Centre for Health Economics - University of York



University of York

CENTRE FOR HEALTH ECONOMICS

INSTITUTIONAL CV

The Centre for Health Economics (CHE) was established at the University of York in 1983, and was one of the world’s first research institutes dedicated to the study of the economics of health and health care. It rapidly established a leading international reputation, and is now one of the world’s largest health economics research centres, employing about 40 researchersand having associations with at least 200 academics forming the broader community of health economics specialists at the University of York.

The mission of CHE is “to undertake, publish and otherwise disseminate high quality research in the field of health economics capable of informing policy decisions”. To that end, CHE has specialized in the development of methodology capable of application across a wide range of institutional and health care settings. Particularly important developments have been:

• A leading role in the development of the notion of the Quality Adjusted Life Year (QALY) as a basis for measuring health benefits, and the development of associated health status measurement instruments, such as the Euroqol EQ5D.

• The development of economic approaches towards cost-effectiveness analysis, decision analytic modelling and health technology assessment, and the application of advanced methods to inform policy at the National Institute for Health and Clinical Excellence and their international counterparts.

• The development of methodologically and empirically robust capitation formulae for the distribution of health care finance throughout the United Kingdom (such as the ‘York formulae’ for English hospital and community health services).

• The application of advanced econometric techniques to large and complex datasets in order to address important policy questions, such as quantifying the impact of GP fundholding on health care utilization.

• The development of new approaches to measuring the productivity of health systems, capable of being incorporated into systems of National Accounts.

A noteworthy feature of this work has been the principle of using advanced methodological thinking in order to achieve practical outcomes that have changed the way health care is delivered.

CHE attaches high importance to scientific quality. Its researchers play a leading role in many national and international societies, and are regularly invited to make high-profile presentations at scientific meetings across the world. In 2001 CHE acted as host to the international Health Economics Association Conference (iHEA) at York, with over 1200 delegates from all over the world and presentations by two Nobel prize winners.

Staff publish in the leading international journals in their field, and the two leading international health economics journals are edited from York. In the 2008 Research Assessment Exercise, CHE staff made a major contribution to the University’s submission to the Health Services Research unit of assessment, which was ranked first for quality in the UK. The average number of publications per year is approximately 130.

CHE also has a very strong policy impact both nationally and internationally. Within the UK, examples include work at the most senior level with policy formulation in:

• The Department of Health and its devolved equivalents

• HM Treasury

• The National Institute for Health and Clinical Excellence

• The Healthcare Commission

• The Office for National Statistics

• The Audit Commission.

• The Cabinet Office

• The Home Office

Internationally, its researchers have worked at a senior level with many national ministries and health care agencies, in countries in every continent, and with international organizations including the World Health Organization, the World Bank, the International Monetary Fund, the European Commission and the Organization for Economic Cooperation and Development.

CHE engages in a variety of teaching activities. Its researchers contribute to the long-standing masters programme in health economics at York and to masters courses in the Department of Health Sciences. CHE plays a leading role in the York distance learning courses in Health Economics, and has a vibrant PhD programme of about 12 research students. CHE delivers specialist expert workshops in a variety of fields, including economic evaluation, health technology assessment, econometric methods and efficiency measurement.

CHE is funded entirely by research grants. It receives core funding from the Department of Health, accounting for about 30% of its income. The remainder of its income is secured mainly from competitive bids for applied and methodological research from government, research councils and overseas sources. Staff have also competed successfully for personal fellowships from the Medical Research Council, the National Health Service, the Economic and Social Research Council and the Wellcome Trust.

We are at the centre of a large network of health service researchers including the, the Centre for Reviews and Dissemination, the Department of Economics and Related Studies, Hull York Medical School, York Health Economics Consortium and the National Primary Care Research and Development Centre based at the Universities of Manchester and York. The health-related research and teaching activity in York encompasses a large network of research and support staff with a community of around 200 health service researchers. Further details of CHE’s activities can be found on our web site: .

In 2007 the University of York was awarded the Queen’s Anniversary Prize for Higher and Further Education, in recognition of the contribution health economics research has made to the way society thinks about health and health care over the last 25 years.

The University of York is widely recognised as one of the leading research universities in the UK. In the 2008 Research Assessment Exercise carried out by the Higher Education Funding Council for England, York is ranked 8th overall for the quality of its research, according to The Guardian league table. The University is also at the top of the teaching quality rankings. It has high levels of demand for undergraduate and postgraduate places from the UK, Europe and across the world. The University was described by The Sunday Times as “one of Britain’s academic success stories, forging a reputation to rival Oxford and Cambridge in the space of 40 years”.

