Title: Cross-cutting theme - Health Economics
Funder: Department of Health and Social Care

Abstract: The success of any new device depends not just on its design and usability and not just on its effectiveness. It must meet individual user requirements (discussed above) and it must be cost effective and it must be accommodated in the service. This cross-cutting theme brings scientific principles to bear on the service delivery and health economic aspects of new devices/technologies. Health Economics Health economic evaluation is usually carried out to inform procurement decisions for technology that has been developed – at the demand side. We have long argued that health economic evaluation has an important role at the supply side, when investment and development decisions are made [1]. Supply side health economics is different in two respects from demand side health economics [2]. First, there is greater uncertainty and so a Bayesian approach is not just desirable but necessary [3] Second, given resolvable uncertainty, the option value must be considered alongside the options to develop or abandon the idea at the outset. Where a full analysis is not affordable, we have promoted the ‘headroom method’ to help inform decisions along with methods to facilitate more comprehensive models [4]. Service delivery and new technology Uptake of new technology is not automatic in a service, even if it is adapted to the individual user and is cost effective. People may need to be trained (as in the case of cochlear implants in children), supply chains must be developed and psychological barriers overcome [5]. We have experience from our two CLAHRC grants in developing services to facilitate adoption of technologies such as home dialysis [6]. Some devices are easily incorporated into existing work-flows but other, such as embolectomy for intra-cranial thrombotic stroke, disrupt normal working patterns. Operations research can identify the most efficient pathways in such cases. Work Programme/objectives Short term objectives (year 1)  Prospective health economic assessment of new technology so that the value proposition is carried out from an economic perspective as early as possible in the translational path. o All new applications rapidly screened using ‘headroom method’. o Minimum of one application for full prospective health economic analysis. o Perform a demonstration example of operations research to evaluate and model service implications of a new device. Medium term objectives (years 2-3)  Further economic analyses o Two further prospective economic analyses o Minimum of one value of information analysis as prelude to grant application for HTA  Service implications of new devices o Minimum one application of operation’s research for a MIC developed device o Minimum one analysis of barriers and facilitators to guide introduction of new technology Long term objectives (years 4-5)  Evaluation of value of health economics to the program including ‘log’ of decisions affected.  Scholarly article on service delivery and disruptive technology.  Evaluation of the testing in a simulated environment of new technology.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE