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Establishing the Economic Value of Carbon-Minimal Inhalers

With over 60 years of expertise, the Office of Health Economics (OHE) is the world’s oldest independent health economics research organisation. We are a registered charity and an Independent Research Organisation.
Every day we work to improve health care through pioneering and innovative research, analysis, and education.
As a global thought leader and publisher in the economics of health, health care, and life sciences, we work in partnership with Universities, Government, health systems and the pharmaceutical industry to research and respond to global health challenges.
Support better health care policies by providing insightful economic and statistical analyses of critical issues.
In 2022, we celebrated our 60th anniversary, here are some of the highlights of those first 60 years…
We are a trusted and well-connected collaborator, providing authoritative resources, research and analyses
We develop evidence-based policy positions and thought leadership to inform the most challenging debates facing the life sciences sector
We highlight urgent and important issues facing health systems around the world and raise awareness of research that can help address them
We combine expertise in health economics with theory and methods drawn from other fields of economics
We have an international reputation for independent, credible insights that shape healthcare and health policy around the world
We improve knowledge and understanding around innovation policy to support the next generation of health technologies
As a government–recognised Independent Research Organisation and not–for–profit, our international reputation for the quality and independence of our research is at the forefront of all we do.
OHE provides independent and pioneering resources, research and analyses in health economics, health policy and health statistics. Our work informs decision–making about health care and pharmaceutical issues at a global level.
Since 1962 we have been commissioned to undertake agile and responsive research in a myriad of health care areas, ranging from Antimicrobial Resistance (AMR) to Gene Therapies and health system effectiveness.
Through our independent Research and Policy Committees, our work is continually shaped by world–leading economists, ensuring we are always working at the frontiers of our sector.
We use the evidence we generate to promote evidence-based health care policies and the effective and efficient use of health care resources. Our work supports decision-making and raises awareness of health care policy issues, by encouraging debate and dissemination of critical health economics research.
OHE is an independent not-for-profit (registered charity in the UK) and research organisation. Our work is or has recently been supported directly by research grants, awards and funding from a wide range of UK and international partners including: the Association of the British Pharmaceutical Industry (ABPI), the Department of Health Policy Research Programme (PRP), the National Institute of Health Research (NIHR), the Medical Research Council (MRC), the Health Foundation, the EuroQol Foundation and a number of charitable and other organisations.
Through our wholly-owned subsidiary, OHE Consulting Ltd, OHE provides Contract Research services allowing organisations around the world to access the talent and resources of world-leading team of researchers. All of the proceeds of this work is gift-aided to the charity and supports our research activities.
Our Annual Report provides the most recent information on our funding and activities.
Over 60 years, we have a rich history of innovating across health economics and health care.
When the Office of Health Economics (OHE) was founded in 1962, the health care world was a vastly different place. Formal approval of drugs before…
OHE launches its initial publications programme, Monographs and papers that primarily address: NHS organisation, costs and financing; health care system performance in the UK and…
OHE launches its Series on Health with an analysis of the costs of tuberculosis and its treatment. Subsequent topics in the series covered a wide range of…
Funding innovation. Medical science rapidly advanced in the 25 years following WWII, making it possible to treat a growing range of diseases. The issue of who pays…
Cost of the NHS. As new possibilities for treatment are developed, the costs of care inevitably rise and provoke debate about total costs and spending. An OHE publication examined…
Encouraging innovation. The 1966–67 OHE Winter Lecture series discussed a series of eight papers that offered new perspectives on emerging issues that have proven to…
The OHE Early Diagnosis series of eight monographs are released. These are written by outside experts and underline the importance to cost and…
Pricing and innovation. A series of OHE Winter Lectures tackled the growing issue of if and how the pricing of medicines can reflect the costs…
AMR. Antimicrobial resistance to antibiotics, already identified as a possible concern by the late 1950s, was the focus of a national UK committee (the Swann…
Regulation and innovation. OHE sponsors a symposium that examines the relationship between pricing, profits, regulation, and innovation in the pharmaceutical industry. The monograph of the…
Global health. An OHE publication reviews the emerging challenges of providing health care in the “developing” world and the importance of tailoring approaches to local needs.
Vaccine development and use. OHE publishes a monograph that recounts the history of vaccines, discusses the debate about risks and benefits, and considers whether incentives for innovation are sufficient.
…OHE Briefing series debuts, prepared by OHE staff and external experts on a range on a range of issues.
Pricing of medicines. OHE publishes a monograph on its “Canberra Hypothesis” which suggests that price competition in the market for medicines exists, and
The OHE Compendium series is launched in 1976. This was an annual publication providing a comprehensive collection of healthcare statistics. Pre
Benefits and risks. Concern about the potential risks of prescription medicines threatens to reduce appropriate use and/or produce overregulation. The fifth in the series of OHE M
The Health Economics Research Group (HERG) was founded in 1981 at Brunel University London under the leadership of Professor Martin Buxton. OHE research funding was key to getting this…
International price comparisons. OHE publishes an early study by a noted economist that sought to compare the pricing of prescriptions medicines across countries.