The Centre's research is organized into seven themes

Research Themes

Economic evaluation of health technologies

Econometric methods

Health care financing, expenditure and purchasing

Health system design and reform

Performance assessment

Population health

Equity in health and health care

This programme of work is currently organized into four teams:

Health Policy

Team for Economic Evaluation and Health Technology Assessment

Primary Care

Health, Econometrics and Data Group

Research Teams

ECONOMIC EVALUATION AND HEALTH TECHNOLOGY ASSESSMENT (TEETHA)



Team Leader: Mark Sculpher

TEEHTA focuses on research and training relating to the assessment of the cost-effectiveness of health care programmes and interventions. It aims:

• To conduct and disseminate high quality and scientifically rigorous research on the costs and benefits of health and social care technologies

• To critically assess and further develop the methods of economic evaluation

• To provide training and workshops in various aspects of economic evaluation methods.

The team provides a focal point for economic evaluation within CHE and the University of York in general. Projects fall into four main categories:

1. Applied research

A major activity for all members of the team is the design, conduct and analysis of applied economic evaluations. These include collection of economic data alongside clinical randomised trials, decision analytic modelling studies, and economic and statistical evaluation of observational and retrospective data sets.

2. Technology Assessment Reviews for the National Institute for Health and Clinical Excellence

This programme, in collaboration with the Centre for Reviews and Dissemination at York, to undertake a series of Technology Assessment Reviews each year for the National Institute for Health and Clinical Excellence. This involves the critical review of published economic evaluations and manufacturers’ analyses and, for NICE’s multiple technology appraisals, the development of decision analytic cost-effectiveness models based on the synthesis of available evidence,

In addition, TEEHTA is part of the NICE Decision Support Unit, a collaborative group which also involves colleagues at the Universities of Sheffield and Leicester.

3. Methodological research

The team also contributes to methods research in economic evaluation. In part, this is funded by a programme grant from the Medical Research Council as part of CHE's involvement with the MRC Health Services Research Collaboration (2004-2009). This programme of work is entitled 'Methodological issues relating to decision analysis for resource allocation in health care'.

• The team also undertakes a range of methods research funded in other ways including projects grants from public and commercial funders and individual fellowships.

It is also part of the group's objectives to make methodological contributions as part of applied evaluation projects.

This research relates to several key topics:

• Bayesian statistical methods in economic evaluation

• Methods for evidence synthesis

• Methods to prioritise evaluative health services research

• Methods for decision analytic cost-effectiveness modelling

• Handling missing data in economic evaluation using patient-level data

• Methods for the assessment of generalisability in economic evaluation

• Option pricing in economic evaluation

• Use of econometric methods in economic evaluation

• Valuation of health-related outcomes

• Economic evaluation in decision-making

TEEHTA is also part of a collaboration with colleagues at the University of Sheffield called the White Rose Initiative in Health Technology Assessment. WRIHTA was established in recognition of the significant shared research agenda of the ScHARR and CHEBS at the University of Sheffield and the Centre for Health Economics of the University of York. Its objective is to facilitate effective collaboration between the three research centres in order to promote progress on the shared areas of interest.

4. Workshops and training

• Economic evaluation workshops. TEEHTA organises a series of workshops in economic evaluation involving inside and outside speakers.

• Training short course in advanced modelling methods for economic evaluation. This is a three-day computer-based residential course aimed at health economists and those health professionals with experience of health economic modelling who wish to learn about recent methodological developments in this area.

• Training short course in regression analysis for economic evaluation. This is a three-day computer-based residential course aimed at health economists interested in developing their statistical skills, primarily relating to the use of regression modelling in the context of economic evaluation and health technology assessment.

• York expert workshops in the socio-economic evaluation of medicines. Each summer a series of training short courses are held in York on the methods of economic evaluation and health technology assessment. This includes a 5-week course in foundations of economic evaluation methods and a 5-day course in advanced methods for decision making.

PRIMARY CARE



Team Leader: Hugh Gravelle

CHE houses the York contribution to the National Primary Care Research and Development Centre, a multi-disciplinary collaboration of the Universities of Manchester and York. NPCRDC has long term funding from the Department of Health and has also attracted funding from other bodies such as the NHS Executive, Health Authorities, the Medical Research Council, Economic and Social Research Council and private sector organisations.

NPCRDC research is organised in three themes:

1. Workforce: supply and effective deployment

2. Primary care organisations: governance and incentives

3. Quality in primary care: access, effectiveness, equity

The Primary Care team in CHE consists of three economists and provides the bulk of the economic input for NPCRDC. We apply microeconomics and econometrics to analyse policy issues in primary care. We use both traditional health economics tools and to draw on concepts from other areas of economics, such as industrial economics, labour economics, spatial economics, economics of regulation, micro-econometrics and the economics of uncertainty and insurance.

