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Research at York has had a direct impact on national guidance about the use of health technologies in the NHS. It provided methods that are used to assess whether a technology is expected to be a cost-effective use of NHS resources, how uncertain this assessment is likely to be and whether additional evidence is sufficiently valuable to recommend further research to support its widespread use. It has had an impact on the technologies available in the NHS and the evidence available to support their use: improving patient outcomes; saving NHS resources and strengthening the evidence base for clinical practice. It gives an explicit signal and incentive to manufacturers; informing development decisions and the type of evidence collected. It has had an international impact on how the adequacy of evidence is judged and research is prioritised; particularly in recent reforms in the United States (US) where the principles of this value of information (VOI) analysis are informing the prioritisation of $3.8bn for `comparative effectiveness research'. It has also informed the methods used in low and middle income countries, especially national agencies in health care systems in South East Asia and South America, as well as global funding bodies.
The NHS spends about £11bn annually on pharmaceuticals, of which £8bn is on branded drugs, representing about 13% and 10% respectively of available NHS resources. Research at York has been central to the public and policy debate about how branded pharmaceuticals ought to be priced and has made a material contribution to the development of government policy to introduce a value based pricing (VBP) scheme for all new pharmaceuticals. VBP has significance for the prices that the NHS pays for pharmaceuticals, access to new drugs for NHS patients, and the return that manufacturers can expect from future research and development. There is also an international impact in two respects: UK prices are estimated to influence 25% of the world market and York has contributed to a wider policy debate about international pharmaceutical pricing and the potential role of value based pricing in European, North American, South American and South East Asian health care systems.
Methods developed at the University of York for measuring NHS productivity have changed how the Office of National Statistics values the NHS in the national accounts. Our methods, which take into account improvements in the quality of care, have been incorporated into submissions to the Comprehensive Spending Reviews that determine the NHS budget and are internationally influential. Research on productivity at hospital level has influenced the tariffs set by the Department of Health for reimbursement of specialist hospital care. Research on the productivity of hospital consultants influenced the reviews of doctors' pay and rewards by the Doctors' and Dentists' Pay Review Body and the National Audit Office and formed the basis of benchmarking tools distributed for use in the NHS.
Patients are more likely to get the most effective healthcare, at affordable cost to the NHS, as a result of research methodology, developed by researchers at the University of Bristol, that allows the efficacy and cost-effectiveness of multiple treatment options to be compared, based on all the available evidence, much more efficiently than in the past. Since 2008, these methods have been used to inform Clinical Guidelines issued by the National Institute for Health and Care Excellence (NICE) and in submissions to NICE's Technology Appraisals. Guidance in NICE's Technology Appraisals is mandatory and therefore impacts directly on clinical practice. The methodology is used in decision making by NICE's equivalents in other countries including Canada, Germany, and South Korea, and by consultancy firms that conduct analyses for pharmaceutical companies.
York research has, continuously since the early 1990's, underpinned the methods by which a substantial proportion of the total NHS budget is allocated by the Department of Health to the organisations providing or arranging healthcare. Despite numerous NHS reforms, our research has produced formulae appropriate to each new system. These formulae have driven NHS policy on allocations across geographical areas and health care administrative entities in England, thereby ensuring that the population of approximately 55 million people receives a share of over £90 billion of healthcare resources that is fair and better reflects relative health care needs.
About 800,000 people are living with Alzheimer's disease in the UK today, at a cost of about £23 Billion/annum. Researchers in Exeter produced a report in 2010 about the effectiveness and cost- effectiveness of available drugs, which formed the basis for revised NICE guidelines (2011), recommending more widespread drug usage. 2012 NHS data showed a big increase in drug prescribing since 2010. We estimate that if the 110,000 people with untreated mild disease at the time of the report are now being treated, there would be an average delay in time to admission to care of 13,000 person years.
The National Institute for health Care Excellence (NICE) in England and Wales makes timely and equitable decisions regarding the use of health technologies (medical devices and pharmaceuticals) within the NHS in order to improve patient care. Such decisions are reliant on Health Technology Assessment (HTA) — the processes of evidence generation and synthesis, and the methods that underpin these. Methods pioneered and developed at Leicester over the last 15 years are now used routinely in HTA both by NICE and the pharmaceutical industry and healthcare consultancy companies who make submissions to NICE. Internationally, these methods are also now being adopted in the US by Agency for Healthcare Research and Quality (AHRQ), as well as in rapidly developing countries such as Brazil and Colombia.
LSE research has formed the basis for a new assessment framework which helps healthcare planners set priorities within fixed budgets. Since 2005, a group of scholars at LSE has been developing a programme of applied research that is enabling organisations responsible for commissioning health services to make better use of their limited resources to improve value for their populations. It has led to: (a) new health spending strategies in the Isle of Wight in 2007, 2008 and 2009 that delivered a 50% reduction in emergency asthma admissions; (b) 15% savings on the spend on eating disorder services in Sheffield from 2009; (c) new guidelines for commissioning cost-effective care in chronic obstructive pulmonary disease; (d) a user-friendly Excel decision support tool, user-guidance and instructions for facilitators available for free download, as well as training modules for potential users; and (e) the evaluation of alternative strategies for the allocation of US$10 million per year to fight tuberculosis in Sudan in 2013-15, this being the first of a series of pilots to adapt the LSE assessment framework to the new funding model of the Global Fund.
Research by G Favato of Kingston University established that it is cost-effective to vaccinate males against the HPV virus, overturning previous studies that had suggested such vaccination was not cost-effective.
This research was presented to the Italian Agency for Drug Approval (AIFA). As a result, AIFA changed its vaccination policy for HPV, removing its previous restriction of vaccination to females only and approving vaccination also for males.
The Italian regions of Emilia-Romagna and Sicily have now begun voluntary vaccination programmes for males under 26, with economic benefits amounting to €98.9 million. In addition, Emilia-Romagna has introduced a vaccination programme for HIV-infected males under 26, providing health benefits for a high-risk sub-population.
Research at Bangor University's Centre for Health Economics and Medicines Evaluation has had significant influence on pharmaceutical policy development across the UK. This has impacted directly on the parameters by which the prices of new medicines are to be set in the UK, and how the All Wales Medicines Strategy Group (AWMSG) and the National Institute for Health and Care Excellence (NICE) appraise treatments for rare diseases. Research findings have also defined the methods by which biosimilar medicines are appraised in Wales, and underpinned the Welsh (2012) and Scottish (2013) Governments' decisions against establishing Cancer Drugs Funds.