Economic Evaluation
Welcome to the Applied Research Collaboration – Yorkshire and Humber (ARC YH) overview of economic evaluation of health and social care interventions. In this guide we aim to provide people who are new to the concept of economic evaluation in a health setting an intuitive guide of what the approach aims to achieve, and introduce some of the concepts and terminology you may come across.
START
ARC HEEE research
Funders
ContacT
Main Menu
This guide will take you through the intuition of economic evaluation, starting with why you might want to conduct an economic evaluation, and then exploring some of the possible approaches, or ‘frameworks’ to doing so.
Click on each topic to jump to it or press the next arrow to go through each in turn.
Who are we talking about?
What is the role of economic evaluation?
What is the aim of the different groups?
How might we value these different aims?
How do we estimate the cost of a treatment?
How do we value the things we have to stop doing?
But what about...?
Additional resources and information
How do we value health?
Menu
The main principle of economic evaluation is we can't do it all. How do we measure the value of what we want to do, and what we have to stop in order to do it?
Cost
Benefit
How do we get the most from the limited resources we have?
Why do we value certain things?
What is the role of economic evaluation?
Economic evaluation aims to bring together all of the important questions that come to mind when we think about a number of competing options and which are the best. We focus on its use in health but it is relevant to decisions that involve trading off different options.
Whose value is it?
What is value?
What is the value of the other stuff that we can do if we do the new thing?
Menu
Imagine you are a child and have 10 pence with which to buy sweets? You could buy the same 10 sweets every week
Menu
Imagine a new sweet appears in the shop but costs 2p. You still only have 10p with which to buy sweets. How will you now spend your money?
Exchange money for sweets
1p sweets
2p sweets
Menu
Now replace the sweets with healthcare. You still only have 10p to spend so you need to decide how you will spend your money?
Exchange money for healthcare
1p Healthcare
2p Healthcare
Menu
Who are we talking about when we conduct an economic evaluation?
The first part of creating an economic evaluation is to be clear who it is aimed at informing, and who it is talking about. It is not always possible or practical to include everyone in the evaluation, although it is important to understand where groups may have different priorities and aims. In a health and social care setting it is accepted to aim to inform whoever pays for the treatment or activity being considered, with the patient or recipient being the group talked about.
Drag each group to where you think it belongs
Include
Exclude
Funders
Taxpayers
Patient
Families/carers
Public
Menu
What is the aim of the different groups?
Once it has been decided who the economic evaluation will talk to and about, we need to consider what the aims of those groups is. Ultimately, we need to understand what we are trying to get the most or the least of. This can feel like a simple question, but often groups have different aims or more than one that might clash.
Drag each option in preference to the group you are thinking about
Most important aim
Least important aim
Minimising costs
Getting the most of source outcome
Creating a minimum standard
Saving lives
Fairness
Menu
How might we value those different aims?
To conduct an economic evaluation we need to be able to measure the aims of each group, for example longer lives, better quality of life, economic growth.
Focus on your own personal values and drag each aim to include or exclude
Include
Long Life
Exclude
Healthy life
Fairness
Economic growth
Happiness
Wellbeing
Personal wealth
All of it
Menu
How do we value health?
There are three ways in which we can value health, based on resources, clinical (biomarkers) and patient outcome measures. We use patient outcome measures in economic evaluations to represent the patient 'voice' as resources and clinical values don't.
Resources If you have a health condition it can lead to a visit to a hospital. The hospital may have an administrative target and may need to look at re-admissions or delayed transfers
Patient outcome measures We use outcome measures to represent the patient 'voice'. A patient is asked about their health over the last few weeks, focused on different areas e.g., mobility, self-care.
Clinical (biomarkers) You can look at someone’s blood sugars, their blood pressure or HIV CD-4 count. These are medical markers (values) of health.
Menu
How do we estimate the cost of a treatment?
Things to consider
Consistent with the idea of a single health commissioner conventionally focus on costs to the NHS
Upfront cost of treatment
Split into 'resource use' and 'unit costs'
Long-term costs of care
'Resourse use'
How much of something a patient uses
'Unit cost'
The cost of each addtional bit of care provision
All other costs are put to one side
Menu
How do we value the things we have to stop doing?
One way to think about it is to visualise a bookshelf . Each book represents a way to spend money on health. Each book has a health benefit and cost. The taller the book the more health benefit and the wider the book the more it costs. Rearrange the books on the shelf by replacing the books with new books. Ideally you want to remove the books with the greater cost and least health benefit.
