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The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services


  • Sebastian Hinde

    (University of York)

  • Louise Horsfield

    (NHS Vale of York Clinical Commissioning Group)

  • Laura Bojke

    (University of York)

  • Gerry Richardson

    (University of York)


Since 2013, obesity services in the UK National Health Service (NHS) have focused on a tiered structure, with tiers 3 (specialist weight management services) and 4 (primarily bariatric surgery) commissioned by Clinical Commissioning Groups (CCGs) and widely reported as cost effective and recommended by national guidelines. However, CCGs have been reluctant to fully conform to the guidance. We explore how the different evaluative perspective of those generating evidence from local decision makers has contributed to this failure of the CCGs to provide services considered cost effective. We explore four elements where the conventional economic evaluation framework, as applied by the National Institute for Health and Care Excellence (NICE), differ from the reality faced by local decision makers: the cost-effectiveness threshold, the implications of decision uncertainty and budgetary excess, the valuation of future costs and outcomes, and the scope of included costs. We argue that the failure of the conventional framework to reflect the reality faced by local decision makers is rendering much of the existing literature and guidance inappropriate to the key commissioners. Our analysis demonstrates that it is not reasonable to assume that the framework of economic evaluation used to inform national guidance applies to local decision makers, such as in the commissioning of weight loss services. This failure is likely to apply to the majority of cases where evidence is generated to inform national decision makers but commissioning is at a local level.

Suggested Citation

  • Sebastian Hinde & Louise Horsfield & Laura Bojke & Gerry Richardson, 2020. "The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 351-356, June.
  • Handle: RePEc:spr:aphecp:v:18:y:2020:i:3:d:10.1007_s40258-019-00538-8
    DOI: 10.1007/s40258-019-00538-8

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    References listed on IDEAS

    1. Mikhaylov, Andrey Sergeyevich, 2013. "Международные Кластерные Инициативы Как Форма Реализации Кластерной Политики Стран Региона Балтийского Моря," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, pages 169-173.
    2. Beth Woods & Rita Faria & Susan Griffin, 2016. "Assessing the Value of New Treatments for Hepatitis C: Are International Decision Makers Getting this Right?," PharmacoEconomics, Springer, vol. 34(5), pages 427-433, May.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 1st June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-01 11:00:00

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