Module Directory

This module focuses on the technique of economic evaluation. As resources are scarce choices need to be made about how to best allocate those scarce resources. Given resources are finite provision of one option means there is less resource that can be spent elsewhere and as such another option will likely have to be sacrificed (i.e., there is generally an opportunity cost associated with the provision of a particular health care intervention as it means another intervention will not be provided). Economic evaluation typically compares the costs and benefits of different health care interventions with a view to establish which intervention is more cost-effective i.e., which intervention offers value for money and should therefore be provided (at the expense of another intervention which would not be provided).

The module will outline the different types of economic evaluation, and explain the steps of identification, measurement and valuation of both costs and outcomes. It will include applied work where students would be able to use hypothetical data to estimate costs based on different levels of resource use e.g., the number of visits to different types of health professionals, and outcomes based on reported quality of life data. Exercises would be developed in e.g., Microsoft Excel / STATA. The analysis performed on such estimated cost and outcome data in order estimate levels of cost-effectiveness/value for money will also be covered. The use of critical appraisal to assess the quality of the economic evidence and use of recommended reporting checklists/standards will also be outlined. 

The aims of this module are:

• To introduce students to basic health economic principles.


• To provide students with an understanding of what an economic evaluation is and how it might be conducted.


• To enable students to critically appraise an economic evaluation / understand associated reporting standards.

By the end of this module, students will be expected to be able to:

1. Critically explain why there is a need for health economics.


2. Provide a critical explanation of what an economic evaluation is and why it would generally be conducted.


3. Explain what data might be used to estimate the cost and outcome data required for an economic evaluation.


4. Demonstrate an advanced understanding of analyses that can be undertaken in order to assess whether an intervention is cost-effective.


5. Demonstrate a knowledge of how to critically appraise an economic evaluation / associated reporting standards.

Indicative syllabus information

INTRODUCTION

Need for health economics. What is an economic evaluation?  Economic concepts: choice, scarcity, opportunity cost, allocative and technical efficiency; types of economic evaluation (design / economic question). National Institute of Clinical and Care Excellence (NICE) Methods guide / Reference case.

COST

Identification, valuation and measurement; non-market items; cost vs charges; average and marginal cost distinction; opportunity cost; indirect costs and approaches to measurement; overheads; perspective; data collection.

OUTCOMES: MONETARY

History of Cost Benefit Analysis (CBA); willingness to pay; willingness to accept; elicitation; discrete choice models.

OUTCOMES: SUBJECTIVE

Defining utility; measurement; standard gamble, time tradeoff, rating scale; Quality Adjusted Life Years (QALYs); questionnaire elicitation, EuroQol- 5 Dimensions (EQ-5D); who’s value and perspective; equity and QALYs.

OUTCOMES: CLINICAL

Outcome measurement; clinical measures; Health Related Quality of Life (HRQoL); disease specific; Short Form 36 (SF36); incremental approach; psychometrics (acceptability, validity, etc); mapping.

ANALYSIS

Incremental Cost Effectiveness Ratio (ICERs); cost effectiveness planes; uncertainty, bootstrapping, cost effectiveness acceptability curves; sensitivity analysis, boundaries, confidence intervals; time, discounting, costs/outcomes.

SYSTEMATIC REVIEWS & MODELLING

Alternatives to Randomised Controlled Trial (RCTs); Systematic reviews, what they are and why, their role in economic evaluation; Modelling, what is it, why, types e.g. decision trees / Markov modelling.

CRITICAL APRAISAL

How is economic evidence used in decisions? How can the quality of economic evidence be assured?  What are the obstacles to appropriate use of evidence?

Critical appraisal of real economic evaluation studies / reporting standards.

This module will be delivered via:

• Nine weeks x 3 hour sessions. These would include lectures and student-led workshops, some of which will based in an IT laboratory.