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Economic evaluation under managed competition: Evidence from the U.K

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  • Drummond, Michael
  • Cooke, Jonathan
  • Walley, Tom
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    Abstract

    Although economic evaluation in health care has a long-standing tradition in the United Kingdom, very little is known about its impact on decision making, particularly following the introduction of the internal market. Since managed competition appears to be growing in popularity worldwide, the U.K. is an interesting case study, as the reforms are well underway and there have been a number of efforts to conduct and disseminate economic evaluations. In this paper the potential for using economic evaluation in health care decision making in the U.K. is discussed. Then its actual impact is assessed in two ways. First, two case studies are discussed, on heart transplantation and the use of pharmaceuticals in the management of labour in pregnancy. Second, new data from a recent survey of potential users of economic evaluations are presented, with the emphasis on exploring the reasons for the impact, or lack of impact, of economic results. It is concluded that the NHS reforms increase the potential for the use of economic evaluation. However, there is a need to increase decision makers' awareness of economic studies and to help them interpret study methodology and results. Although worries about validity of economic studies are one of the major barriers to their use, other important barriers relate to the multiple objectives being pursued, of which increased efficiency is just one, and the difficulties of freeing resources from existing services in order to divert them to more cost-effective treatments and programmes.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 45 (1997)
    Issue (Month): 4 (August)
    Pages: 583-595

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    Handle: RePEc:eee:socmed:v:45:y:1997:i:4:p:583-595

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    Related research

    Keywords: cost-effectiveness analysis resource allocation technology assessment health care decision making;

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    Cited by:
    1. Don Kenkel, 2006. "WTP- and QALY-Based Approaches to Valuing Health for Policy: Common Ground and Disputed Territory," Environmental & Resource Economics, European Association of Environmental and Resource Economists, vol. 34(3), pages 419-437, July.
    2. Gijs Wetering & Willem Woertman & Eddy Adang, 2012. "Time to incorporate time in cost-effectiveness analysis," The European Journal of Health Economics, Springer, vol. 13(3), pages 223-226, June.
    3. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    4. Stirling Bryan & Iestyn Williams & Shirley McIver, 2007. "Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 179-193.
    5. James Mason & Martin Eccles & Nick Freemantle & Mike Drummond, 1998. "NICEly does it: economic analysis within evidence-based clinical practice guidelines," Working Papers 164chedp, Centre for Health Economics, University of York.
    6. Williams, Iestyn & Bryan, Stirling, 2007. "Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework," Health Policy, Elsevier, vol. 80(1), pages 135-143, January.

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