Drag each book on to and off the bookshelf
Health benefit
Healthcare expenditure (cost)
Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use. / Culyer, Tony. York, UK : Centre for Health Economics, University of York, 2015. p. 1-22 (CHE Research Paper; No. 121).
Menu
But what about...?
Valuing different types of health
Inequality
Uncertainty
Different Decision Contexts
Valuing what we stop doing
Non-NHS costs
Comparing health
Non-health outcomes
End of life and fair innings
Menu
Take away - Economic Evaluation basics
An Economic Evaluation aids decision making, it does not make it.
An Economic evaluation is not about valuing health or life, it is about getting the most of each for what the NHS has to spend.
An Economic Evaluation informs those paying for the treatment, with the patient being the group discussed.
Each Economic Evaluation potentially has a knock-on effect.
Menu
Additional resources and information
Click on each topic to to find out about the additional resources and information available
Unlocking Real-World Data
Health Inequalities
Economic Evaluation In Practice
National ARC Shared Learning Event
YH ARC Resources
Menu
Want to learn more about economic evaluation in practice?
Menu
Economic evaluation in practice
Economic evaluation evidence for resource-allocation decision making: bridging the gap for local decision makers using English case studies – published within Applied Health Economics and Health Policy. DOI: https://doi.org/10.1007/s40258-022-00756-7
Menu
Health Inequalities resources and information
Understanding and Addressing Inequalities: Sebastian Hinde – HSR UK Conference presentation of peer-reviewed publication (1). URL: https://www.youtube.com/watch?v=XL5ItvLmLVw
Health inequalities: to what extent are decision-makers and economic evaluations on the same page? Greg Fell talks to Seb Hinde and Dr Matt Franklin – available on Spotify or The University of Sheffield Player – ScHARR’s Communicable Research podcast, episode 11, of peer-reviewed paper (1). URL: https://player.sheffield.ac.uk/events/health-inequalities-what-extent-are-decisionmakers-and-economic-evaluations-same-page
Health inequalities: to what extent are decision-makers and economic evaluations on the same page? An English case-study – published within Applied Health Economics and Health Policy. DOI: https://doi.org/10.1007/s40258-022-00739-8
Menu
Unlocking Real-World Data
Full report and supplementary material 1. Unlocking Data to Inform Public Health Policy and Practice: The Whole Collection – access to the report, supplementary material, and public briefing document. DOI: https://doi.org/10.15131/shef.data.c.6225912.v1
2. Unlocking Data to Inform Public Health Policy and Practice – the main report. DOI: https://doi.org/10.15131/shef.data.21221606.v1
3. Unlocking Data to Inform Public Health Policy and Practice: WP1 Mapping Review Supplementary Excel S1 – supplementary material for WP1. DOI: https://doi.org/10.15131/shef.data.21222272.v1
Online Blogs with hyperlinks
1. Unlocking real-world data to promote and protect health and prevent ill-health in the Yorkshire and Humber region – published via the Health Economics and Decision Science (HEDS) Blog. DOI: https://doi.org/10.15131/shef.data.14723685.v1
4. Data sharing between the NHS and councils to improve the health of local people– public briefing document. DOI: https://doi.org/10.15131/shef.data.21222239.v1
2. “It’s A Grey Area”: searching the grey literature on how local governments use real-world data – published via the HEDS Blog. DOI: https://doi.org/10.15131/shef.data.16644916.v1
3. Unlocking linked real-world data presents opportunities to improve public health – published via the London School of Economics (LSE) Impact Blog. URL: https://blogs.lse.ac.uk/impactofsocialsciences/2022/01/26/unlocking-linked-real-world-data-presents-opportunities-to-improve-public-health/
Menu
Unlocking Real-World Data
Online Webinar or video with hyperlink1. An introduction to care metadata – published via the HEDS Blog and NIHR ARC-YH website/ newsletters. URL: https://digitalmedia.sheffield.ac.uk/media/Unlocking+data+-+an+introduction+to+care+metadata/1_29shr8vt
2. Understanding and Addressing Inequalities: Sebastian Hinde – HSR UK Conference presentation of peer-reviewed publication (1). URL: https://www.youtube.com/watch?v=XL5ItvLmLVw
