OHE in the Spotlight: Summer 2011

This is the first in a series of posts that will review OHE’s contributions to advancing thought and stimulating innovative ideas in its three key research areas: financing and delivery of health care, HTA methods and processes, and the economics of the pharmaceutical and life sciences industries.

This is the first in a series of posts that will review OHE’s contributions to advancing thought and stimulating innovative ideas in its three key research areas: financing and delivery of health care, HTA methods and processes, and the economics of the pharmaceutical and life sciences industries.  Below, we briefly review the outside activities of the OHE team for June through August 2011.

Financing and Delivery of Health Care

With resources for health care increasingly constrained by the state of economies worldwide, the efficient use of resources available becomes even more critical.  Nancy Devlin’s research on patient reported outcomes measures (PROMs) in the UK is intended to help develop an important new approach to valuation.  At the summer 2011 UK Health Economists Study Group (HESG) meeting, she presented the first paper to analyse hospital efficiency by relating costs to the production of improvement in health using PROMs, rather than the volume of services.  Also at that meeting, Nancy presented new research on whether and how the mode of survey administration – online versus in-person – affects survey results.

In July, Jon Sussex was a panellist in a roundtable discussion sponsored by WCG and The Holmes Report.  Providing the health economist’s perspective on issues affecting future access to health care in high incomes countries, he explained that expenditures inevitably will increase, making patient outcome measures even more important.

Economics of the Pharmaceutical and Life Sciences Industries

Pricing pharmaceuticals in a way that both maximises patient access and encourages continued innovation remains a global challenge.  In June, Adrian Towse presented his recent research on optimal pricing of pharmaceuticals across and within countries at the University of York’s Centre for Health Economics and at the University of Oxford’s Health Economics Research Centre.  He also  presented in a session at the Health Technology Assessment International (HTAi) Annual Meeting on cost and value in pharmaceutical pricing.

HTA Methods and Processes

Value-based pricing (VBP), due to be implemented in the UK for newly marketed medicines as from 2014, remains a key focus of OHE activities.  In June, Jon Sussex’s presentation at the NextLevel Pharma conference focused on the principles behind VBP for drugs as proposed by the UK government, the most recent developments in plans to implement it, and lessons that the UK might learn from other countries.  (With Nancy Devlin, Jon has recently published an analysis of the options for operationalising VBP.)

At the HESG meeting, Jon chaired a session on what values should count in HTA for new medicines under VBP in the UK.  At the 8^th World Congress of the International Health Economics Association (iHEA), Adrian Towse chaired a session of experts from the UK, the US and France that focused primarily on the role VBP would have in aligning the incentives for investment in pharmaceutical R&D with the needs of the NHS.  Another session debated the issues around the use of VBP for pharmaceuticals.

HTA in emerging markets was the focus of two OHE posters and participation in a discussion session at the HTAi Annual Meeting.  One poster focused on the evolution of HTA in Brazil and the other on understanding the evolution of HTA in emerging market health care systems.  With Lou Garrison of University of Washington, Adrian Towse presented at the Industry HTA Learnings session on progress on the HTA emerging markets project that is being funded by PhRMA and EFPIA.

HTA methods and practical application was the focus of three OHE activities over the summer.  At the HTAi Annual Meeting, Adrian Towse participated at a symposium on personalised health care that discussed how to properly assess the value of innovation in that area.  He presented on how HTA agencies should evaluate personalised health care solutions and how this might apply in developing countries.

Nancy Devlin was a panellist at the iHEA Congress in a symposium intended to introduce the concept of multi-criteria decision analysis (MCDA) in Canada.  She presented her views on the UK local frameworks for decision making, including how MCDA is designed and being applied.

With Jon Sussex, Nancy published an invaluable primer on MCDA in April 2011.

As part of the NHS Financial Leadership Programme, Nancy leads the training on methods for assessing value for money in the NHS portion of the Cass Business School programme.  The purpose is to develop the technical and behavioural skills of NHS directors that are essential to meeting the challenges arising from the current reforms.

Applying HTA in decision making is an area of study in which OHE long has been involved.  At the iHEA Congress, Adrian Towse chaired a session on decision rules in cost-effectiveness analysis, examining in particular how alternative decision rules perform.  He also was part of a panel on the role of cost-effectiveness thresholds in decision making about health care technologies and argued threshold estimates must be informed by a broader, societal perspective, including willingness to pay.

Ruth Puig-Peiró’s presentation at the iHEA Congress reported the latest on her research that examines the extent to which the practice of economic appraisals varies across English government agencies and what this means for efficiency.

The UK’s National Institute for Health and Clinical Excellent (NICE) has applied various HTA methods since its inception in 1999.  Adrian Towse participated in the Only in Research workshop funded by the Medical Research Council Methodology Research Programme.  Held at NICE and led by the University of York’s Centre for Health Economics, the workshop’s purpose was to discuss when NICE should recommend the use of health technologies in the context of an appropriately designed programme of evidence development.  At the iHEA Congress, Koonal Shah presented his research on the substantive social value judgments about equity in health and health made by NICE.