Economic evaluation
CHE research in economic evaluation spans applied and methods work within health technology assessment (HTA), policy and public health. Our research is conducted in collaboration with local and national decision makers, as well as with global health partners.
Our expertise includes economic analyses integrated into clinical trials, decision analytic modelling studies, evidence synthesis and economic and statistical evaluation of observational and retrospective data sets. It also covers policy analysis related to health care technologies and other interventions and their regulation by public bodies. We deliver a number of short courses focused on decision analytic modelling, advanced methods for economic evaluation in HTA, statistical methods for economic evaluation and distributional cost effectiveness analysis.
Our work in economic evaluation is founded in our established links to policy. CHE, jointly with CRD, is an assessment group for the NICE Technology Appraisals programme. This work supports the role of NICE in improving outcomes for people using the NHS and other public health and social care services by ensuring national guidance is underpinned by rigorous and independent assessments of clinical effectiveness and value for money. CHE is also part of the NICE Decision Support Unit (DSU), with several other universities. The DSU is commissioned by NICE to provide research and training resources, including guidance on HTA methods.
The NIHR Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions (EEPRU) is a collaboration between the University of Sheffield and CHE. The unit conducts a broad programme of applied and methods research to assist policy makers in the Department of Health and Social Care and its arms-length bodies to improve the allocation of resources in health and social care.
The Applied Research Collaborations (ARC) is a programme of regional networks, for which CHE co-leads the Health Economic Equity and Evaluation theme for ARC Yorkshire & Humber. This fosters collaborative research across a range of public health topics.
The expected costs and health effects of healthcare interventions are used to inform funding decisions, but this approach is limited if the health opportunity cost is unknown. That is the health that could have been achieved if the money required to fund the intervention was spent more on existing funded healthcare.
An assessment of the likely health opportunity costs in different healthcare systems means that evidence of the effectiveness and cost of an intervention can better inform decisions. Most importantly, it ensures that decisions improve rather than reduce health outcomes overall.
Health opportunity costs can be empirically estimated as the marginal cost per unit of health produced by the healthcare system, reflecting the rate at which the healthcare system generates health. Estimates are specific to healthcare systems, reflecting differences in levels of infrastructure, demographies, disease burdens, budgets, etc.
Such estimates can also inform appropriate prices for new interventions, priorities and the value of developing new healthcare interventions, the design of health benefits packages, the benefit (or lack of) to countries of adhering to global guidance, and other policy questions.
Elicitation is the process of transforming the subjective and implicit knowledge of experts into their quantifiable expressions, for use in decision-models.
When making decisions about policy and practice, expert elicitation can provide valuable information.
This is particularly true where evidence is missing, underdeveloped or limited in some way - for example, insufficient, not very relevant, contradictory or flawed.
Examples of areas where elicitation can particularly help include diagnostics, medical devices, early access to medicines schemes and public health.
Here, formal methods to elicit expert judgements are preferred to improve the accountability and transparency of the decision-making process, as well as to reduce biases.
CHE researchers regularly conduct applied expert elicitations for decision-making in healthcare, and are at the forefront of research into methods for elicitation in this setting. They have led on the following:
- The development of a reference protocol for the elicitation of experts’ judgements to inform health care decision making.
- The ISPOR task force on Structured Expert Elicitation for Healthcare Decision Making to provide an introduction to formal elicitation methods to support the implementation of existing guidance in a wide range of decision and modelling contexts.
- The development of STEER open-access resources for conducting structured expert elicitation.
The NIHR Technology Assessment Reviews (TAR) programme enables rapid commissioning of economic evaluations and health technology assessments (HTA) to inform the National Institute for Health and Care Excellence (NICE) and other policy makers.
Our applied work in this programme supports the role of NICE in improving outcomes for people using the NHS and other public health and social care services by ensuring national guidance is underpinned by rigorous and independent assessments of clinical effectiveness and value for money. Our broader methodological research also aims to inform the processes and methods applied by NICE and continues to evolve in response to key policy initiatives.
The process of systematically assessing and combining clinical and economic evidence to inform policy decisions brings economics together with other disciplines such as clinical epidemiology, statistics and information specialists. The TAR programme at York is held jointly between CHE and the Centre for Reviews and Dissemination (CRD).
In addition, CHE is part of the NICE Decision Support Unit (DSU), a collaborative group which also involves colleagues at several universities. The DSU is commissioned by NICE to provide a research and training resource.
