Search This Blog

Loading...

Sunday, 15 November 2015

HARPS | Full text | Comparing research investment to United Kingdom institutions and published outputs for tuberculosis, HIV and malaria: a systematic analysis across 1997–2013

 Source: http://www.health-policy-systems.com/content/13/1/63


















This article is part of the series Informing the Establishment of the WHO Global Observatory on Health Research and Development.



Open Access

Research

Comparing research investment to United Kingdom institutions and
published outputs for tuberculosis, HIV and malaria: a systematic
analysis across 1997–2013






Michael G. Head12*, Joseph R. Fitchett38, Gemma Derrick4, Fatima B. Wurie1, Jonathan Meldrum5, Nina Kumari6, Benjamin Beattie9, Christopher J. Counts7 and Rifat Atun3



1 Farr
Institute for Health Informatics, University College London, 222 Euston
Road, London NW1 2DA, UK




2
Faculty of Medicine and the Global Health Research Institute, University
of Southampton, Southampton, UK




3 Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA




4 Health Economics Research Group, Brunel University, London, UK




5 Faculty of Medical Sciences, UCL Medical School, University College London, London, UK




6 Imperial College London, School of Medicine, London, UK




7 Johns Hopkins University School of Medicine, Baltimore, USA




8 London School of Hygiene & Tropical Medicine, London, UK




9 Northumbria Specialist Emergency Care Hospital, Northumbrian Rd, Cramlington, Northumberland, UK




For all author emails, please log on.


Health Research Policy and Systems 2015, 13:63 
doi:10.1186/s12961-015-0052-5






The electronic version of this article is the complete one and can be found online at: http://www.health-policy-systems.com/content/13/1/63




Received:9 August 2015
Accepted:8 October 2015
Published:4 November 2015

© 2015 Head et al.






Open AccessThis article is distributed
under the terms of the Creative Commons Attribution 4.0 International
License (http://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any
medium, provided you give appropriate credit to the original author(s)
and the source, provide a link to the Creative Commons license, and
indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/)
applies to the data made available in this article, unless otherwise
stated.





Abstract

Background

The “Unfinished Agenda” of infectious diseases is of great importance to policymakers
and research funding agencies that require ongoing research evidence on their effective
management. Journal publications help effectively share and disseminate research results
to inform policy and practice. We assess research investments to United Kingdom institutions
in HIV, tuberculosis and malaria, and analyse these by numbers of publications and
citations and by disease and type of science.

Methods

Information on infection-related research investments awarded to United Kingdom institutions
across 1997–2010 were sourced from funding agencies and individually categorised by
disease and type of science. Publications were sourced from the Scopus database via
keyword searches and filtered to include only publications relating to human disease
and containing a United Kingdom-based first and/or last author. Data were matched
by disease and type of science categories. Investment (United Kingdom pounds) and
publications were compared to generate an ‘investment per publication’ metric; similarly,
an ‘investment per citation’ metric was also developed as a measure of the usefulness
of research.

Results

Total research investment for all three diseases was £1.4 billion, and was greatest
for HIV (£651.4 million), followed by malaria (£518.7 million) and tuberculosis (£239.1
million). There were 17,271 included publications, with 9,322 for HIV, 4,451 for malaria,
and 3,498 for tuberculosis. HIV publications received the most citations (254,949),
followed by malaria (148,559) and tuberculosis (100,244). According to UK pound per
publication, tuberculosis (£50,691) appeared the most productive for investment, compared
to HIV (£61,971) and malaria (£94,483). By type of science, public health research
was most productive for HIV (£27,296) and tuberculosis (£22,273), while phase I–III
trials were most productive for malaria (£60,491). According to UK pound per citation,
tuberculosis (£1,797) was the most productive area for investment, compared to HIV
(£2,265) and malaria (£2,834). Public health research was the most productive type
of science for HIV (£2,265) and tuberculosis (£1,797), whereas phase I–III trials
were most productive for malaria (£1,713).

