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12 November 2025
Dr Peter May explains the population health outcomes of a recent evaluation, and how connecting across KHP equipped him to maximise the strength, relevance and impact of his work on breathlessness.
Can you tell us a little about your role at King’s Health Partners?
I am a health economist at Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation in King's College London. My research programme encompasses three main areas: cost-effectiveness analyses as a part of clinical trials; projecting population health needs and costs, and evaluating associated policy choices, for service planning; and applying decision-making principles from economics to other contexts such as doctor-patient communication.
What has your most recent research found?
Our most recent paper is an economic evaluation as part of the BETTER-B trial. BETTER-B was an international programme of work on breathlessness, including a multi-country trial to evaluate mirtazapine, an anti-depressant.
We found that mirtazapine has a significant negative effect on patient outcomes, is associated with increased use of healthcare and unpaid family care, has a very low probability of cost-effectiveness, and should not be prescribed.
How will this research impact patients and/or professional practice?
The BETTER-B clinical trial found no benefit of mirtazapine but, in a context where patients find symptoms highly distressing, no effective treatments in advanced disease have been identified and the drug is widely available at low cost, prescribers may continue to view it as ‘worth a shot’.
We hope that our results dissuade prescribers from mirtazapine for breathlessness, thus sparing patients, families and systems the additional burden. Furthermore, we hope that we have highlighted more broadly the risks of prescribing off-label, repurposed medicines without a strong evidence base.
How has connecting across King’s Health Partners created opportunity for you and your work?
As a health economist, I seldom work alone. I am a methodologist most at home, and most useful, as a part of interdisciplinary teams. Working within King's Health Partners gives the chance to collaborate with nurses, doctors, allied health workers and professionals from many other backgrounds, which not only creates opportunities to work together but also equips us to maximise the strength, relevance, and impact of the work.