HTA. An OHE Briefing provides an early overview of efforts to develop a quality–of–life measures. The
In 1985 OHE held a symposium on Health, Education and General Practice chaired by Sir John Butterfield, Regus Professor of Medicine at the University of Cambridge and…
Health care costs and medicines. OHE publishes a report that includes findings of a survey conducted by OHE on the performance of the pharmaceutical industry, its contribution to national…
Health care costs and medicines. OHE publishes an analysis of the broader impact of new medicines on NHS costs, focussing on their ability…
HTA. OHE publishes its first practical guide to the use of health economics, in conjunction with the newly established Pharmaceutical Industry Health Economics…
Prescribing decisions. An analysis by OHE of variations in prescribing across clinical practices and across Britain showed prescribing volume is not…
In April 1993 Adrian Towse became Director of OHE, taking over from OHE’s long serving founder director, Professor George Teeling–Smith. At that point in time OHE had…
In 1994, OHE began a series of annual lectures that examined issues critical to health economics and policy. The intent is both to educate a…
As the field of health economics grew, the available literature burgeoned. Sorting through it to find studies relevant to a health economics project became a…
Health economics, or health technology assessment (HTA), did not exist as the field we know today when OHE was founded in 1962. Early assessments of the economic value of health care were broad and rarely…
In 1999 OHE’s Director Adrian Towse was first elected to the Board of Directors of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). ISPOR is the largest professional…
OHE Seminar Briefings launched, providing concise summaries of the presentations and discussions at OHE’s seminars. Since its inception, one of OHE’s core objectives has been to provide…
Since its creation the OHE has been producing leading research on the nature of competition in various pharmaceutical markets. These include support for the 2001…
As OHE expanded in the late 1990s, the ability to continue growing required additional funding sources to be found. With an increasing importance of health…
In 2002 OHE published Cost–Effective Thresholds: Economic and Ethical Issues edited by Adrian Towse, Clive Pritchard and Nancy Devlin. This was the proceedings…
OHE Consulting Reports debut, sharing output as agreed by the client when the content is of interest to a wider audience. The first report was
The launch of the OHE popular interactive e–source The Economics of Health Care, focusing on the UK and aimed
at post
OHE published a comprehensive reference guide to applied econometrics for health economists. It provides an explanation of econometric methods and test statistics useful to those who wish to understand…
OHE established a Commission on NHS Outcomes, Performance and Productivity. A distinguished panel was assembled that provided expertise from academia, government, the public and private sectors and groups representing…
OHE’s Deputy Director Jon Sussex published a key paper with University of Aberdeen collaborators on Payment Models for the NHS. (Farrar et al., 2009): https://www.bmj.com/content/339/bmj.b3047
…OHE appoints its first Director of Research, Prof Nancy Devlin, to establish OHE’s reputation for innovative methodological and applied health economics research.
HTAInsite was a unique resource, a subscriber database enabling researchers to elicit information on NICE HTA assessment decisions. It provided a framework capturing detailed information on all NICE HTA evaluations
An OHE Briefing analyses important delays and barriers in access to medicines for rare diseases even after development and licensing are completed. The analysis compared…
OHE Research Papers debut, providing information on and encouraging discussion based on OHE’s research programme in advance of formal publication in peer reviewed journals.
OHE Consulting Report publications debut, sharing output as agreed by the client when the content is of interest to a wider audience.
OHE’s Occasional Paper series is launched to report the results of OHE’s research programme that may not be intended for publication in peer reviewed journals.
OHE’s Prof Nancy Devlin elected as chair of the Euroqol Group’s Executive Committee, the principal scientific committee of the EuroQol Group.
