In recent years, health economic evaluations have assumed increasing importance as documentation in connection with prioritisations and policy decisions in healthcare and medical care. This creates demands in terms of the ability to review and compare scientific evaluations, and in terms of good access to quality health economic studies. There is also a need for continued research and development of the health economic methods being used. The Centre for Medical Technology Assessment conduct research within the area of Health Economic Evaluations and there are three specialised fields of study within the research area.
A great deal of the work done in the area of health economic evaluations pertains to applied evaluations. These include cost-effectiveness analyses, cost-benefit analyses, and disease cost studies. These studies utilise statistical analyses of observed data, and can be based on prospective randomised clinical studies, retrospective data, meta-analyses, electronic patient record systems, county council care data registers, and healthcare quality registers. Decision models are often used in such studies to compare and incorporate data from several different sources.
Health economic method development
Theoretical starting points
This field includes research on the theoretical bases for health economic evaluations and how they affect the choice of method used. How do these theoretical starting points impact national and international guidelines on how an evaluation is to be conducted? What types of costs and effects are to be included in such evaluations? How can international differences be accounted for? How should health economic evaluations be tied in to determining healthcare and medical care priorities?
This field covers the development of methods for health economic evaluations. It includes the development of methods for decision models focusing on result extrapolation from clinical trials, the handling of uncertainty and the value of information analysis, the use of expert assessments in cases where data are limited, and so on.
The statistical methods relevant to this type of evaluation include methods for analysing cost and effect data from clinical studies, primarily multinational trials and meta-analyses. Extensive method development takes place during the design of the health economic Case Report Forms used to collect data in clinical studies, where different methods based on, for instance, micro-costing and DRG costs are compared and analysed.
The measurement of effects plays a key role in health economic evaluations. This specialised field involves the development and application of methods to measure the value of the technologies that are being evaluated. One key element is measurement of the weights used for calculating quality-adjusted life years, based on standardised instruments and via direct methods. Studies of willingness to pay, along with other research concerned with quality-of-life issues, are also included.
Systematic reviews and literature studies
This specialised field of study includes systematic literature reviews of health economic studies. These reviews take place mainly at the behest of government agencies such as the Swedish National Board of Health and Welfare, the Swedish Pharmaceutical Benefits Board, and the Swedish Council on Technology Assessment in Health Care (SBU).
Photo credit: Emma Busk Winquist
Group of researchers that work with Health Economic Evaluations.
Back row from the left: Lars-åke Levin, Lars Bernfort, Martina Lundqvist, Martin Henriksson, Jonathan Siverskog
Front row: Jenny Alwin, Johanna Wiss, Mattias Aronsson, Thérèse Eriksson