NIHR ARC-YH Blogs with hyperlinks1. Unlocking real-world data to inform public health policy and practice – an introduction to care metadata – NIHR ARC-YH short blog which links to our online webinar (1). URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/news/unlocking-real-world-data-webinar-jan-2022
2. “It’s A Grey Area”: searching the grey literature on how local governments use real-world data – NIHR ARC-YH short blog which links to online blog (2). URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/news/its-a-grey-area-how-local-governments-use-data
3. Unlocking Data to Inform Public Health Policy and Practice – NIHR ARC-YH blog of our report’s plain English summary. URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/blogs/unlocking-data-to-inform-public-health-policy-and-practice
Menu
National ARC Shared Learning Event
Watch a series of seven presentations featured at the, How Economic Evaluation Has Been Adapted for Service Delivery event, held in May 2022. The presentations feature: * Rachel Meacock, Senior Lecturer in Health Economics, The University of Manchester, ARC Greater Manchester. * Dr Matt Franklin, Senior Research Fellow, School of Health and Related Research, NIHR ARC Yorkshire & Humber. * Laura Bojke, Professor of Health Economics, Team for Economic Evaluation and Health Technology Assessment, Centre for Health Economics. * Sebastian Hinde, Research Fellow, Health Economics Equality and Evaluation theme, NIHR ARC Yorkshire and Humber * Chris Bojke, Professor of Health Economics, University of Leeds, NIHR ARC Yorkshire & Humber
Menu
YH ARC Resources
Here are a range of resources, developed and/or sourced by the YH ARC Health Economics theme, including:
- Checklist when planning an economic evaluation
- Patient Reported Outcome Measures (PROMs) resource and checklist
- Video explaining the EQ 5D in about two-and-a-half minutes
https://www.arc-yh.nihr.ac.uk/resources#h.p_mpzh-EFgITb7
Menu
Contact details
Thank you for using this guide. Get in touch with us if you have any questions at ARC_HEEE@sheffield.ac.uk
Dr Matthew Franklin
Seb Hinde
https://www.york.ac.uk/che/staff/research/sebastian-hinde/ sebastian.hinde@york.ac.uk @sebh2005
https://www.sheffield.ac.uk/scharr/people/staff/matthew-franklin matt.franklin@sheffield.ac.uk @DrMattFranklin
Menu
Contributors
Andy Tatttersall
Amanda Lane
Peter Murphy
https://www.york.ac.uk/crd/staff/peter-murphy/
https://www.sheffield.ac.uk/scharr/people/staff/andy-tattersall
https://www.sheffield.ac.uk/scharr/people/staff/amanda-lane
@Andy_Tattersall
@AJaneLane
Menu
Our funders
https://www.arc-yh.nihr.ac.uk/
https://www.nihr.ac.uk/
@NIHR_ARC_YH
@NIHRresearch
The project is funded by NIHR Public Health Research (PHR), with in-kind support from the NIHR Applied Research Collaboration Yorkshire and Humber's Health Economics, Evaluation and Equality.
Menu
Deciding cost-effectiveness
NICE
Checklist for planning Economic Evaluation
But what about...?
What is the NICE approach?
Menu
Imagine you are the commissioner of healthcare in a public system looking to buy healthcare services for your population You need to consider 3 things
The cost to you of the drug the pharma company is hawking (compared to the generic that doesn’t come with a free pen and a sandwich platter)
What else you could spend it on ?
The amount of additional health benefit it is likely to entail (ideally not based on the company’s leaflet)
Menu
If you only usually spend 1p on sweets and the new sweet costs 2p you will need to find the rest somewhere...
Exchange money for sweets
1p sweets
2p sweets
Menu
How do we value the things we have to stop doing?
One way to think about it is to visualise a bookshelf . Each book represents a possible way to spend money on health. For example, one book may be a new medicine for the population. Each has a health benefit and cost, the taller the book the more health benefit for each pound spent, the wider the book the more it costs in total. Rearrange the books on the shelf by replacing some of the books with new books. Ideally you want to remove the books with the greater cost and least health benefit.
Drag each book on to and off the bookshelf
Health benefit
Healthcare expenditure
Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use. / Culyer, Tony. York, UK : Centre for Health Economics, University of York, 2015. p. 1-22 (CHE Research Paper; No. 121).
