Nicóla Novielli is a research fellow in Medical statistics and Health Economics.
Nicóla’s research has focussed mainly on the application of Bayesian statistical modelling techniques to the meta-analysis of the accuracy of diagnostic tests. He is now also interested in the economics of service delivery interventions and clinical interventions at the supply side. He is also a systematic reviewer for the Cochrane collaboration.
Nicóla is also investigating the differences in clinical handover (patient transition between or within hospital settings) in developing countries with a group of colleagues (hodc@contacts.bham.ac.uk).
Nicóla Novielli qualified with a BSc in Economic and Statistical Sciences from the University of Bari (Italy) in 2006. He went to study for a MSc in Medical statistics at the University of Leicester, where he continued to study for a PhD in health Economics. His interest has been in the use of Bayesian statistics for the estimation of the accuracy of diagnostic tests, in particular, when tests are used in combination. Nicóla has started working at the University of Birmingham in July 2010 in the economics of service delivery and clinical interventions before their implementation.
RESEARCH THEMES
Bayesian statistics, Statistical modelling, Diagnostic accuracy, Health Economics, cost-effectiveness of interventions at pre-implementation stage.
RESEARCH ACTIVITY
Accuracy of combinations of diagnostic tests
A number of meta-analysis techniques have been developed in the last few decades for the estimation of the accuracy of diagnostic tests. During his PhD, Nicóla reviewed the most common modelling approaches and developed a modelling framework for the meta-analysis of data for the estimation of the accuracy of combinations of diagnostic tests. Usually, tests are assumed to be independent when results from a number of studies have to be combined. However, often such assumption is not true. Therefore, a meta-analytic framework is needed that considers (i) the heterogeneity between such studies, (ii) the variation due to differences in the test “cut-off” value that is used to categorise patients into positives (i.e. if the test value is above the cut-off value) or negative (i.e. if the test value is below the cut-off value), and (iii) the conditional dependence between tests. The last objective can be achieved by systematically reviewing the accuracy of tests when used in combinations and include in the meta-analysis the conditional accuracy data of each test. The lack of publications reporting the conditional accuracy can be a barrier to the application of such methods, however it highlights the needed of single studies reporting such conditional accuracy. On the other hand, as shown by the application of such methods to an example dataset for the accuracy of Wells score and Ddimer for the diagnosis of Deep Vein Thrombosis, the assumptions of conditional independence between tests may lead to wrong clinical and economic decisions.
HandOver European Collaborative Project.
He has also been involved in the second half of the HandOver European Project. The aim of such collaboration has been the development of an intervention that could improve the handover of patients between hospital and community and within hospital settings. The intervention is called the Handover Training Toolbox, which offers a set of tools to facilitate specific training to improve handover into European institution over a web based platform. The university of Birmingham was in charge of the economic evaluation of such intervention. Since the intervention was in a developmental phase, ad-hoc techniques have been used to investigate the potential benefit of such interventions. Bayesian elicitation of expert opinions was used to estimate the potential effect of the toolbox on adverse event rates and readmission event rates. The headroom method was used to determine “how much can be spent on the development and implementation of such intervention if it worked as he most optimistic opinion indicates”.
HandOver for developing countries (HODC)
He was instrumental in initiating an investigation of the handover in developing countries. The main tools for this investigation are a systematic review of the literature, and questionnaires to be delivered to WHO officials, directors and, optimistically, to members of staff of medical institutions in developing countries.
Clinical trials and other research activities
Nicóla also participates in the statistical analysis of data from clinical trials in the university of Birmingham and is co-applicant for some trial as junior health economist.
Novielli, N., N. J. Cooper, et al. (2010). "How Is Evidence on Test Performance Synthesized for Economic Decision Models of Diagnostic Tests? A Systematic Appraisal of Health Technology Assessments in the UK Since 1997." Value in Health 13(8): 952-957.
Novielli, N., N. J. Cooper, et al. (2010). "Bayesian model selection for meta-analysis of diagnostic test accuracy data: Application to Ddimer for deep vein thrombosis." Research Synthesis Methods: n/a-n/a.
Virgili, G., N. Novielli, et al.(2010). "Pharmacological Treatments for Neovascular Age-Related Macular Degeneration: Can Mixed Treatment Comparison Meta-Analyses be Useful?" Current drug target: 12
Oddone, F., G. Virgili, M. Parravano, M. Brazzelli, N. Novielli, M. Michelessi (2010). "Optic nerve head and fibre layer imaging for diagnosing glaucoma." Cochrane Database of Systematic Reviews:11.