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A programme of methodological research undertaken by the University of York has shaped the economic evaluation methods used by the National Institute for Health and Care Excellence (NICE) since its inception, to assess the cost-effectiveness of healthcare interventions. Therefore the methods developed by York underpin many of the healthcare decisions by NICE on which new and existing interventions and programmes should be funded and used in the NHS. The methods used by NICE have also had a major influence on the approach taken to technology assessment internationally and so York's underpinning research has had wide impact beyond the UK.
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.
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.
Globally, many health research-funding organisations, public and charitable, felt the need to demonstrate to policymakers and the public how their investments in research were benefitting society. HERG's research on developing techniques for assessing the payback (or impact) from health research tackled this need. The payback stream of research itself has had significant, wide- reaching and cumulative impacts. First, internationally, health research funding bodies adopted the framework in their evaluation strategies, including to provide accountability. Second, many stakeholders made extensive use the findings of payback studies in public debate and private lobbying for public expenditure on health research. Third, governments, public research funding bodies and medical research charities, from the UK to Australia, used the findings from payback studies to inform decisions regarding the levels and distribution of health research funding, with the aim of increasing the health and economic benefits that come from investments in research.
The Department of Health seeks to distribute the NHS budget to local commissioning organisations to achieve equal access for equal need and reduce health inequalities. The formula upon which it bases this distribution must be evidence-based, robust and up-to-date. We summarise four pieces of applied econometric research undertaken at the University of Manchester (UoM) and commissioned by the Department of Health that have developed the methodology for setting budgets fairly and determined the content of the formula in use in England from 2008-date. Adoption of the findings of this research by government has led to a substantial redistribution of NHS funding between areas.
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.
Health inequalities are recognised as a critical UK policy issue with life expectancy gaps of up to 28 years between the least and most deprived areas. This case-study demonstrates how Durham University research has led to: (a) changing health service commissioning (with County Durham and Darlington Primary Care Trust [PCT]): (b) influencing NHS funding policy (by generating Parliamentary debate); as well as (c) contributing to the development of the new public health system in England and Wales (as part of the Strategic Review of Health Inequalities in England post-2010 [Marmot Review]).
Methods for valuing quality of life developed by Professor Devlin at City University London are used internationally to help governments make healthcare decisions. Her research focuses on a widely-used questionnaire for measuring patient reported health, the European Quality of Life 5-Dimensions (EQ-5D). Government organisations routinely use the EQ-5D to judge whether new medicines work and are cost-effective. Over 15 countries are undertaking EQ-5D studies using Professor Devlin's methods to inform decisions on pricing and provision of new medicines. These developments have been achieved through active dissemination to the academic community and governments and through Professor Devlin's scientific leadership of the European Quality of Life (EuroQol) Group. The impact of this research is highly significant in improving health and health care decision-making and has had wide reach throughout the UK and in many other countries.
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.