OHE and University of Sheffield win a Department of Health grant to develop and test methods for valuing the EQ– 5D–5L. This included…
OHE publishes a monograph that offers an early, comprehensive analysis of the potential of and the challenges in using Multiple Criteria Decision Analysis (MCDA) as an adjunct…
During a period of intense debate about the role of competition in the NHS, OHE established a Commission on Competition to consider the issue. Members of the distinguished panel were drawn…
The report of OHE’s Commission on Competition appears. Comprised of thought leaders from academia, think tanks and the NHS, it concludes that competition would benefit…
OHE and University of Sheffield win an NIHR grant to produce an EQ–5D–5L value set for England. This was the first…
In 2014 Adrian Towse became an Honorary Professor at the Department of Health Policy (formerly integrated within the Department of Health Policy and Social Care) at the London School of Economics…
OHE formalised its visiting fellows programme, which offers OHE the opportunity to benefit from the expertise of distinguished academics, researchers and practitioners. Established thought leaders in their…
OHE obtained charitable status as a not–for–profit research company, legally registered with the Charity Commissioners,…
First published in 2017, OHE led the development of an EQ–5D–5L value set for England, facilitating the use of
In 2019, Professor Graham Cookson became OHE’s third Director and first CEO. An econometrician by training, Prof Cookson has a PhD from Imperial College London…
An ambitious research programme was initiated by Cancer Research UK and the Greater Manchester Health and Social Care Partnership (GMHSCP), who awarded OHE a research grant along with collaborators…
OHE was awarded a research grant funded by the Health Foundation’s Efficiency Research Programme. Using routinely collected data, this study developed a new measure for efficiency in primary care,…
OHE launched the Masterclass Series; its flagship educational programme is intended to sharpen understanding of health economics and its role in decision making. Masterclass events are collaborative, led by global experts…
OHE initiated a long term collaboration with the City Health Economics Centre (CHES) at City, University of London. This includes: OHE team members as honorary…
As part of its mission to help increase capacity in health economics in the UK, OHE began funding two students each year to work toward an MSc degree in health economics…
Independent Research Organization (IRO) status was awarded to OHE by UK Research and Innovation (UKRI). This both offers new opportunities for research funding and recognises the quality of OHE’s independent
Professor Mireia Jofre–Bonet, OHE’s Chief Research Officer and Head of Education, becomes the convenor of the UK Health Economics Heads of Unit (HEHoU),…
For the second phase of the research funded by Cancer Research UK and GMHSCP, OHE collaborated with researchers from RAND Europe, University College London and…
OHE launched a monthly newsletter, providing a timely and reliable source of information and commentary on crucial topics. Each month, a leading OHE researcher or external expert curates the content, which…
To mark its 60th year, OHE launched a biennial prize fund to support its charitable goal of enhancing debate on health economics. The intent is to stimulate fresh ideas…
The Economics of Vaccines in Africa (EVIA) Program makes history as OHE’s first fully virtual multi–module and multi–
When the Office of Health Economics (OHE) was founded in 1962, the health care world was a vastly different place. Formal approval of drugs before marketing was yet not required in the UK and pharmacology was in its infancy. Drug therapy was just beginning to tackle major illnesses such as heart disease: the beta blocker propranolol was patented in 1962 by Sir James Black. But the societal cost of disease was known only in the broadest terms. Although the NHS already was concerned about cost, little was known about the real cost or benefit of any aspect of health care. One thing was clear: improving the knowledge to address these questions was essential to the success, or failure, of the NHS, drug development and health care around the world.
Against this backdrop, OHE was established by the far–sighted Professor George Teeling–Smith OBE, who served as its Director for three decades. He positioned the OHE as an independent research group that operated at arm’s length from the pharmaceutical industry yet attracted enough research funding from it to address the major issues of the day. To both ensure this independence and raise visibility of critical issues, Teeling–Smith established advisory boards that included prominent economists such as Professor Brian Abel–Smith, Lords John Vaizey and Maurice Peston, and Professor Tony Culyer CBE. Such advisory boards ably continue to guide OHE today along with its Board of Trustees.
OHE launches its initial publications programme, Monographs and papers that primarily address: NHS organisation, costs and financing; health care system performance in the UK and elsewhere; innovation the UK and in other countries; challenges in drug development worldwide; the economics of the pharmaceutical industry; the value of medicines; pricing and reimbursement of medicines; plus a series of about 60 publications on the disease burden, diagnosis and treatment of specific diseases. Several monographs report on seminars and conferences hosted by OHE. Publications are authored both by OHE staff and by outside experts.
OHE launches its Series on Health with an analysis of the costs of tuberculosis and its treatment. Subsequent topics in the series covered a wide range of topics from specific diseases to the factors affecting pharmaceutical innovation and the organisation and productivity of the NHS.
Funding innovation. Medical science rapidly advanced in the 25 years following WWII, making it possible to treat a growing range of diseases. The issue of who pays for medical research and the appropriate roles of public and private financing quickly became important. OHE published one of the earliest analyses of sources of funding for and expenditures on medical research in the UK and included comparisons with the US.
Cost of the NHS. As new possibilities for treatment are developed, the costs of care inevitably rise and provoke debate about total costs and spending. An OHE publication examined the costs of care across NHS sectors for 27 disease categories, suggesting what factors affect spending and the difficulties of both controlling the rate of growth and determining allocation. Although today’s data and analyses are far more detailed, the challenges in delivering economically efficient medical care are remarkably similar.
Encouraging innovation. The 1966–67 OHE Winter Lecture series discussed a series of eight papers that offered new perspectives on emerging issues that have proven to be of lasting importance to innovation in medicines. Published in July 1967 as a single volume, the lectures addressed: the role of patents in encouraging innovation in the UK and worldwide; whether, how and how much government should contribute to R&D; early efforts to model competition, pricing and profits; the relationships between marketing and R&D; and the international nature of both innovation and the market for medicines. OHE’s role then, as now, was to provide a forum for healthy debate.
