Harkness Project Title: Coverage Policy in the U.S. and the U.K.: An Investigation of Principles, Processes and the Use of Cost-Effectiveness Information
Mentor: Alan Garber, M.D., Ph.D.
Placement: Center for Primary Care and Outcomes Research, Stanford University
Biography at time of Harkness Fellowship: Stirling Bryan, Ph.D., a 2005-06 Commonwealth Fund Harkness Fellow in Health Care Policy, is director of the Health Economics Facility and professor of health economics at the University of Birmingham, U.K. His principal research interest is in the challenge posed by new medical technologies, and policy approaches to deal effectively with such challenges. His work in the U.S. has explored these issues at Kaiser-Permanente, Aetna, Blue Cross Blue Shield, and the Veterans Health Administration. More broadly his research has covered the areas of economic evaluation and health technology assessment from applied and methodological perspectives, including preference elicitation and outcome measurement, and the use of economic analyses in decision-making. He has published extensively in these areas. Bryan is a member of the U.K. Medical Research Council’s College of Experts and the Standing Scientific Committee of the International Health Economics Association (iHEA). Formerly he sat on the Appraisal Committee of the U.K. National Institute for Health & Clinical Excellence. Bryan holds a doctorate in economics from Brunel University.
Project: Bryan’s research sought to describe technology coverage policy in a number of U.S. health care organizations, and to elicit stakeholders’ views on coverage policy and, specifically, on the use of cost-effectiveness information. He undertook a literature review and case studies at four U.S. organizations that make coverage decisions (Kaiser Permanente, Aetna, Blue Cross Blue Shield, and the Veterans Health Administration), including interviews, document analysis, and workshops with senior decision-makers.
Career Activity Since Fellowship
Current Position: Director, Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Canada & Professor, School of Population and Public Health, University of British Columbia (Updated 1/2014)
Mills EJ, Gardner D, Thorlund K, Briel M, Bryan S, Hutton B, Guyatt GH. A users' guide to understanding therapeutic substitutions. J Clin Epidemiol. 2014 Mar;67(3):305-13.
Whitehurst DG, Bryan S. Trial-based clinical and economic analyses: the unhelpful quest for conformity. Trials. 2013 Dec 5;14:421.
Davis JC, Bryan S, Marra CA, Hsiung GY, Liu-Ambrose T. Challenges with cost-utility analyses of behavioural interventions among older adults at risk for dementia. Br J Sports Med. 2013 Nov 6.
Smith N, Mitton C, Bryan S, Davidson A, Urquhart B, Gibson JL, Peacock S, Donaldson C. Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey. BMC Health Serv Res. 2013 Jul 2;13:247.
Bryan S, Lee H, Mitton C. 'Innovation' in health care coverage decisions: all talk and no substance? J Health Serv Res Policy. 2013 Jan;18(1):57-60.
Stewart PM, Bryan S, Dukes P, van Oudheusden HL, Walker R, Maxwell PH. What happens to clinical training fellows? A retrospective study of the 20 years outcome of a Medical Research Council UK cohort. BMJ Open. 2012 Aug 30;2(4). pii: e001792.
Bryan S, Dormandy E, Roberts T, Ades T, Barton P, Juarez-Garcia A, Andronis L, Karnon J, Marteau TM. The cost-effectiveness of primary care screening for sickle cell and thalassaemia. British Journal of General Practice 2011.
Jowett S, Bryan S, Mant J, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Hobbs FD. Cost Effectiveness of Warfarin Versus Aspirin in Patients Older Than 75 Years With Atrial Fibrillation. Stroke. 2011 Apr 21.
Whitehurst DG, Bryan S, Hay EM, Thomas E, Young J, Foster NE.Cost-effectiveness of acupuncture care as an adjunct to exercise-based physical therapy for osteoarthritis of the knee. Phys Ther. 2011 May;91(5):630-41. Epub 2011 Mar 17.
Whitehurst DG, Bryan S, Hay EM, Thomas E, Young J, Foster NE. Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee. Phys Ther. 2011 Mar 17.
Whitehurst DG, Bryan S. Another Study Showing that Two Preference-Based Measures of Health-Related Quality of Life (EQ-5D and SF-6D) are not Interchangeable. But why Should we Expect Them to be? Value Health. 2011 Feb 9.
Brealey S, Andronis L, Dennis L, Atwell C, Bryan S, Coulton S, Cox H, Cross B, Fylan F, Garratt A, Gilbert F, Gillan M, Hendry M, Hood K, Houston H, King D, Morton V, Robling M, Russell I, Wilkinson C. Participants’ preference for type of leaflet used to feed back the results of a randomised trial: a survey. Trials. 2010 Dec 1;11:116.
Kaambwa B, Bryan S, Gray J, Milner P, Daniels J, Khan KS, Roberts TE. Cost-effectiveness of rapid tests and other existing strategies for screening and management of early-onset group B streptococcus during labour. BJOG. 2010 Dec;117(13):1616-27.
Dormandy E, Gulliford M, Bryan S, Roberts TE, Calnan M, Atkin K, Karnon J, Logan J, Kavalier F, Harris HJ, Johnston TA, Anionwu EN, Tsianakas V, Jones P, Marteau TM. Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial. BMJ. 2010 Oct 5;341:c5132.
McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, Kaambwa B, Banting M, Bryan S, Little P, Williams B, Hobbs FD. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010 Jul 17;376(9736):163-72. Epub 2010 Jul 8.
Liu-Ambrose T, Eng JJ, Boyd LA, Jacova C, Davis JC, Bryan S, Lee P, Brasher P, Hsiung GY. Promotion of the mind through exercise (PROMoTE): a proof-of-concept randomized controlled trial of aerobic exercise training in older adults with vascular cognitive impairment. BMC Neurol. 2010 Feb 17;10:14.
Bryan S, Jowett S. Hypothetical versus real preferences: results from an opportunistic field experiment. Health Econ. 2009 Nov 27.
Arrow K, Auerbach A, Bertko J, et al. “Toward a 21st-century health care system: recommendations for health care reform.” Ann Intern Med. 2009 Apr 7;150(7):493-5
Bryan S, Sofaer S, Siegelberg T, Gold M. "Has the time come for cost-effectiveness in U.S. health care?" Health Economics, Policy and Law 2009 Oct;4(Pt 4):425-43
Williams I, McIver S, Moore D, Bryan S. “The Use of Economic Evaluation in NHS Decision-Making: A Review and Empirical Investigation.” Health Technology Assessment 2008;12(7)
Bryan S. “Editorial: Darzi on NICE: The Case for Clinician Management in HTA.” Health Economics, 2008; 17: 1321-1327.
Bryan S, Williams I, McIver S. “Seeing the NICE Side of Cost-Effectiveness Analysis: A Qualitative Investigation of the Use of Cost-Effectiveness Analysis in NICE Technology Appraisals,” Health Economics 2007;16(2):179-193
Williams I, Bryan S, McIver S. “How Should Cost-effectiveness Analysis be Used in Health Technology Coverage Decisions? Evidence from the NICE approach,” Journal of Health Services Research & Policy 2007;12(2):73-79
Gold M, Bryan S. “Some Reasons to be Cheerful About NICE,” Health Economics, Policy and Law 2007; 2(2):209-216
Williams I, Bryan S. “Understanding the Limited Impact of Economic Evaluation in Health Care Resource Allocation: a conceptual framework,” Health Policy 2007; 80:135-143.