Menu
Economic Evaluation
ARC HEEE
Created on May 9, 2022
Economic Evaluation - Health Economics Resource
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Transcript
Economic Evaluation
Welcome to the Applied Research Collaboration – Yorkshire and Humber (ARC YH) overview of economic evaluation of health and social care interventions. In this guide we aim to provide people who are new to the concept of economic evaluation in a health setting an intuitive guide of what the approach aims to achieve, and introduce some of the concepts and terminology you may come across.
START
ARC HEEE research
Funders
ContacT
Main Menu
This guide will take you through the intuition of economic evaluation, starting with why you might want to conduct an economic evaluation, and then exploring some of the possible approaches, or ‘frameworks’ to doing so.
Click on each topic to jump to it or press the next arrow to go through each in turn.
Who are we talking about?
What is the role of economic evaluation?
What is the aim of the different groups?
How might we value these different aims?
How do we estimate the cost of a treatment?
How do we value the things we have to stop doing?
But what about...?
Additional resources and information
How do we value health?
Menu
The main principle of economic evaluation is we can't do it all. How do we measure the value of what we want to do, and what we have to stop in order to do it?
Cost
Benefit
How do we get the most from the limited resources we have?
Why do we value certain things?
What is the role of economic evaluation?
Economic evaluation aims to bring together all of the important questions that come to mind when we think about a number of competing options and which are the best. We focus on its use in health but it is relevant to decisions that involve trading off different options.
Whose value is it?
What is value?
What is the value of the other stuff that we can do if we do the new thing?
Menu
Imagine you are a child and have 10 pence with which to buy sweets? You could buy the same 10 sweets every week
Menu
Imagine a new sweet appears in the shop but costs 2p. You still only have 10p with which to buy sweets. How will you now spend your money?
Exchange money for sweets
1p sweets
2p sweets
Menu
Now replace the sweets with healthcare. You still only have 10p to spend so you need to decide how you will spend your money?
Exchange money for healthcare
1p Healthcare
2p Healthcare
Menu
Who are we talking about when we conduct an economic evaluation?
The first part of creating an economic evaluation is to be clear who it is aimed at informing, and who it is talking about. It is not always possible or practical to include everyone in the evaluation, although it is important to understand where groups may have different priorities and aims. In a health and social care setting it is accepted to aim to inform whoever pays for the treatment or activity being considered, with the patient or recipient being the group talked about.
Drag each group to where you think it belongs
Include
Exclude
Funders
Taxpayers
Patient
Families/carers
Public
Menu
What is the aim of the different groups?
Once it has been decided who the economic evaluation will talk to and about, we need to consider what the aims of those groups is. Ultimately, we need to understand what we are trying to get the most or the least of. This can feel like a simple question, but often groups have different aims or more than one that might clash.
Drag each option in preference to the group you are thinking about
Most important aim
Least important aim
Minimising costs
Getting the most of source outcome
Creating a minimum standard
Saving lives
Fairness
Menu
How might we value those different aims?
To conduct an economic evaluation we need to be able to measure the aims of each group, for example longer lives, better quality of life, economic growth.
Focus on your own personal values and drag each aim to include or exclude
Include
Long Life
Exclude
Healthy life
Fairness
Economic growth
Happiness
Wellbeing
Personal wealth
All of it
Menu
How do we value health?
There are three ways in which we can value health, based on resources, clinical (biomarkers) and patient outcome measures. We use patient outcome measures in economic evaluations to represent the patient 'voice' as resources and clinical values don't.
Resources If you have a health condition it can lead to a visit to a hospital. The hospital may have an administrative target and may need to look at re-admissions or delayed transfers
Patient outcome measures We use outcome measures to represent the patient 'voice'. A patient is asked about their health over the last few weeks, focused on different areas e.g., mobility, self-care.
Clinical (biomarkers) You can look at someone’s blood sugars, their blood pressure or HIV CD-4 count. These are medical markers (values) of health.
Menu
How do we estimate the cost of a treatment?
Things to consider
Consistent with the idea of a single health commissioner conventionally focus on costs to the NHS
Upfront cost of treatment
Split into 'resource use' and 'unit costs'
Long-term costs of care
'Resourse use'
How much of something a patient uses
'Unit cost'
The cost of each addtional bit of care provision
All other costs are put to one side
Menu
How do we value the things we have to stop doing?