The OHE Early Diagnosis series of eight monographs are released. These are written by outside experts and underline the importance to cost and outcomes of early diagnosis and treatment of specific diseases.
Pricing and innovation. A series of OHE Winter Lectures tackled the growing issue of if and how the pricing of medicines can reflect the costs and risks of innovation. The resulting monograph captures early thinking about how to measure and value R&D and encourage continuing investment.
AMR. Antimicrobial resistance to antibiotics, already identified as a possible concern by the late 1950s, was the focus of a national UK committee (the Swann Committee) studying the appropriate use of antibiotics in agriculture. An OHE publication reviewed the policy challenges from an economic viewpoint to provide a framework for further discussion and informed policy choices.
Regulation and innovation. OHE sponsors a symposium that examines the relationship between pricing, profits, regulation, and innovation in the pharmaceutical industry. The monograph of the presentations includes early analyses of the effect of regulation on the costs of R&D and notes the importance of harmonising licensing regulations across countries.
Global health. An OHE publication reviews the emerging challenges of providing health care in the “developing” world and the importance of tailoring approaches to local needs.
Vaccine development and use. OHE publishes a monograph that recounts the history of vaccines, discusses the debate about risks and benefits, and considers whether incentives for innovation are sufficient.
OHE Briefing series debuts, prepared by OHE staff and external experts on a range on a range of issues.
Pricing of medicines. OHE publishes a monograph on its “Canberra Hypothesis” which suggests that price competition in the market for medicines exists, and not just product competition. This underlies major new research in the UK and the US on therapeutic value, price and market success.
The OHE Compendium series is launched in 1976. This was an annual publication providing a comprehensive collection of healthcare statistics. Pre–Internet this was a unique resource supplying timeseries of data for various aspects of healthcare. These included international population, mortality and morbidity statistics, as well as healthcare funding and expenditure information and resource and workforce statistics for the NHS in the UK. The compendium collated data from the inception of the NHS not readily available from public sources. It was an invaluable resource for public and private sector researchers and was by far the highest profile and successful publication produced by OHE.
Benefits and risks. Concern about the potential risks of prescription medicines threatens to reduce appropriate use and/or produce overregulation. The fifth in the series of OHE Monographs on the medicines market in British presents examples of diseases and treatments provide context and basic principles for an appropriate balance between benefits and risks.
The Health Economics Research Group (HERG) was founded in 1981 at Brunel University London under the leadership of Professor Martin Buxton. OHE research funding was key to getting this unit started. The grant initially funded Martin Buxton, who had been working as an economist at the Department of Health and Social Security (DHSS), and subsequently provided flexible funding to tie in with project–grant funding HERG received from the DHSS (and subsequently the Department of Health) and other public sector bodies. The first example of this was that OHE funding in part supported Professor Bernie O’Brien who was appointed primarily to work on the ground–breaking evaluation of the heart transplant programmes at Papworth and Harefield Hospitals. This research led to both programmes, who had been supported entirely from charitable sources, receiving ‘mainstream’ DHSS/DH funding, and it proved to be the first of many economic evaluations undertaken by HERG for DH and MRC. That study also began HERG’s long–term research interest in the measurement and valuation of health–related quality of life, and Martin Buxton was one of the co–founders of the EuroQol Group.
The OHE support for Bernie enabled him to complete a PhD developing ideas he first published in an OHE Publication reviewing Clinical Risks. OHE funding supported at least in part several subsequent postgraduate students including Professors Mark Sculpher, Andy Briggs and Julia Fox–Rushby who also were commissioned to provide monographs and briefings on a variety of topics for OHE. Most importantly the funding formed the solid foundation on which HERG subsequently was able to obtain a series of 5–year Programme Grants from the DH Policy Research Programme. Within those programmes HERG undertook economic evaluations to inform DH policy on a wide range of health technologies including beast screening options, AAA screening, liver and small bowel transplantation, and changes to managerial/budgetary structures within hospitals (the Resource Management Initiative). Under Martin Buxton’s leadership, HERG established a national and international reputation for both methods and applications of policy–relevant, applied economic evaluation, and for training young health economists as demonstrated by the number of his PHD students who hold, or have held, Professorships in universities not only in the UK but in Europe, Canada, USA and Australia.
International price comparisons. OHE publishes an early study by a noted economist that sought to compare the pricing of prescriptions medicines across countries.
HTA. An OHE Briefing provides an early overview of efforts to develop a quality–of–life measures. The Briefing forecasts that formal measurement of quality of life will become a routine part of the assessment of new medicines.