Conclusions

When comparing total publications and citations with research investment to United
Kingdom institutions, tuberculosis research appears to perform best in terms of efficiency.
There were more public health-related publications and citations for HIV and tuberculosis
than other types of science. These findings demonstrate the diversity of research
funding and outputs, and provide new evidence to inform research investment strategies
for policymakers, funders, academic institutions, and healthcare organizations.

Keywords:
AIDS; Bibliometrics; Funding;
Health policy; HIV; Infectious disease; Malaria; Publications; Research
impact; Research investments; Tuberculosis

Background

The “Unfinished Agenda” of infectious diseases is of great importance to policymakers
and funders of global health. The Global Burden of Disease study reaffirms the continuing
high burden of communicable disease [1], [2]. The outbreak of Ebola in West Africa has illustrated the challenges faced by WHO
and individual countries in effectively managing transmission across national borders
and closing the gaps in global surveillance systems [3].
Peer-reviewed publications in academic journals – a typical output for funded research
– can help to effectively disseminate the latest knowledge to policymakers, clinicians
and other health professionals to inform policy and practice. Researchers at United
Kingdom institutions have been prolific at publishing manuscripts in peer-reviewed
journals [4]. Infectious disease is also a common topic of scientific papers [5], [6], and the vast majority of references within these papers are citing other journal
articles [7]. Previous research analysing the returns from public research investment have concentrated
on estimating the societal benefits received from research in the case of cancer [8]; cardiovascular and stroke research [9]; arthritis [10]; as well as from medical research in general [11]. However, this study is one of the first that directly links the publication return
from public research investment. Although there have been criticisms of the emphasis
applied to publishing in journals, and particularly in those with high impact factors
[12], journals remain an important medium to sharing new knowledge and research findings.
In addition, links between GDP and research productivity [13], [14] illustrate a policy need to understand a nation’s return on investment as an indicator
of economic competitiveness and potential for growth.
The Research Investments in Global Health study [15] has systematically analysed investments between 1997 and 2013 in infectious disease
research, highlighting funding levels by disease area [16], awarding body [17], receiving institution [18], and the sex of the principal investigator [19]. A 2015 publication showed that publication numbers for pneumonia broadly increased
over time, with no clear relationship to changes in funding [20]. Herein, we consider three major infectious diseases, HIV, tuberculosis and malaria,
and analyse individual trends in research investment and published outputs. We use
a novel metric to assess the numbers of publications relative to research investments.
We explore the impact of investment and published outputs by analysing citations for
each disease area and by type of science.

Methods

Awards for infectious disease research were sourced from the leading funders of infectious
disease research in the public and philanthropic sectors. The compilation of the research
investments data has been described in detail elsewhere [16], [20], but briefly reiterated here – we systematically examined investment data from 585
awarding bodies [21]. Data was obtained by searches on the funder website, requesting data directly from
the funder, or searches on databases such as the National Research Register (now-archived
and owned by the Department of Health) and ClinicalTrials.gov. Each downloaded study
was examined for relevance to human infection. We excluded symposium grants, studies
purely related to veterinary or plant infectious disease, and infrastructure grants
unless there was clear emphasis on use for human infectious disease.
Studies from 1997 to 2010 were categorised under one of four types of science along
the research pipeline – pre-clinical, phase I–III trials, product development, and
public health research. In the updated analysis including the years 2011–2013, a fifth
category, cross-disciplinary, was included in response to a perceived increase in
awards that encouraged research across more than one type of science. Owing to resource
constraints, this category has not yet been retrospectively applied to the 1997–2010
dataset. Awards were also categorised under a range of diseases and cross-cutting
areas, including specific infections such as HIV, tuberculosis and malaria. Investment
data across all years were adjusted for 2013 inflation, and awards in international
currencies were converted to UK pounds using the average exchange rate in the year
of the award.
Publications data from 1997–2013 was extracted from the Scopus database. Searches
for article types were restricted to original article, editorial or review. Keywords
searches were ‘AIDS’ OR ‘HIV’; ‘malaria’ OR ‘plasmodium’; and ‘tuberculosis’ OR ‘Mycobacterium’.
By country, results were restricted to ‘UK’. All available information was downloaded
into Excel spreadsheets, and conditional formatting equations applied in Excel to
separate the list of authors into individual cells and thus be able to filter for
publications with a United Kingdom-based first and/or last author. This criterion
was used as a surrogate marker of significant United Kingdom involvement and thus
presumed to be more comparable as a measure of outputs from United Kingdom research
investments. Amongst the data available for analysis were publication title, abstract,
article type, year of publication, journal title, and number of citations for each
paper. Each publication was individually read by one of the authors and assessed for
relevance to disease in humans for HIV/AIDS, malaria and tuberculosis, and grouped
in one of the five types of science along the research and development pipeline used
in the research investments categories (pre-clinical, phase I–III trials, product
development, public health, cross-disciplinary).
To reduce inter-observer error, random samples of data were checked by a second author,
with errors corrected and disagreements settled by consensus; a Cohen’s kappa score
was calculated to measurement levels of agreement using GraphPad software [22].
In order to compare investments, publications and citations, a ‘UK pound per publication’
and ‘UK pound per citation’ metric was developed, across the three diseases and by
type of science. The sum of investments across 1997–2010 was divided by the number
of publications or citations from 1997–2013. Cross-disciplinary science was excluded
from these analyses. Microsoft Excel 2013 and Stata V13 were used to assemble and
analyse the datasets.

