About OHE

The Office of Health Economics (OHE) is founded.

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 publishes its first Monograph.

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 Briefings series launched.

OHE Briefing series debuts, prepared by OHE staff and external experts on a range on a range of issues.

The OHE Compendium series is launched.

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.

Adrian Towse took over as director.

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.

The OHE Annual Lecture debuts.

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.

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OHE launched a series of interactive seminars, which continues today.

OHE Seminar Briefings launched.

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.

OHE founds OHE Consulting Ltd.

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.

Launch of OHE Consulting Reports.

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.

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OHE appoints its first Director of Research, Prof Nancy Devlin.

OHE appoints its first Director of Research, Prof Nancy Devlin, to establish OHE’s reputation for innovative methodological and applied health economics research.

OHE Research Paper launched.

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 Reports launched.

OHE Consulting Report publications debut, sharing output as agreed by the client when the content is of interest to a wider audience.

OHE Occasional Papers launched.

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 chair of the Euroqol Group’s Executive Committee.

OHE’s Prof Nancy Devlin elected as chair of the Euroqol Group’s Executive Committee, the principal scientific committee of the EuroQol Group.

The beginning of OHE’s Honorary Visiting Professorships.

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.

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.

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.

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Professor Graham Cookson became OHE’s third Director and first CEO.

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.

OHE awarded research grant.

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.

First OHE funded MSc degree students.

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 or economic evaluation in health care at City, University of London. While studying for their degrees, the students work twenty hours a week at OHE. On graduation, the fellows work as economists for a year at OHE.

OHE awarded Independent Research Organization (IRO) status.

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 research programme. Fewer than 100 groups across the UK—from all disciplines—enjoy IRO status and can compete for the roughly £7 billion in annual funding.

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