In 1985 OHE held a symposium on Health, Education and General Practice chaired by Sir John Butterfield, Regus Professor of Medicine at the University of Cambridge and (then) chair of the OHE Editorial Committee. Participants included Dr Donald Acheson, the Chief Medical Officer at the Department of Health, and David Willets from the No. 10 Policy Unit. Contributors included Professor Alan Maynard, Director of the Centre for Health Economics, University of York, who proposed introducing GP fundholding, GP commissioning, and prescribing budgets, all of which came to pass within a little over 5 years of that meeting.
Health care costs and medicines. OHE publishes a report that includes findings of a survey conducted by OHE on the performance of the pharmaceutical industry, its contribution to national well–being in both social and economic terms and the factors which have been responsible for its success.
Health care costs and medicines. OHE publishes an analysis of the broader impact of new medicines on NHS costs, focussing on their ability to contain overall costs.
HTA. OHE publishes its first practical guide to the use of health economics, in conjunction with the newly established Pharmaceutical Industry Health Economics Group.
Prescribing decisions. An analysis by OHE of variations in prescribing across clinical practices and across Britain showed prescribing volume is not the same as prescribing quality. OHE concluded that attempts to contain NHS costs by promoting uniform prescribing practices are likely both to fail and, to the extent they do succeed, produce unintended negative consequences for the quality of patient care.
In April 1993 Adrian Towse became Director of OHE, taking over from OHE’s long serving founder director, Professor George Teeling–Smith. At that point in time OHE had established a reputation for high quality independent analysis of, and the promotion of informed debate on topics including: the NHS; the role of pharmaceutical innovation; the importance of the emerging role of health economics and the measurement of health related quality of life in assessing the value of health care interventions, and the costs and benefits associated with particular diseases. It “punched above its weight” with a staff of only six full–time staff, supported by a high–quality Advisory Committee, chaired by the Labour peer and economist Professor Lord Maurice Peston.
In 1994, OHE began a series of annual lectures that examined issues critical to health economics and policy. The intent is both to educate a wide audience and stimulate continuing discussion. The choice of topic and lecturer has balanced interests specific to the UK, e.g. the policies and operation of the NHS, with those that are broader, e.g. the nature and challenges of health technology assessment or health system improvement round the world. A theme that underlies the entire series of lectures is the challenge of basing decisions and behaviour on appropriate and reliable evidence, as in the examples noted below.
In one of the first annual lectures, Prof David Sackett addressed the widespread concern about whether physicians would face an ethical dilemma in following treatment guidelines derived from evidence–based medicine rather than their own judgement. He saw no conflict. What is needed, he argued, is more and better evidence, not less, that can inform efforts to both improve care and manage costs in the NHS.
The quality of the evidence base was the focus of Prof Sir Michael Rawlins who argued against a formulaic, hierarchical approach to valuing evidence. Randomised controlled trials (RCTs) have become the “gold standard,” he noted, but other “real world” approaches to evidence development, including use of observational studies, are
equally valid in some circumstances. He cautioned against allowing hierarchies to become a substitute for careful judgement that considers the totality of the evidence base.
Profs Tony Atkinson and Alan Maynard separately focused on efforts to analyse and improve NHS performance, noting that health care systems worldwide face similar challenges. Prof Atkinson discussed new approaches to measuring productivity in health care in the UK, i.e. whether the inputs to the NHS produce commensurate outputs.
In health care outputs were health outcomes. Increases in productivity became evident using more complex approaches including QALYs. Prof Alan Maynard noted that difficulties inherent in assessing performance in the NHS have meant that NHS reforms too often have lacked a sound evidence base. In particular, still unclear are the relative roles of financial and non–financial incentives in improving efficiency in a cost–effective manner.
As the field of health economics grew, the available literature burgeoned. Sorting through it to find studies relevant to a health economics project became a tedious and lengthy undertaking. In response to this, the OHE and IFPMA jointly developed HEED, the Health Economic Evaluations Database, the first comprehensive database of health economics studies. Launched in 1995, this provided researchers in the pharmaceutical industry and elsewhere with a single access point for summaries of the quickly growing body of literature. A network of academic health economists sifted the literature monthly, selecting for inclusion studies that could provide examples of both the use of assessment techniques and analyses of specific health technologies, using a reviewer template to provide summaries of key findings, outcomes measures used, and methods of analysis.
An average of 250 new fully reviewed studies and approximately 300 bibliographic references were added to the database each month. By the time the database was acquired by the Wiley Online Library in 2005, it contained over 80,000 rigorously selected records and bibliographies from many international databases and included data from over 4,500 journals. A detailed search system ensured ease of use. HEED was the only health economics database that provided its data in two different formats: via the internet and on CD–ROM, using what was then the newest technology.
