The topic I have been asked to address, 'Doctors, Economics and Clinical Practice Guidelines: Can they be Brought Together', is both difficult and controversial. It is also timely. With the creation of the National Institute for Clinical Excellence (NICE), the National Service Frameworks, and the clinical governance project, the UK has an opportunity to develop systematic national solutions to problems that have challenged every society - how to balance the quality and cost of health care in a way that respects both people's humanity and their pocketbooks.
This OHE Briefing summarises the presentations and discussion at the session on 'Efficacy to cost-effectiveness' at the Conference of the International Society for Technology Assessment in Health Care (ISTAHC) in Barcelona on 26 May 1997.
The aim of this paper is to consider recent trends in the volume and characteristics of economic evaluation literature by interrogating the Health Economic Evaluations Database (HEED), and to offer some comments on how the quality of such studies can be assessed by reviewing existing work which has considered this issue. HEED has been developed as a joint initiative between the Office of Health Economics (OHE) and the International Federation of Pharmaceutical Manufacturers' Associations (IFPMA).
Getting value for money from the use of pharmaceuticals is crucial for the NHS. This publication explores the role for guidelines in generating good quality value for money information examining the experience of Australia, Canada and the UK – the first three health care systems to introduce national guidelines for economic assessments.
This OHE- Briefing summarises the presentations and discussion at the session on 'Modelling in Economic Evaluation' at the Conference of the International Society for Technology Assessment in Health Care (ISTAHC) in San Francisco 26th June 1996.
The use of models in economic studies evaluating medicines and other health technologies has become a controversial issue. This is because study results now matter - decision makers are increasingly acting on information about the cost effectiveness of treatments.
The idea that clients or users of public services might legitimately have opinions about how they should be delivered is a relatively new one in the United Kingdom, where producers' views have dominated decisions about how things should be done. This tendency can be observed not only in health care, but also in other public services such as education, the provision of social security benefits, policing, and the criminal justice system. Such neglect of users' views is predictable where services are provided (often for excellent reasons) in a non-market context.
The recent increase in the number of published economic evaluations has been considerable [Wellcome, 1992; Udvarhelyi et al, 1992]. It is of some concern, however that reviews of economic evaluations have highlighted a high degree of methodological shortcomings in many studies [Adams at al, 1992; Gerard, 1992]. Furthermore, the situation does not appear to have improved over time [Udvarhelyi et al, 1992]. In particular, the importance of dealing systematically and comprehensively with uncertainty appears to have been overlooked by many analysts.
Inequality in health is back on the political agenda in the UK. Three factors have made inequality an issue - firstly, concern that the internal market will enable some, notably patients of GP Fundholders, to get better treatment than other NHS patients, secondly, a revival of interest in community values, bringing with it a recognition of the impact of poverty on life expectancy, and thirdly, greater awareness that health care is being rationed, and will increasingly be so, irrespective of which political party is in Government.
Treatment of children with growth hormone is well recognised under the NHS and its cost (between £5,000-£10,000 per annum per child) has generally been accepted. Since the biotechnologically produced hormone (rhGH) first appeared on the market in 1985 it has been increasingly prescribed by general practitioners at the request of hospital consultants whose pharmacies felt unable to pay the high cost.