Any new invention in healthcare needs to be evaluated not just from a pure science/technology perspective but also from a broader perspective of desired outcome, cost and effectiveness !

Shilpi Swami, our next pathbreaker, Associate Director at Merck Sharp & Dohme (MSD), UK, assesses the cost-effectiveness of new treatments in Oncology compared with existing treatments through health economic models.

Shilpi talks to Shyam Krishnamurthy from The Interview Portal about the multi-disciplinary nature of health economics that brings together economists, epidemiologists, statisticians, policy professionals and scientists/technologists with a larger common goal of improving healthcare for all.

For students, the field of healthcare is always evolving – irrespective of whether you work in the industry or academia. So professionally, it’s important to be updated on new research methods and their applications. This is more exciting than challenging though!

Shilpi, can you talk a little bit about your background?

I was born and brought up in a middle-class family in Delhi, India. I completed my education in Delhi, and I have been living and working in the UK for the last four years or so… 

I did my schooling from St Margaret Sr. Sec. School, Delhi. Since my school days, I was interested in science, and I had opted for science subjects in 11th and 12th grade. 

I, on my own, explored economics in my 12th grade by reading my brother’s books, who was doing graduation in Economics back then. At this point, I became deeply interested in Economics and decided to learn it further. So, I opted for B.A. (Hons) Economics after 12th grade and continued to pursue a Master’s degree in Economics; however, my interest in pure science always remained.

During school, besides my studies, I engaged myself in extra-curricular activities like dancing, acting, debating and poetry recitations. These activities helped build my confidence and leadership skills that helped (…and are continuing to help) throughout my career. 

I continued to pursue my interest in acting for more than seven years after school by joining a professional theater company (The Films and Theater Society) as a part-time actor. I still follow my passion for dancing and acting alongside my work and busy life, in whatever capacity I can; as this helps me rejuvenate.

Also, I started doing meditation and breathing exercises while I was in grade 10th in school. Ever since then, I have been meditating regularly; and meditation has helped me to release stress and to think positively in my personal and professional life.

What did you do for graduation/post-graduation?

I completed my graduation and post-graduation in Economics from premier public universities in India.

I have always believed in keeping multiple options open early in one’s career-so if one fails, instead of being disappointed, it’s easier to sail in another direction! One of the reasons for opting for science in school was also to be open to pursuing different subjects after school. 

I applied a similar approach after 12th grade while waiting for my exam results. Since graduation in all fields is competitive in India, I gave entrance exams for good colleges in diverse subjects (that I was interested in) such as Engineering, English literature, and Business Studies to keep my options open. 

Based on my grade 12th marks and my primary interest in Economics, I pursued B.A. (Hons) in Economics from Sri Ram College of Commerce (SRCC), Delhi University. During graduation, I also studied for entrance exams for top-tier institutes in post-graduation in Economics. I pursued an M.A. in Economics (with specialization in World Economy) at Jawaharlal Nehru University, Delhi, India. 

For my higher studies, I made the deliberate decision to not spend much money on private institutes for IIT or MBBS or MBA. I knew my parents did not have much funds and I was not keen on burdening myself or my family with any educational loan. Hence, I systematically planned to pursue my higher education from premier but public universities in India, which had very low tuition fees. 

What were the influences that led you to such an offbeat, unconventional and unique career?

With strong foundations in economics and interest in pure sciences during school, I was exposed to different subject areas by then. So, while looking for my first job after post-graduation, I was interested in technical and research-oriented roles related to my interest areas. 

While looking for a job after my post-graduation, I was initially disappointed as I could not get a campus placement with any big MNC. With a strong belief, I kept on searching for a good role. I posted my resume on all Indian recruitment websites. Through one of the job websites, I received an interview call for an Analyst role at a Health Economics and Outcomes Research (HEOR) consultancy. 

The HEOR was a naïve subject area in India at that time (and, is still growing…), and despite not knowing much, it interested me, as it is a multidisciplinary field that combines different subjects, such as economics, biology, epidemiology, data science and statistics. 

So, I decided to take up the HEOR role as my first job. During my first job, I learned a lot while working on different aspects; and got further interested in HEOR. That’s when HEOR became my stable career option going forward.  

How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path

When a new technology is invented in healthcare, apart from researchers in pure medicine, there is also a need for researchers in epidemiology, health economics and policy to assess the technology from a broader perspective. The role of a health economist (or more broadly, an HEOR professional) is to synthesise the evidence in medicine and economics, assess patient’s outcomes and compare the new technology with alternative options with respect to costs and/or effectiveness. 

During the initial years, I was focused on learning and working on different domains within and related to HEOR such as literature reviews or evidence synthesis, economic modeling and real-world data analysis.    

After working in India during the initial years, I wanted to develop myself further in HEOR by studying or working internationally. I was especially interested in the UK, as the methodology development and applications in my profession were further advanced in the UK.

Since I did not have the funds for (foreign) for higher education, I started looking for either PhD scholarships (100%) or jobs. Interestingly, in the UK, though you don’t’ necessarily need a PhD for a ‘research job’ in universities in health economics, having work experience is essential. So, I started applying for research jobs in health economics in the UK. I approached this systematically, by shortlisting pioneering universities in health economics, keeping track of open job positions, fulfilling their application processes and interviewing with a couple of universities.  