Health economics, or health technology assessment (HTA), did not exist as the field we know today when OHE was founded in 1962. Early assessments of the economic value of health care were broad and rarely specific to a particular intervention. By the mid-1980s, however, valuing new medicines and other interventions from an economic viewpoint had begun. In 1987, OHE published an edited volume that captured expert opinion about how the field of health economics might, and should, develop. A year later, it produced a monograph that reviewed current approaches in layman’s terms. In 1989, OHE published its first practical guide on the health economic analysis of medicines. Prepared in consultation with the first pharmaceutical industry health economics group, it explained terminology and basic concepts, and included illustrations of studies. Within the pharmaceutical industry and among health policy decision makers, the demand for HTA grew exponentially. In 1996, OHE published a hands-on health economics guide written by Gisela Kobelt, a leading practitioner in the pharmaceutical industry. This short volume, perhaps the first such guide, used actual examples of HTA for specific products to illustrate appropriate use. OHE published successive volumes by the same thought leader in 2002 and again in 2013. Those practical volumes also provided hands-on guidance, but with increasingly sophisticated examples that reflected the rapid evolution of the field. Written in an accessible style, the publications provided important background both for those who undertake evaluations and those who use them as the bases for decisions.
Over this key decade in the emergence of health economics, OHE offered additional opportunities for hands-on learning about HTA. These were open to all stakeholders and intended both to encourage appropriate use and advance the field. Details can be found on the website:
Teeling Smith, G. ed. (1987) Health Economics: Prospects for the Future. OHE Monograph. Available here.
Drummond, M.F., Teeling Smith, G. and Wells, N. (1988) Economic Evaluation and Develop Medicines in the Development of Medicines. OHE Monograph. Available here.
Teeling Smith, G. (1989) Cost-Benefit Analysis of Medicines – a Guide for Industry. OHE Monograph. Available here.
Kobelt, G. (1996) Health Economics: An Introduction to Economics Evaluation. OHE Monograph.
have to scan publication and add link
Kobelt, G. (2002) Health Economics: An Introduction to Economic Evaluation. OHE Monograph. Available here.
Kobelt, G. (2013) Health Economics: An Introduction to Economic Evaluation. OHE Monograph. Available here.
In 1999 OHE’s Director Adrian Towse was first elected to the Board of Directors of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). ISPOR is the largest professional scientific society for health economists and outcomes researchers with around 20,000 members globally. In 2013 he was elected as ISPOR’s President. In 2015 OHE’s Director of Research, Nancy Devlin, was elected to the ISPOR Board of Directors, and in 2018 she was elected as ISPOR’s President. In July 2021, OHE’s Deputy Chief Executive Lotte Steuten was elected to ISPOR’s Board of Directors. OHE’s leaders have additionally served on key ISPOR committees, and the OHE team presents regularly at ISPOR’s meetings and conferences.
OHE Seminar Briefings launched, providing concise summaries of the presentations and discussions at OHE’s seminars. Since its inception, one of OHE’s core objectives has been to provide a forum for discussion. In 1999, a seminar programme was launched to increase the frequency and accessibility of such exchanges. Each seminar involves thought leaders for a topic on an emerging and perennial issue, which may be national or global in scope. The format encourages an open and full exchange of views. The mix of participants varies by topic and may include: academics and research groups, policy makers, government agencies, the biomedical research
industries, health care providers, patients’ groups, and other NGOs. Summaries of the seminar are published by OHE.
Some seminars focus directly on the UK, such as the seminar led by Nicholas Timmons that tackled the issue of NHS funding. The group discussed a “hypothecated” tax that would earmark funds for the NHS, potentially increasingly both transparency and funding stability. Experience in the UK for specific programmes provided
examples and suggested potential challenges to this approach.
Prof Peter Smith addressed health system strengthening, a concept familiar in the field of global health but also potentially useful in UK planning. The approach urges a wholistic, horizontal perspective wherein policy makers explicitly consider the interdependence of various aspects of the health care system. Recent research demonstrates how CEA might be applied at the system level to help maximize benefits when resources are limited.
Prof David Grabowski led a seminar that offered a health economics perspective on how payment and delivery interventions can encourage high–value nursing home care. Lessons from the US effort to encourage high–value care were applied to the UK, which has also relied on regulation as the key guarantor of quality. Unacceptably
poor outcomes are common in both countries, partly because of insufficient research on the causes of poor care, and efforts and incentives to improve care are not well targeted.
The apparent productivity crisis in pharmaceutical R&D was the seminar topic of Prof Massimo Riccaboni. Shifts in internal company R&D strategy towards higher risk, higher payoff targets is a leading explanation for a headline decline in productivity. Portfolio decisions are strongly affected by incentives for innovation from public payers,
including the regulatory framework for pricing and reimbursement.
