Clifton Insight
Optimizing Health Technology Submissions with Expert Analysis

Established by Dr. Howard Thom in 2014, Senior Lecturer in Health Economics at the University of Bristol, Clifton Insight has provided expert advice and analytical support on dozens of health technology submissions (HTA) to payers in the U.K. and worldwide, including the National Institute of Health and Care Excellence (NICE).

Starting as a network of academic researchers, the firm today provides evidence synthesis and health economics support to major pharmaceutical and health economic consulting companies worldwide. Clifton Insight’s strong links to academia, flexible workforce, vast experience with NICE, excellent track record of publications, and innovative solutions make it a prominent player in the industry.

Thom notes that challenges encountered in HTAs, such as evaluation of oncology treatment sequences, tumor agnostic treatments, and gene and curative therapies, are forcing indirect treatment comparisons, economic models, and systematic literature reviews to become more distinctive. A more competitive drug landscape and increasing use of novel trial designs are compounding the shift toward advanced methods in HTA.

A significant related challenge is the exploding volume of emerging methods and guidelines published by HTA agencies. These accelerate the need for experts capable of tracking the latest methods and recommendations.

This is where Clifton Insight takes center stage.

“We are brought in after standard methods have been exhausted. We showcase our differentiation from other companies by using the latest methodology, or inventing new ones, to solve client problems and maximally demonstrate product value,” says Thom.

In systematic reviews, for example, Clifton Insight’s team faced a challenge where the number of studies to extract was far more extensive than anticipated due to the widening scope.

Instead of expanding the time and budget, they used statistical programming in the R language to rapidly map the evidence network and prioritize the extraction of studies connected to the intervention of interest.

In indirect treatment comparisons, Clifton Insight helped overcome bias caused by rescue treatment by developing a novel technique for unanchored simulated treatment comparison (STC) using covariate-adjusted standard parametric and spline regression models. In the process, they highlighted how standard network meta-analysis (NMA) was likely far from representing the true value of the client’s product.

Similarly, Clifton Insight assisted a study on eptinezumab in migraine prevention for Lundbeck— a Danish international pharmaceutical company engaged in research, development, manufacturing, marketing, and sale of treatments for brain disease. Eptinezumab is intravenously (IV) delivered, while investigational products are subcutaneously delivered. This meant the drug’s placebo response to IV would be much greater, biasing standard NMA against eptinezumab.

Clifton Insight proposed and implemented three methods to adjust for this placebo effect. These were class effects NMA, network meta-regression (NMR), and unanchored STC which have innovative applications in overcoming placebo responses. The NMA and NMR concurred while unanchored STC favored eptinezumab. Clifton Insight’s scientific background enabled the successful adoption of this ground-breaking approach.

Currently, most health economic models are done in Excel, but it is slow and inefficient, non-transparent, and not flexible. A highlighting aspect of Clifton Insight is its emphasis on R, a programming language that can efficiently capture complicated disease or treatment pathways and drives innovative modelling. Clifton Insight’s proficiency in R also enables it to help other companies refactor and optimize their models. Furthermore, Clifton Insight uses RShiny graphical user interfaces to enable easy communication and interaction with these advanced models.

At the heart of Clifton Insight’s success is its experienced and flexible team, comprising experts from the U.K., Ireland, Chile, Uganda, America, and more. This group is backed by the firm’s sophisticated IT infrastructure and cutting-edge software, which keep data secure, despite the distributed organization. Another critical facet of the firm’s success is its solid relationship with academia, which drives the maintenance of an impeccable subcontracting system and the ability to remain up-to-date and develop new methodology.

Clifton Insight emerges as a significant player in the health economics and outcomes research landscape by providing expert advice and analytical support across diverse HTAs to regulatory bodies in the U.K. and beyond.