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


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


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.

Suggested Citation

  • Drummond, Michael & Cooke, Jonathan & Walley, Tom, 1997. "Economic evaluation under managed competition: Evidence from the U.K," Social Science & Medicine, Elsevier, vol. 45(4), pages 583-595, August.
  • Handle: RePEc:eee:socmed:v:45:y:1997:i:4:p:583-595

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    Cited by:

    1. Mason, James & Eccles, Martin & Freemantle, Nick & Drummond, Michael, 1999. "A framework for incorporating cost-effectiveness in evidence-based clinical practice guidelines," Health Policy, Elsevier, vol. 47(1), pages 37-52, April.
    2. Andrew M. Jones (ed.), 2012. "The Elgar Companion to Health Economics, Second Edition," Books, Edward Elgar Publishing, number 14021.
    3. repec:bla:ijhplm:v:32:y:2017:i:2:p:e232-e260 is not listed on IDEAS
    4. Hoffmann, Christiane AU -, 2000. "The influence of economic evaluation studies on decision making.: A European survey," Health Policy, Elsevier, vol. 52(3), pages 179-192, July.
    5. Michael Drummond, 2012. "Economic Evaluation and Decision-makers," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 54 Edward Elgar Publishing.
    6. Don Kenkel, 2006. "WTP- and QALY-Based Approaches to Valuing Health for Policy: Common Ground and Disputed Territory," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 34(3), pages 419-437, July.
    7. 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.
    8. Jansson, Sandra & Anell, Anders, 2006. "The impact of decentralised drug-budgets in Sweden - a survey of physicians' attitudes towards costs and cost-effectiveness," Health Policy, Elsevier, vol. 76(3), pages 299-311, May.
    9. 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.
    10. 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.
    11. 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.
    12. Duthie, Tessa & Trueman, Paul & Chancellor, Jeremy & Diez, Lara, 1999. "Research into the use of health economics in decision making in the United Kingdom--Phase II: Is health economics `for good or evil'?," Health Policy, Elsevier, vol. 46(2), pages 143-157, January.
    13. Legood, Rosa & Wolstenholme, Jane & Gray, Alastair, 2009. "From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap," Health Policy, Elsevier, vol. 89(2), pages 193-200, February.
    14. Gijs Wetering & Willem Woertman & Eddy Adang, 2012. "Time to incorporate time in cost-effectiveness analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(3), pages 223-226, June.
    15. Williams, Iestyn P. & Bryan, Stirling, 2007. "Cost-effectiveness analysis and formulary decision making in England: Findings from research," Social Science & Medicine, Elsevier, vol. 65(10), pages 2116-2129, November.


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