Results

The number of publications extracted from Scopus was 19,461 for HIV, 9,355 for tuberculosis
and 15,173 for malaria. Author categorisation produced 9,322 publications for HIV
(47.9% of the initial number), 3,498 for tuberculosis (37.4%), and 15,173 for malaria
(29.3%; Table 1). Major reasons for exclusion included keywords cross-cutting across different areas
(e.g. ‘AIDS’ is also found in studies discussing ‘hearing aids’) and publications
containing a United Kingdom author but not in first or last position. The agreement
between authors (Cohen’s kappa) for categorisation was assessed as 0.88, rated as
‘very good’.

Table 1. Summary of total research investment, publication and citation numbers for tuberculosis,
HIV and malaria
Summary funding data have been published previously [16]. The total research investment (Table 1) for all three diseases was £1.4 billion and was greatest for HIV (£651.4 million),
followed by malaria (£518.7 million) and tuberculosis (£239.1 million). Research investment
per annum for each disease showed considerable variation (Figure 1). By type of science for each disease (Additional file 1), preclinical science received proportionately the greatest funding followed by public
health and phase I–III, whereas product development awards received the least funding.
A small amount of funding focused on cross-disciplinary studies across 2011–2013.
Proportionate quantities for public health research increased for all infections in
the later years of this dataset, typically at the expense of preclinical research.
Similar findings were observed for publication and citation numbers (Additional file
1).

thumbnailFigure 1. Annual research investment for HIV, tuberculosis and malaria.
There were 17,271 publications included for analysis (Table 1; 9,322 for HIV, 4,451 for malaria and 3,498 for tuberculosis). The predominant type
of science (Additional file 1) was public health for HIV (62.9%) and tuberculosis (51.0%). Unlike research investments,
publication numbers for all infections typically showed a steady increase year on
year (Figure 2) from 793 in 1997 to 1,458 in 2013.

thumbnailFigure 2. Annual publication numbers for HIV, tuberculosis and malaria.
The total number of citations (Table 1) was 503,752 and these showed more variability by year and a steady yearly decline
for all three infections after 2006 (Figure 3). HIV publications received the most citations (254,949), followed by malaria (148,559)
and tuberculosis (100,244; Table 1).

thumbnailFigure 3. Annual citations arising from publications relating to HIV, tuberculosis and malaria.
By investment per publication (Table 2), tuberculosis (£50,691) appears the most productive area for investment, compared
to HIV and (£61,971) malaria (£94,483). By type of science (Additional file 1), public health was most productive for HIV (£27,296) and tuberculosis (£22,273),
with phase I–III trials being the least productive (£326,440 and £187,185, respectively).
For malaria, phase I–III trials were the most productive (£60,491) and all other types
of science highlighted between £93 and £96,000 of investment per publication.