After months of effort, I was successful and was appointed as a Research Fellow (Health Economics) at the University of York, UK (a pioneer institute in health economics methods development and research). It was the first time I stepped out of my home country, and the motive was to advance my knowledge. 

I had some savings while working in India that helped me with the relocation and since it was a research job and not a study programme, I had the means to pay for my expenses in the UK. 

My research work at the University of York was focused on global health. I was working on assessing costs and cost-effectiveness of policies or interventions targeted at stopping tobacco consumption and substance abuse in south-Asian countries and in the UK. Alongside, I participated in application-focused training or modules on statistics and economic evaluation in healthcare.

After my research contract at the University of York was over, I joined a health economics’ consultancy in London. Currently, I am working in a pharmaceutical company in London. I have been in the same field since I started working, however, I was always interested in understanding my field holistically and as a result, I have worked in different job roles and organizations.

I have personally found LinkedIn and recommendations from personal connections or mentors very helpful in finding opportunities and in my career. So, I would suggest that students reach out to experienced people and ask them questions without hesitation.

How did you get your first break?

While some believe that joining an esteemed college is your ultimate break, I would say life gives you opportunities at multiple points, and you learn to make smart choices over time. For example, in my case, these points came at graduation, post-graduation, first job, move to the UK, move within UK, current job and to be continued future options throughout life….

Though I completed my graduation in Economics from Asia’s finest Commerce College – SRCC, a career in HEOR can be an independent phenomenon. Since HEOR is a multidisciplinary field, a lot of health economists are also from different fields (other than economics) such as statistics, operations research, pharmacy, and biology. 

Even though society will make you believe that making it through the best university is your only chance to succeed, it’s not. For example, in my case, people outside of India hardly know about SRCC; and skills and experience matter more which are developed over time.

What were some of the challenges you faced? How did you address them?

My field is always evolving – Irrespective of whether you work in the industry or academia, so professionally, it’s important to be updated on new research methods and their applications. This is more exciting than challenging though!

On a personal level, my challenge was when I first moved out of my home country. I was adjusting to a new culture and environmental differences and learning to be independent while making sure that I also advance myself in my career. 

Another challenge was to find a job within the UK when my research contract at the University of York was over. I had written a blog on some of the tips that helped me to find a job, which could be useful for people looking out for jobs:

 (https://www.linkedin.com/pulse/busy-finding-your-next-first-job-here-ten-bits-advice-shilpi-swami/)

Where do you work now? What problems do you solve as a Health Economist?

I am working in a global role in a big pharmaceutical company as an Associate Director in Health Economics. 

Health Economists in a pharmaceutical company often support healthcare organisations in timely access of new and cost-effective technologies to the patients. For example, currently, I assess – through health economic models- the cost-effectiveness of new cancer treatments compared with existing treatments. I also assess financial implications on healthcare bodies due to availability of the new treatments. And I work towards supporting access to these new and innovative treatments across different geographies.    

The main skills for my job are interest and expertise in understanding the disease and treatment pathways (say, biology in simple terms), statistics, and research. 

There is always something new to learn in the (HEOR) field and it never gets boring! The underlying motive of my work is to help the society which keeps me engaged and motivated!

How does your work benefit society? 

My work helps the society by improving healthcare; and more specifically, to help provide on-time access to new technologies that are cost-effective (meaning their costs are vis-à-vis the benefits they provide) to the patients.

Tell us an example of a specific memorable work you did that is very close to you!

My research work at the University of York. I worked on health economics related to public health. One specific project, for example, was where I worked towards tobacco cessation in South Asia (India, Pakistan, Bangladesh and Nepal), where tobacco use is a more predominant cause of cancers and related deaths.

Your advice to students based on your experience?

Sure, I have a lot of them and hope these help!

1 ) Start with gaining a basic idea of different fields (via google, teachers, parents, friends), pick what interests you and choose those subjects in school or college. If you are interested in other subjects (outside of your curriculum), you can choose them as optional subjects, or learn them on your own through online courses on the internet. 

2) There are scholarships available in different fields for education and some institutes have lower fees than others, so research and consider these aspects if you are struggling with finances. 

3) The education space is changing rapidly with new technological advancements. So, focusing on developing skills is the key. In today’s world, there are some public platforms as well where you can get noticed if you are talented, e.g. kaggle community for machine learning, stackoverflow, GitHub etc. Also, there are plenty of free learning resources on the internet. 

4) The attitude of teachers or professors towards learning is very liberal across the globe. So, if you want to connect with someone in your field, do not hesitate to ask them (write them an email/ connect on LinkedIn/Twitter, for example), you will be surprised as a lot of people are more than happy to help and support you. 

5) Remember, you can always choose different paths at different stages of your life. If one direction fails, do not be disappointed and prepare yourself for another direction. It’s important to have a positive outlook to stay motivated and growing. 

6) And, lastly, keep on doing those extra-curricular activities that you enjoy….The activities beyond the textbooks teach you soft skills that are helpful throughout your career such as teamwork, confidence, presentation skills, public speaking and effective communication. 

Future Plans?

To continue helping others through my work, and to keep on finding more new actions to be more helpful to society.