Health economics

Health economics research in our department focuses on informing decisions around the delivery of health care and on the economic aspects of health and disease, particularly at the end-of-life stage. Our work centres on conducting economic appraisals as a component of clinical trials, utilising experimental data for both costs and effects of treatment or intervention. We also evaluate complex health and social care programmes. Where warranted, modelling techniques are applied for a comprehensive health economic analysis.

In the Compassion Programme health economic evaluation considers resource allocation in caring for patients with severe mental problems in their last year of life, as well as the quality of life of their family carers and associated economic impact on these family carers in this period. Economic costs are calculated from the perspectives of the NHS (such as averted hospital admission, costs for a typical episode); from personal social services (such as training and education for care home staff) and from societal perspective (such as local commissioners' decisions on scarce resource allocation, additional costs to public purse where caring responsibilities had been met by the state instead of family carers).

In CanTalk RCT we analyse cost effectiveness of cognitive behaviour therapy plus treatment as usual for the treatment of depression in advanced cancer. Using multivariate regression methods, we explore differences in costs and outcomes between groups, adjusting for need-related factors. Bootstrapped incremental cost-effectiveness ratios and acceptability curves are estimated in order to relate differences in costs and outcomes between groups. Capturing benefits over a patient's lifetime is important and we use assumption-based modelling techniques to explore the cost-effectiveness of the intervention using a lifetime horizon. Threshold analysis is used as one method of framing assumptions around transition probabilities in order to assess the key thresholds at which the intervention remains cost-effective.

In CanAct, a feasibility study for Acceptance and Commitment Therapy in the management of dysfunction in advanced cancer, we construct a cost-utility model to analyse health economic outcomes of survivors and costs from the NHS perspective.

In End stage liver disease project (provide link) we employ a micro-costing technique to produce detailed estimates of the cost of care for patients in the last year of life. A sensitivity analysis is performed to assess the degree of variability between the volume of resource use data and unit cost data from published sources. We investigate differences in costs controlling for confounders (gender, age and co-morbidities) and compare costs of care for a cohort with terminal hospital admission with costs for those who spent their last days at a hospice.