Table 2. Relative investment in type of science for HIV, tuberculosis and malaria research,
as described by a ‘UK pound per publication’ metric
By investment per citation (Table 3), tuberculosis (£1,797) appears the most productive area for investment, compared
to HIV (£2,265) and malaria (£2,834). By type of science (Additional file 1), public health was the most productive for HIV (£2,265) and tuberculosis (£1,797),
with phase I–III trials being the least productive (£7,479 and £4,035, respectively).
For malaria, phase I–III trials were most productive (£1,713) and all other types
of science highlighted between £2,600 and £3,200 of investment per publication.

Table 3. Relative investment in type of science for HIV, tuberculosis and malaria research,
as described by a ‘UK pound per citation’ metric

Discussion

Across 1997–2013, significant public and philanthropic investments of over £1.4 billion
have been awarded to United Kingdom institutions for HIV-, tuberculosis- and malaria-related
research, with the vast majority of investment (£1.1 billion; 80.2% of total) directed
to preclinical science or public health research. There were 17,271 published outputs
on these disease areas, which were cited on 503,752 occasions. The most published
and cited disease was HIV, and publications and citations were most numerous in preclinical
science for HIV and tuberculosis, but for malaria this was phase I–III trials. The
‘investment per publication’ and ‘investment per citation’ metrics show tuberculosis
to be the most productive area of research investment. By type of science, the metrics
suggest public health research to be the most productive area for HIV and tuberculosis
and phase I–III trials for malaria. The publication trends show that publication numbers
steadily increase over time, distinct from the annual volatility of research funding.
HIV, tuberculosis and malaria are infections of huge global burden, and priority areas
for WHO [23] and as well as the Global Fund, which has an annual budget of around US$4 billion
and collaborates with local, national and international entities from the public,
private and philanthropic sector with the aim of addressing and greatly reducing the
impact of these diseases in the countries of highest burden [24]. Given the burden and international focus, the significant level of research investment
is important and the extent of the publications and resultant citations unsurprising.
However, funders and policymakers need to know how well their investments are performing
and quantifications of the numbers and usefulness of the published outputs are an
important measure of the impact and quality of research. The metrics developed herein
highlight the more efficient performance of tuberculosis investments and (more generally)
public health research, and will be of interest to the funding agencies and academic
and clinical institutions which seek to engage in the highest-quality and best-performing
research. It is also important that the large volume of knowledge generated by the
research and disseminated by the publications is made clearly available to those involved
in decision making regarding future funding priorities and more immediate considerations
for policy and implementation.
The approach described herein covers three important disease areas, but it would be
useful for future work to consider other infectious diseases and to systematically
analyse investments and publications in non-communicable disease research. The investment
dataset does not consider private sector investments, which may particularly impact
upon the metrics used here for phase I–III trials and for product development research
in these infections.
As journal requirements and publication databases evolve, it will become increasingly
possible to link individual investment and published outputs via grant reference numbers
and name of the agency sponsoring the research. This will provide the ability to generate
more precise metrics of the relationship between investment and publications and citations.
There is also the possibility for future work to consider published outputs by individual
journal and journal metrics. Other research has suggested that the infectious disease
content of the Lancet and New England Journal of Medicine journals consists of up to 35% for HIV and tuberculosis combined and 65% for all
other infections [6]; therefore, the relative importance of each disease area for funders and publishers
would be important to assess. Alongside the ResIn study [15], other research has highlighted the importance of the United Kingdom infectious disease
research portfolio [25], and also the publication record of United Kingdom authors [4]. Funders such as the Wellcome Trust also use bibliometric analyses to assess their
portfolio of studies [26]. Whilst detailed and informative, the disadvantage of these reports is that they
focus solely on a single funder and each funder uses different criteria to analyse
their work; one strength of this paper, and the ResIn study as a whole, is the unified
approach across funders and disease areas, allowing simultaneous comparison of multiple
awarding bodies.
The analysis in this study used data from one comprehensive publications database
(Scopus) and inclusion of data from other databases may have modified the results
as the content of each database is slightly different [ [27]. Categorisation of both investments and publications is necessarily a pragmatic process
and open to subjectivity, though the rigour of the process is strengthened by the
cross-checks of random samples of data by a second author. We made pragmatic decisions
when applying our methodology – (1) that investments across 1997–2010 would publish
most of their papers during 1997–2013; (2) that only including first or last authors
from a United Kingdom institution would be a suitable measure of significant United
Kingdom involvement and therefore likely to have received research funding. It is
difficult to estimate how many papers have been excluded, or included, in error via
these methods. Due to small numbers, we do not anticipate a significant impact of
any retrospective reclassification of the cross-disciplinary category by type of science
in the 1997–2010 data. Individual publications were assumed to be of equal impact
and not controlled for by journal impact factor or any other publication or journal
metric or weighting.