Since its creation the OHE has been producing leading research on the nature of competition in various pharmaceutical markets. These include support for the 2001 PPRS study into competition and commentary on a study by the OFT in 2007. More recently the OHE has been at the forefront of the considerations of the various issues associated with the introduction of biosimilar medicines. In 2008 the OHE published an overview of the issues, and it has hosted various seminars and roundtables through the last 15 years. These included a roundtable discussion and briefing on HTA considerations when assessing biosimilars and an assessment of factors influencing their adoption in various markets.
As OHE expanded in the late 1990s, the ability to continue growing required additional funding sources to be found. With an increasing importance of health economics including the establishment of NICE, there were opportunities for the OHE to provide consulting services. This led to the establishment of OHE Consulting in 2002. Early projects included an evaluation of NICE HTA decisions to establish whether there was a threshold associated with those decisions.
In 2002 OHE published Cost–Effective Thresholds: Economic and Ethical Issues edited by Adrian Towse, Clive Pritchard and Nancy Devlin. This was the proceedings of a workshop jointly organised by the OHE and the King’s Fund on 1 March 2002. It addressed the question: ‘Ought NICE to have a threshold incremental cost–effectiveness ratio (ICER)?’ – with an implicit second question ‘Should the threshold be explicit?’ Contributors included economists Tony Culyer, then NICE Vice Chair and Chairman of the Office of Health Economics Policy Board, Alan Williams, and Graham Loomes. Analysis by OHE’s Adrian Towse and Clive Pritchard provided evidence that NICE was operating a £20K – £30K threshold. This was confirmed and clarified in a BMJ article in 2004 by NICE’s chair Mike Rawlins and former NICE Vice Chair Tony Culyer.
OHE Consulting Reports debut, sharing output as agreed by the client when the content is of interest to a wider audience. The first report was Innovation In Medicine sponsored by EFPIA.
The launch of the OHE popular interactive e–source The Economics of Health Care, focusing on the UK and aimed
at post–16 students of economic courses
OHE published a comprehensive reference guide to applied econometrics for health economists. It provides an explanation of econometric methods and test statistics useful to those who wish to understand the concepts without being overwhelmed by the technical details.
OHE established a Commission on NHS Outcomes, Performance and Productivity. A distinguished panel was assembled that provided expertise from academia, government, the public and private sectors and groups representing patients and the general public. The overall conclusion of the Commission was that the collection and use of outcomes measures can lead to improved outcomes, performance and productivity. A number of specific recommendations are offered including a timetable for extending the collection of outcome measures across disease areas and across the NHS.
OHE’s Deputy Director Jon Sussex published a key paper with University of Aberdeen collaborators on Payment Models for the NHS. (Farrar et al., 2009): https://www.bmj.com/content/339/bmj.b3047
The paper analysed the Payments by Results (PBR) model introduced in 2002 in England. PBR Payment was motivated by policy objectives to increase efficiency, volume of activity, and quality of care. The study found: Length of stay fell more quickly, and the proportion of day cases increased more quickly where PBR was implemented. Some association between PBR and growth in acute hospital activity was found. Little measurable change occurred in the quality–of–care indicators.
OHE appoints its first Director of Research, Prof Nancy Devlin, to establish OHE’s reputation for innovative methodological and applied health economics research.
HTAInsite was a unique resource, a subscriber database enabling researchers to elicit information on NICE HTA assessment decisions. It provided a framework capturing detailed information on all NICE HTA evaluations undertaken from the start of the HTA process in 2000. This included the clinical and cost effectiveness evidence associated with each evaluation. The database was launched in May 2009, achieving 400 subscribers by 2010. It was a joint collaboration between OHE, City University London and Abacus International.
An OHE Briefing analyses important delays and barriers in access to medicines for rare diseases even after development and licensing are completed. The analysis compared approaches to economic evaluation and coverage decisions in seven European countries for the first 43 products approved under the 2000 EU Orphan Medicinal Products legislation. The serious challenges it identified have been the focus of continuing work both within the OHE and outside.
OHE Research Papers debut, providing information on and encouraging discussion based on OHE’s research programme in advance of formal publication in peer reviewed journals.
OHE Consulting Report publications debut, sharing output as agreed by the client when the content is of interest to a wider audience.
OHE’s Occasional Paper series is launched to report the results of OHE’s research programme that may not be intended for publication in peer reviewed journals.
OHE’s Prof Nancy Devlin elected as chair of the Euroqol Group’s Executive Committee, the principal scientific committee of the EuroQol Group.
OHE and University of Sheffield win a Department of Health grant to develop and test methods for valuing the EQ– 5D–5L. This included further developing and testing new time trade off methods which now form the basis of the EQ–VT protocol used worldwide.
OHE publishes a monograph that offers an early, comprehensive analysis of the potential of and the challenges in using Multiple Criteria Decision Analysis (MCDA) as an adjunct to HTA decisions about health care resource allocation. The OHE has since remained involved in research and analysis on the appropriate use of MCDA, and was part of the important work of the ISPOR MCDA Emerging Good Practices Task Force.
