Diarmuid Coughlan

M.Pharm, MSc. (Health Economics), M.Sc.(Pharmacy Practice Research)

PhD student NUI Galway



Diarmuid Coughlan is a HRB/NCI Health Economics Fellow in Cancer Prevention. After qualifying as a pharmacist, Diarmuid worked in hospital and community pharmacy in England, Ireland and Australia. He has a Masters in Pharmacy Practice Research from University College Cork and a Masters in Health Economics from the University of York. As part of his current Fellowship, he spent two years at the prestigious Johns Hopkins School of Public Health under the supervision of Professor Kevin Frick. While in Baltimore, Diarmuid furthered his interest in health literacy and developed his thesis on the role of the human papilloma virus (HPV) in head and neck cancer.

Economic essays on head and neck cancer in the HPV era—cost, impact and knowledge

The Human Papilloma Virus (HPV) is a causal agent in a subset of Head and Neck Cancers (HNC) predominately seen in younger men without a significant history of tobacco and alcohol use. The increasing incidence of these cancers and the burgeoning cost associated with treatment should make this issue a legitimate oncopolicy agenda priority. This thesis examines the economic, clinical and epidemiological metrics commonly used by decision-makers in discussing HPV-related and unrelated HNC. A number of actionable strategies that could be implemented to reduce the number of people diagnosed with the disease, enhance the quality of life for those living with the disease and lessen the likelihood of dying from the disease are proposed.

Cost-of-illness (COI) is a common methodology used in health economics to shine light on the burden of a disease. Using the Medical Expenditure Panel Survey (MEPS), the nuances involved at arriving at the national estimate of the direct medical expenditures of HNC in the US are examined. Disease specific attribution, matching and regression methods are thoroughly examined in this analysis highlighting the weaknesses with COI estimates. The impact of a cancer diagnosis is the subject of the second empirical piece. Survey data used in this analysis are TILDA in Ireland and HINTS in the US. Time since cancer diagnosis (Within the past year, 2–5yrs, 6–10years and >11yrs) and health insurance status are used as the main independent variables in regression models examining a host of burden measures including self assessed health. As HPV-related HNC is a morbidity issue, the impact of a cancer diagnosis in Ireland and the US is compared. The analysis highlights that cancer ought to be seen as a chronic condition and that health insurance really does matters in a cancer diagnosis.

As HPV vaccination is a controversiol issue, a literature review of individual’s knowledge pertaining to HPV is examined and leads to the the third empirical piece that looks at the motivation for a health literate healthcare system. Data was pooled from two waves of the Survey of Lifestyle, Attitudes and Nutrition (SLÁN) and using health inequalities principles, it was established that motivation for a health literate healthcare system is seen across the socioeconomic gradient. The thesis concludes that policy-makers need to be cognizant of health literacy principles when approaching the public about gender-neutral HPV vaccination.

Keywords cancer prevention, public health, health literacy, Human Papilloma Virus (HPV), cost analysis, health inequalities


PhD research funding

  • HRB/NCI Health Economics PhD fellowship

Head of Economics

Prof Alan Ahearne

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