Conclusions

The analyses reported herein suggest that tuberculosis is the best-performing disease
area in terms of public and philanthropic research investment and publication and
citation productivity, and public health is generally the type of science that is
most prolific. These investments and publications generate great amounts of knowledge,
and the analyses we report here can inform the thinking and priority-setting of policymakers
such as WHO, national and international funding agencies, and the academic and clinical
institutions which carry out research. The ResIn study [15] has secured funding from the Bill and Melinda Gates Foundation to carry out systematic
analyses on investments and publications in infectious diseases in the G20 countries
and so extended datasets will become available for open collaboration across 2016
and 2017.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MGH and JRF designed and created the study. MGH, FBW, JM, NK, BB, and CJC assembled
and categorised the dataset. JRF, RA and GD informed study design, reviewed data,
and contributed to the analyses, drafting and revisions. All authors reviewed the
results and approved the draft and final versions of the manuscript.

Additional file

Additional file 1:. Supplementary information for publication. (XLSX 49 kb)


Format: XLSX
Size: 50KB Download fileOpen Data

Acknowledgements

The authors would like to acknowledge the Infectious Disease Research Network for
their role in original design of the Research Investments in Global Health study,
and also funders who have contributed data to these analyses. No funding is attributed
to this submission.

References


  1. Global, regional, and national age–sex specific all-cause and cause-specific mortality
    for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of
    Disease Study 2013
    . Lancet. 2014; 385:117-71. OpenURL





  2. Global, regional, and national incidence, prevalence, and years lived with disability
    for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic
    analysis for the Global Burden of Disease Study 2013
    . Lancet. 2015; 386(9995):743-800. Publisher Full Text OpenURL





  3. Report of the Ebola Interim Assessment Panel. WHO, Geneva; 2015. http://www. who.int/csr/resources/publications/ebola/ebola-panel-report/en/ OpenURL





  4. Yao Q, Chen K, Yao L, Lyu P, Yang T, Luo F et al.. Scientometric trends and knowledge maps of global health systems research. Health Res Policy Syst. 2014; 12:26. PubMed Abstract | BioMed Central Full Text OpenURL





  5. Iñigo J, Chaves F. Analysis of publications on infectious diseases. A comparative study of ten countries
    in the period 2000–2009
    . Enferm Infecc Microbiol Clin. 2012; 30:236-42. PubMed Abstract | Publisher Full Text OpenURL





  6. Fätkenheuer G, Roer F, Hirschel B, Cornely OA, Salzberger B. Infectious diseases publications in leading medical journals--a comparative analysis. Eur J Clin Microbiol Infect Dis. 2012; 31:2585-91. PubMed Abstract | Publisher Full Text OpenURL





  7. Rethlefsen ML, Livinski AA. Infectious diseases citation patterns: mapping the literature 2008–2010. J Med Libr Assoc. 2013; 101:55-62. PubMed Abstract | Publisher Full Text OpenURL





  8. Glover M, Buxton M, Guthrie S, Hanney S, Pollitt A, Grant J. Estimating the returns to UK publicly funded cancer-related research in terms of the
    net value of improved health outcomes
    . BMC Med. 2014; 12:99. PubMed Abstract | BioMed Central Full Text OpenURL





  9. Wooding S, Hanney S, Pollitt A, Buxton M, Grant J. Project Retrosight: understanding the returns from cardiovascular and stroke research:
    the policy report
    . RAND Europe, Cambridge; 2011. http://www. rand.org/pubs/monographs/MG1079.html OpenURL