One way to think about it is to visualise a bookshelf . Each book represents a way to spend money on health. Each book has a health benefit and cost. The taller the book the more health benefit and the wider the book the more it costs. Rearrange the books on the shelf by replacing the books with new books. Ideally you want to remove the books with the greater cost and least health benefit.
Drag each book on to and off the bookshelf
Health benefit
Healthcare expenditure (cost)
Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use. / Culyer, Tony. York, UK : Centre for Health Economics, University of York, 2015. p. 1-22 (CHE Research Paper; No. 121).
Menu
But what about...?
Valuing different types of health
Inequality
Uncertainty
Different Decision Contexts
Valuing what we stop doing
Non-NHS costs
Comparing health
Non-health outcomes
End of life and fair innings
Menu
Take away - Economic Evaluation basics
An Economic Evaluation aids decision making, it does not make it.
An Economic evaluation is not about valuing health or life, it is about getting the most of each for what the NHS has to spend.
An Economic Evaluation informs those paying for the treatment, with the patient being the group discussed.
Each Economic Evaluation potentially has a knock-on effect.
Menu
Additional resources and information
Click on each topic to to find out about the additional resources and information available
Unlocking Real-World Data
Health Inequalities
Economic Evaluation In Practice
National ARC Shared Learning Event
YH ARC Resources
Menu
Want to learn more about economic evaluation in practice?
Menu
Economic evaluation in practice
Economic evaluation evidence for resource-allocation decision making: bridging the gap for local decision makers using English case studies – published within Applied Health Economics and Health Policy. DOI: https://doi.org/10.1007/s40258-022-00756-7
Menu
Health Inequalities resources and information
Understanding and Addressing Inequalities: Sebastian Hinde – HSR UK Conference presentation of peer-reviewed publication (1). URL: https://www.youtube.com/watch?v=XL5ItvLmLVw
Health inequalities: to what extent are decision-makers and economic evaluations on the same page? Greg Fell talks to Seb Hinde and Dr Matt Franklin – available on Spotify or The University of Sheffield Player – ScHARR’s Communicable Research podcast, episode 11, of peer-reviewed paper (1). URL: https://player.sheffield.ac.uk/events/health-inequalities-what-extent-are-decisionmakers-and-economic-evaluations-same-page
Health inequalities: to what extent are decision-makers and economic evaluations on the same page? An English case-study – published within Applied Health Economics and Health Policy. DOI: https://doi.org/10.1007/s40258-022-00739-8
Menu
Unlocking Real-World Data
Full report and supplementary material 1. Unlocking Data to Inform Public Health Policy and Practice: The Whole Collection – access to the report, supplementary material, and public briefing document. DOI: https://doi.org/10.15131/shef.data.c.6225912.v1
2. Unlocking Data to Inform Public Health Policy and Practice – the main report. DOI: https://doi.org/10.15131/shef.data.21221606.v1
3. Unlocking Data to Inform Public Health Policy and Practice: WP1 Mapping Review Supplementary Excel S1 – supplementary material for WP1. DOI: https://doi.org/10.15131/shef.data.21222272.v1
Online Blogs with hyperlinks 1. Unlocking real-world data to promote and protect health and prevent ill-health in the Yorkshire and Humber region – published via the Health Economics and Decision Science (HEDS) Blog. DOI: https://doi.org/10.15131/shef.data.14723685.v1
4. Data sharing between the NHS and councils to improve the health of local people– public briefing document. DOI: https://doi.org/10.15131/shef.data.21222239.v1
2. “It’s A Grey Area”: searching the grey literature on how local governments use real-world data – published via the HEDS Blog. DOI: https://doi.org/10.15131/shef.data.16644916.v1
3. Unlocking linked real-world data presents opportunities to improve public health – published via the London School of Economics (LSE) Impact Blog. URL: https://blogs.lse.ac.uk/impactofsocialsciences/2022/01/26/unlocking-linked-real-world-data-presents-opportunities-to-improve-public-health/
Menu
Unlocking Real-World Data
Online Webinar or video with hyperlink1. An introduction to care metadata – published via the HEDS Blog and NIHR ARC-YH website/ newsletters. URL: https://digitalmedia.sheffield.ac.uk/media/Unlocking+data+-+an+introduction+to+care+metadata/1_29shr8vt
