Disability-adjusted life years (DALYs) were introduced in 1993 amid the pages and policy directives of the World Development Report ‘Investing in Health’ (World Bank, 1993). DALYs are a measure of life years lost from disease, adjusted for assumptions about disability as well as the impact of age and future time. They were launched to widen the measurement of disease from the presence of morbidity and mortality, usually cited by the World Bank, to include the impact on disability in a commensurable way with mortality. The World Development Report was ground breaking for two reasons:
The second edition of this guide to economic evaluation is significantly extended. This mirrors the development of economic evaluation since the first edition was published in 1996. The methodology has developed and new techniques, both regarding costing and outcome measurement, have been introduced. Some concepts have, with the same arguments, been deleted or reduced in importance. The application of economic evaluation in decision making has also taken a step forward. This is manifested in the inclusion of a section on NICE.
The Secretary of State for Health has recently described health care as a form of ‘social investment’ which is ‘of instrumental importance in improving national economic performance’. This concern with economic productivity is shared by decision makers in other countries, where the impact of health care on workplace productivity has been specified as part of the economic analyses to be submitted in support of claims for the public reimbursement of pharmaceuticals.
International and UK experience illustrates the difficulty of involving the publica in health caare priority setting in ways that enable politicians, managers and doctors to incorporate public preferences into practical decision making.
Many techniques for measuring public preferences fail to incorporate key concepts:
opportunity cost. What are people prepared to give up or have less of, in order to have more of something else? The public have to be asked to make trade-offs;
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.