  10. Wooding S, Hanney S, Buxton M, Grant J. Payback arising from research funding: evaluation of the Arthritis Research Campaign. Rheumatology. 2005; 44(9):1145-56. PubMed Abstract | Publisher Full Text OpenURL





  11. Medical research: what’s it worth? Estimating the economic benefits from medical research
    in the UK
    . UK Evaluation Forum, London; 2008. OpenURL





  12. Ha TC, Tan SB, Soo KC. The journal impact factor: too much of an impact? Ann Acad Med Singapore. 2006; 35:911-6. PubMed Abstract | Publisher Full Text OpenURL





  13. Vinkler P. Correlation between the structure of scientific research, scientometric indicators
    and GDP in EU and non-EU countries
    . Scientometrics. 2008; 74(2):237-54. Publisher Full Text OpenURL





  14. Jonkers K, Tijssen R. Chinese researchers returning home: impacts of international mobility on research
    collaboration and scientific productivity
    . Scientometrics. 2008; 77(2):309-33. Publisher Full Text OpenURL





  15. ResIn, Research Investments in Global Health. www. researchinvestments.org webcite OpenURL





  16. Head MG, Fitchett JR, Cooke MK, Wurie FB, Hayward AC, Atun R. UK investments in global infectious disease research 1997–2010: a case study. Lancet Infect Dis. 2013; 13:55-64. PubMed Abstract | Publisher Full Text OpenURL





  17. Fitchett JR, Head MG, Cooke MK, Wurie FB, Atun R. Funding infectious disease research: a systematic analysis of UK research investments
    by funders 1997–2010
    . PLoS One. 2014; 9:e105722. PubMed Abstract | Publisher Full Text OpenURL





  18. Head MG, Fitchett JR, Moore DA, Atun R. Systematic analysis of funding awarded to institutions in the United Kingdom for infectious
    disease research, 1997–2010
    . JRSM Open. 2015; 6(3):2054270415577056. PubMed Abstract | Publisher Full Text OpenURL





  19. Head MG, Fitchett JR, Cooke MK, Wurie FB, Atun R. Differences in research funding for women scientists: a systematic comparison of UK
    investments in global infectious disease research during 1997–2010
    . BMJ Open. 2013; 3:e003362. PubMed Abstract | Publisher Full Text OpenURL





  20. Head MG, Fitchett JR, Newell M-L, Scott JAG, Harris JN, Clarke SC et al.. Mapping pneumonia research: a systematic analysis of UK investments and published
    outputs 1997–2013
    . EBioMedicine. 2015; 2(9):1193-9. PubMed Abstract | Publisher Full Text OpenURL





  21. ResIn, Research Investments in Global Health. Study methodology. http://researchinvestments. org/about-the-study/study-methodology/ webcite OpenURL





  22. GraphPad Software. QuickCalcs. http://graphpad. com/quickcalcs/kappa2/ webcite OpenURL





  23. Bourzac K. Infectious disease: beating the big three. Nature. 2014; 507:S4-7. PubMed Abstract | Publisher Full Text OpenURL





  24. Davis SLM. Human rights and the global fund to fight AIDS, tuberculosis, and malaria. Health Hum Rights. 2014; 16:134-47. PubMed Abstract | Publisher Full Text OpenURL





  25. Cures P. Neglected disease research and development. Emerging Trends, Sydney; 2014. OpenURL





  26. This is Assessment Framework Report 2012/13. Wellcome Trust. 2013. http://www. wellcome.ac.uk/About-us/Publications/Reports/Biomedical-science/WTVM054494.htm webcite OpenURL





  27. Aghaei Chadegani A, Salehi H, Yunus MM, Farhadi H, Fooladi M, Farhadi M et al.. A comparison between two main academic literature collections: Web of Science and
    Scopus Databases
    . Asian Soc Sci. 2013; 9(5):18-26. OpenURL


HARPS | Full text | Comparing research investment to United Kingdom institutions and published outputs for tuberculosis, HIV and malaria: a systematic analysis across 1997–2013

No comments:

Post a Comment