HEALTH POLICY



Team Leader: Maria Goddard

The Health Policy Team undertakes applied and methodological economics research to critically appraise and evaluate organisational and incentive structures of the health care system. This covers the behaviour and performance of organisations and individuals within the health care system. Our portfolio of current work includes:

• Comparative performance and efficiency analyses of the health care system and health care organisations. This covers a wide range of topics from measurement issues to the impact of performance management systems on organisations and individuals. Recent work includes the methodological issues involved in measuring NHS productivity and the design of composite indicators of performance; the appraisal and application of techniques available for measuring efficiency: stochastic frontier analysis, data envelopment analysis, and multi-level (hierarchical) modelling; and challenges in measuring, comparing and improving the quality of health care.

• Research into health care financing, including costing, pricing and design of financing systems. This includes appraisal of the introduction of casemix funding – termed “Payment by Results” – for financing hospital activity in England.

• Analysis of specific health care issues, including NHS waiting times, of policy to offer patients a choice of hospital provider, the design and effects of practice based commissioning budgets, the use of targets and other regulatory instruments in furthering policy aims, and approaches to priority setting in health care.

HEALTH ECONOMETRICS AND DATA GROUP





Team Leader – Nigel Rice

The Health, Econometrics and Data Group (HEDG) is an initiative at the University of York, involving collaboration between the Centre for Health Economics (CHE) and the Department of Economics and Related Studies (DERS).

The aim of HEDG is to provide expertise in the development and application of state-of-the-art quantitative research methods capable of informing health policy through empirical evidence.

The research focus of HEDG is the quantitative analysis of health, health-related behaviour and health care. The aim of the group is two-fold:

• to provide empirical research evidence of the highest quality capable of informing health policy;

• to develop and disseminate novel research methodology through the application of quantitative techniques to substantive problems of policy and/or academic relevance.

The cornerstone of this work is the application of state-of-the-art econometrics and statistical methods with a focus on the analysis of large and complex datasets from non-experimental settings. This encompasses individual-level micro-analyses together with the analysis of data collected at an aggregated level. The use of economic principles and methods is pivotal to the work of the group.

Much of the work of HEDG is undertaken in the Alcuin Research Resource Centre (ARRC) which houses specialist computing resources for computationally intensive research methods.

HEDG has a dedicated seminar program and a working paper series. The Group is also linked to an international network of researchers, including the annual European Workshops on Econometrics and Health Economics.

Projects undertaken within the Group are varied, comprising work undertaken within national and international research projects, as well as smaller collaborations and PhD research into new applied and theoretical issues in health economics and econometric methods.

HEDG has recently been successful in securing a major grant from the Economic and Social Research Council (ESRC) under their Large Grant Scheme. The research aims to better inform health related policy in areas such as health inequality and ways to evaluate public health initiatives. It will also compare the performance of health care systems on an international level. The themes cover subjects of central concern to research and policy analysis both nationally and internationally while offering the opportunity to exploit and develop innovative research methods. The research themes will be complemented by a programme of annual training courses aimed directly at responding to the needs of early and mid-career researchers for training in applied health economics.

Current research interests of the Group include:

• European Workshops in Econometrics and Health Economics;

• Investigating inequality of opportunity;

• Developing microsimulation models for evaluative analysis in public health;

• Analysing health system performance at an international level;

• Evaluation of health policy reforms and programmes;

• Investigating the impact of health on retirement decisions;

• Analysis of health care utilisation using latent class models;

• Simulation estimators with applications to health and lifestyles;

OTHER POTENTIAL RESOURCES FOR GRANT APPLICATIONS

ALCUIN RESEARCH RESOURCE CENTRE



The Alcuin Research Resource Centre (ARRC) was developed with funding from The Wellcome Trust/ESRC Joint Infrastructure Fund. It offers a multidisciplinary collaborative support infrastructure for researchers involved in health and social sciences research within the University of York. ARRC offers support to all stages of a research project.

There is a library focusing on health economics, evidence synthesis, health technology assessment and social policy. The ARRC also houses a highly experienced information team who provide information retrieval support to research projects. Data collection services include focus group rooms and interview rooms with CCTV and audio recording equipment, and telephone interview rooms. The ARRC also houses a 32-PC data collection suite which can also be used for research training purposes. The York Trials Unit is housed within ARRC and ARRC also offers statistical support to its members. The Data Analysis Laboratory within ARRC is a focal point for the analysis of quantitative and qualitative data. It exists as both a physical space and a virtual laboratory. The physical facilities include a specialised laboratory for computationally intensive research in biostatistics, econometrics, social statistics and modelling. The virtual laboratory gives networked access to proprietary software and locally compiled archives of data and programs for all of the health and social sciences units based in the University of York. Finally, the ARRC houses a publications and dissemination service to produce hard copy and electronic research output in a variety of formats relevant to specific audiences. The ARRC also has facilities to host meetings, seminars and small conferences for research dissemination.

USEFUL LINKS

Word version of Queens Anniversary Prize submission is available on the staff intranet here:



The University Research Strategy and other policy documents are available here:





More information on the RAE results are here:





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