2. Understanding and Addressing Inequalities: Sebastian Hinde – HSR UK Conference presentation of peer-reviewed publication (1). URL: https://www.youtube.com/watch?v=XL5ItvLmLVw
NIHR ARC-YH Blogs with hyperlinks1. Unlocking real-world data to inform public health policy and practice – an introduction to care metadata – NIHR ARC-YH short blog which links to our online webinar (1). URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/news/unlocking-real-world-data-webinar-jan-2022
2. “It’s A Grey Area”: searching the grey literature on how local governments use real-world data – NIHR ARC-YH short blog which links to online blog (2). URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/news/its-a-grey-area-how-local-governments-use-data
3. Unlocking Data to Inform Public Health Policy and Practice – NIHR ARC-YH blog of our report’s plain English summary. URL: https://www.arc-yh.nihr.ac.uk/news-events-and-media/blogs/unlocking-data-to-inform-public-health-policy-and-practice
Menu
National ARC Shared Learning Event
Watch a series of seven presentations featured at the, How Economic Evaluation Has Been Adapted for Service Delivery event, held in May 2022. The presentations feature: * Rachel Meacock, Senior Lecturer in Health Economics, The University of Manchester, ARC Greater Manchester. * Dr Matt Franklin, Senior Research Fellow, School of Health and Related Research, NIHR ARC Yorkshire & Humber. * Laura Bojke, Professor of Health Economics, Team for Economic Evaluation and Health Technology Assessment, Centre for Health Economics. * Sebastian Hinde, Research Fellow, Health Economics Equality and Evaluation theme, NIHR ARC Yorkshire and Humber * Chris Bojke, Professor of Health Economics, University of Leeds, NIHR ARC Yorkshire & Humber
Menu
YH ARC Resources
Here are a range of resources, developed and/or sourced by the YH ARC Health Economics theme, including:
- Checklist when planning an economic evaluation
- Patient Reported Outcome Measures (PROMs) resource and checklist
- Video explaining the EQ 5D in about two-and-a-half minutes
https://www.arc-yh.nihr.ac.uk/resources#h.p_mpzh-EFgITb7Menu
Contact details
Thank you for using this guide. Get in touch with us if you have any questions at ARC_HEEE@sheffield.ac.uk
Dr Matthew Franklin
Seb Hinde
https://www.york.ac.uk/che/staff/research/sebastian-hinde/ sebastian.hinde@york.ac.uk @sebh2005
https://www.sheffield.ac.uk/scharr/people/staff/matthew-franklin matt.franklin@sheffield.ac.uk @DrMattFranklin
Menu
Contributors
Andy Tatttersall
Amanda Lane
Peter Murphy
https://www.york.ac.uk/crd/staff/peter-murphy/
https://www.sheffield.ac.uk/scharr/people/staff/andy-tattersall
https://www.sheffield.ac.uk/scharr/people/staff/amanda-lane
@Andy_Tattersall
@AJaneLane
Menu
Our funders
https://www.arc-yh.nihr.ac.uk/
https://www.nihr.ac.uk/
@NIHR_ARC_YH
@NIHRresearch
The project is funded by NIHR Public Health Research (PHR), with in-kind support from the NIHR Applied Research Collaboration Yorkshire and Humber's Health Economics, Evaluation and Equality.
Menu
Deciding cost-effectiveness
NICE
Checklist for planning Economic Evaluation
But what about...?
What is the NICE approach?
Menu
Imagine you are the commissioner of healthcare in a public system looking to buy healthcare services for your population You need to consider 3 things
The cost to you of the drug the pharma company is hawking (compared to the generic that doesn’t come with a free pen and a sandwich platter)
What else you could spend it on ?
The amount of additional health benefit it is likely to entail (ideally not based on the company’s leaflet)
Menu
If you only usually spend 1p on sweets and the new sweet costs 2p you will need to find the rest somewhere...
Exchange money for sweets
1p sweets
2p sweets
Menu
How do we value the things we have to stop doing?
One way to think about it is to visualise a bookshelf . Each book represents a possible way to spend money on health. For example, one book may be a new medicine for the population. Each has a health benefit and cost, the taller the book the more health benefit for each pound spent, the wider the book the more it costs in total. Rearrange the books on the shelf by replacing some of the books with new books. Ideally you want to remove the books with the greater cost and least health benefit.
Drag each book on to and off the bookshelf
Health benefit
Healthcare expenditure
Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use. / Culyer, Tony. York, UK : Centre for Health Economics, University of York, 2015. p. 1-22 (CHE Research Paper; No. 121).
Menu