to some of the most interesting, provoking, frustrating, complex and challenging projects a medical writer has to face. A writer who has won the respect of health economists and their publishers can, in the same account, truly consider themselves a master of their craft. One health economist holds that health economics is a rewarding field to work in, demanding a combination of scientific rigour and commercial acumen.