During a period of intense debate about the role of competition in the NHS, OHE established a Commission on Competition to consider the issue. Members of the distinguished panel were drawn from academia, think tanks, government, and the NHS. The full report, published in early 2012, recommended careful expansion of competition between providers of NHS–funded health care in England.
The report of OHE’s Commission on Competition appears. Comprised of thought leaders from academia, think tanks and the NHS, it concludes that competition would benefit patients if cautiously applied in certain situations and with careful monitoring.
OHE and University of Sheffield win an NIHR grant to produce an EQ–5D–5L value set for England. This was the first value set internationally for the EQ–5D–5L and included a number of innovative approaches to modelling DCE and TTO data
In 2014 Adrian Towse became an Honorary Professor at the Department of Health Policy (formerly integrated within the Department of Health Policy and Social Care) at the London School of Economics and Political Science. Previous to that he had held a Visiting Professorship at the Department of Economics and Related Studies at the University of York. Since 2014, OHE has promoted its staff’s close relationships with higher education institutions. Former OHE senior staff members have held a number of honorary visiting positions, e.g., Nancy Devlin, who worked at OHE from 2008 to 2018, held one at City, University of London and one at ScHARR, University of Sheffield; and Jon Sussex (1992–2015) at the University of York University. By 2022, all members of the OHE Executive Team held at least one honorary visiting position with a total of nine honorary visiting positions for all OHE staff.
OHE formalised its visiting fellows programme, which offers OHE the opportunity to benefit from the expertise of distinguished academics, researchers and practitioners. Established thought leaders in their fields, OHE visiting fellows participate in a range of OHE activities that focus on the exchange of ideas, ranging from participation in seminars to providing feedback on research in progress and helping identify the crucial emerging issues OHE may wish to address. Their outside perspective enriches and supplements OHE’s own work.
OHE obtained charitable status as a not–for–profit research company, legally registered with the Charity Commissioners, with OHE Consulting becoming a wholly owned for–profit consultancy subsidiary with the ability to donate its profits to the not–for–profit research company to undertake research. The change of status clarifies and makes more transparent OHE’s ownership, objectives and governance, emphasizing that our objective is to serve the public interest by providing research and analyses critically informing public policy. Charitable status also increases funding opportunities and facilitates collaboration with a wider range of organisations.
First published in 2017, OHE led the development of an EQ–5D–5L value set for England, facilitating the use of QALYs in HTA. A series of grants from the Department of Health (2010), NIHR (2012), and EuroQol Research Foundation supported the work. This research has had a far–reaching influence on methods, including the EuroQol Valuation Technology (EQ–VT), which is used globally. The 2017 publication describing the value set has more than 500 citations. Despite the substantial investment and a lack of any reasonable alternative, NICE has not recommended using the value set.
In 2019, Professor Graham Cookson became OHE’s third Director and first CEO. An econometrician by training, Prof Cookson has a PhD from Imperial College London and joined OHE from INRIX Inc where he was head of economic research. After serving as a lecturer at King’s College London, Graham became a Professor at the University of Surrey, where he won and led major grant funded projects in health economics. He also founded an MSc degree programme in health economics. His research interests include the use of “big data” in health and life sciences research, health care organisation and productivity, and the use of real world evidence in health economic evaluation. His work has guided the NHS in adopting new staffing guidelines and he helped to create the Real World Evidence Centre at the University of Surrey.
An ambitious research programme was initiated by Cancer Research UK and the Greater Manchester Health and Social Care Partnership (GMHSCP), who awarded OHE a research grant along with collaborators at RAND Europe and King’s College London, to investigate the potential use of Outcome–Based Payment (OBP) in the NHS in England to address the complex challenges facing patient access to medicines.
These challenges include: accelerated approvals leading to a more limited evidence base and therefore larger uncertainty; increasing funding pressures for payers; differing patient outcomes in real–world settings relative to clinical trials, and the increasing complexity and cost of some innovative medicines.
We investigated what outcomes truly matter to patients and placed those at the heart of our OBP scheme recommendations. The research output – overseen by a prestigious Steering Group comprising representatives of Government, NICE, NHS England, patient groups and Industry – sets out a framework for how OBP could help to accelerate patient access to some new medicines and ensure close monitoring of real–world patient benefit, as well as promoting value for money in NHS spending and supporting innovation.
OHE was awarded a research grant funded by the Health Foundation’s Efficiency Research Programme. Using routinely collected data, this study developed a new measure for efficiency in primary care, and examine its variability and the determinants of productivity, with a particular focus on the role of skill mix, technology and patient mix. Overall, the project aimed to improve the efficiency of primary care by providing measures of current performance and recommendations on how to improve productivity. The study was a collaboration with the Nuffield Department of Primary Care Health Sciences at the University of Oxford and the University of Lancaster.