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Natalia Kunst
Senior Research Fellow (Associate Professor)

Natalia Kunst

I am a decision sciences and health economics researcher with interests in uncertainty and evidence in decision-analytic modelling and health economic evaluations, value of information analysis, and health disparities. I am currently a Senior Research Fellow (Associate Professor) at the Centre for Health Economics (CHE) at the University of York. Further, I serve as a NICE Technology Appraisal Committee member. I am also a Research Affiliate at the Yale University School of Public Health and an Affiliated Member at the Center for Healthcare Research in Pediatrics (CHeRP), Harvard Medical School and Harvard Pilgrim Health Care Institute.

Previously, I worked as a Senior Advisor at the Norwegian Health Directorate and an Associate Professor at the University of Oslo, Norway. In these roles, I gained experience in national policy-making in healthcare by evaluating preventive interventions and priority settings, and developing national guidelines, and maintained an active role in research, mentoring and teaching.

I completed my PhD in Health Economic Evaluation and Health Policy at the University of Oslo, Norway, and spent 2 years of my 3-year PhD program at Yale University, first as a visiting PhD candidate and thereafter working as a Postgraduate Research Fellow. During my PhD, I co-founded and have since co-led the Collaborative Network for Value of Information (ConVOI), which is an international group of over 20 researchers with interests in the application and development of methods for value of information calculation. I pursued a postdoctoral fellowship at Harvard Medical School and the Harvard Pilgrim Health Care Institute where to address challenges associated with the assessment of cost-effectiveness and decision making in precision medicine, also focusing on health disparities. Prior to my PhD, I worked as a Senior Health Economist at LINK Medical Research, Norway, developing and adapting decision-analytic models and preparing Health Technology Assessment (HTA).

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My research interests

Decision-analytic modeling

I have developed several decision-analytic models to simulate clinical benefits, harms and cost-effectiveness of different interventions for various health conditions, such as breast cancer, psoriasis and peanut allergy. Software I use include R, Excel with VBA, and Amua. I am currently learning C++ and Python. When working as a Senior Health Economist, I also adapted a large number of models for various diseases to Norwegian settings.

Health economic evaluation

I have performed a number of health economic evaluations, both in the US settings as part of my research projects and in the Norwegian settings as part of my work with Health Technology Assessment(HTA)/Single Technology Assessment (STA) submissions. Disease areas I have worked with include various types of cancer, immunological disorders, blood disorders and other.

Cancer, precision medicine, genetics

I have built a portfolio of policy-relevant research concerning cancer, genomics, and precision medicine. More specifically, my research has been focusing predominantly on cancer (e.g., breast cancer, colorectal cancer). When formalizing the iterative decision-making framework, I became aware of the challenges associated with the assessment of cost-effectiveness and decision making in precision medicine. Thus, for my post-doctoral training, I moved to Harvard University to gain new skills and expertise in the area of genomics and precision medicine. More specifically, I was awarded Thomas O. Pyle Fellowship and joined the Precision Medicine Treatment (PreEMPT) Modeling team that works on simulating short- and long-term clinical benefits and estimating the cost-effectiveness of integrating different genome screening strategies into clinical care for healthy or high-risk newborns for a wide variety of heritable conditions.

Value of information analysis

An essential part of my work focuses on the use of value of information (VOI) analysis to assess and quantify decision uncertainty. I have published several application and methodological papers in this area. I have also held several short courses, seminars and workshops on VOI. Further, I co-founded and have co-led the Collaborative Network for Value of Information (ConVOI). As part of ConVOI, I work on removing the barriers to using VOI analysis in practice, providing training and guidance on the use of VOI, and develop methodological solutions to improve the application of VOI.

Evidence & uncertainty

In my PhD work, I formalized an iterative decision-making framework that highlights the central role of evidence in the process of health decision analysis. This evidence drives the iteration in the decision-making process. Consequently, the proposed framework emphasizes the importance of including a VOI analysis as a part of the decision analysis to evaluate decision uncertainty, assess whether gathering new evidence would be worthwhile, and identify the optimal designs of research.

Health disparities

My research interests also include health disparities. Some of my previous research projects examined regional variation in healthcare resource use. Further, I am part of PreEMPT II grant application at Harvard University. If funded, I will lead one of the three grant aims focusing on the evaluation of newborn screening when accounting for racial disparities. This aim will also involve the use of VOI to potentially reduce racial disparities and improve health equity by guiding decision makers on how to efficiently invest their limited resources to improve available evidence on genetic screening in underrepresented groups.

Affiliations

Selected publications