Our research spans the field of health economics, covering the four major themes of: economic evaluation and priority setting, policy evaluation, economics of health systems and organisations, and preference and behaviour.

Each of these themes operate as sub-groups within CHIL, and are led by two or more LSHTM academics. Within them, researchers work on empirical and methodological developments, with particular interests in the following methods:

• Causal inference approaches to provide accurate, relevant estimates of the effectiveness and cost-effectiveness of new health care interventions.
• Novel preference elicitation methods and discrete choice experiments
• Study of health care markets
• Incorporating constraints in economic evaluations
• Equity analyses using dynamic demographic and transmission modelling
• Willingness to pay thresholds for multi-sectoral interventions
• Cost functions in data scarce environments
• Standards in global health costing
• Use of behavioural economics and demand analysis to inform intervention and trial design & parameterise uptake in economic evaluation models
• Methods for tracking global and domestic resource flows for health

Read more for overviews, areas of interest, relevant publications, and contact points for each theme:

Economic evaluation and priority setting

Overview of theme

The economic evaluation and priority setting group includes over 30 staff members and research degree students from different disciplines including economics, statistics, mathematical modelling and epidemiology. We work in close collaboration with research partners in the UK and several low and middle income countries.

Our work aims to improve health by informing policy, processes and approaches used to allocate resources across health systems in the UK and around the world. Our research draws on strengths in economic data collection, statistical analysis, valuation of health outcomes, and infectious disease modelling.

We value policy impact, and have long established partnerships with a wide range of both global and national policy makers. We regularly support and participate in advisory work, guideline development, national strategic planning and health technology assessment processes.

The theme leads are Anna Vassall and John Cairns.

Areas of active research

We work across a wide range of health topics, addressing both non-communicable and infectious disease burden. We apply and develop methods in the following areas:

• Improving the statistical analysis of trial and non-trial data
• Incorporating behaviour, demand and health systems considerations into economic evaluation
• Designing frameworks for the economic evaluation of multi-sectoral intervention
• Understanding and estimating costs and resource use
• Incorporating societal perspective, including the measurement of economic impact
• Use of capability and well-being methods in global health
• Incorporating equity in priority settings
• Evaluation of complex interventions
  • Economic evaluation of a complex intervention to reduce bullying in schools
• Evaluating disease models in priority setting
  • Cost-effectiveness of population genetic testing for cancer prevention

Recent publications

Guerriero, C., Cairns, J., Bianchi, F. & Cori, L. (2018) Are children rational decision makers when they are asked to value their own health? A contingent valuation study conducted with children and their parents. Health Economics. 27(2):e55-e68.

Langham, S., Wright, A., Kenworthy, J., Grieve, R. & Dunlop, W.C.N. (2018) Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom. Value in Health. 21(4):407-415.

Li, B., Miners, A., Shakur, H. & Roberts, I. (2018) Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: A cost-effectiveness analysis of data from the WOMAN trial. The Lancet Global Health. 6(2):e222-e228.

Manchanda, R., Patel, S., Gordeev, V.S., Antoniou, A.C., Smith, S., Lee, A., Hopper, J.L., MacInnis, R.J., Turnbull, C., Ramus, S.J., Gayther, S.A., Pharoah, P.D.P., Menon, U., Jacobs, I. & Legood, R. (2018) Cost-effectiveness of Population-Based BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2 Mutation Testing in Unselected General Population Women. Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djx265.

Sandmann, F.G., Robotham, J.V., Deeny, S.R., Edmunds, W.J. & Jit, M. (2018) Estimating the opportunity costs of bed-days. Health Economics. 27(3):592-605.

Torres-Rueda, S., et al. (2018) Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less. Journal of Acquired Immune Deficiency Syndromes. https://doi.org/10.1097/QAI.0000000000001682

Hawkins, N. & Grieve, R. (2017) Extrapolation of Survival Data in Cost-effectiveness Analyses: The Need for Causal Clarity. Medical Decision Making. 37(4):337-339.

Pitt, C., Ndiaye, M., Conteh, L., Sy, O., Hadj Ba, E., Cissé, B., Gomis, J.F., Gaye, O., Ndiaye, J.L. & Milligan, P.J. (2017) Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. Health Policy and Planning. 32(9):1256-1266.

Remme, M., Martinez-Alvarez, M. & Vassall, A. (2017) Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective. Value in Health. 20(4):699-704.

Greco, G., Lorgelly, P. & Yamabhai I. (2016) Outcomes in Economic Evaluations of Public Health Interventions in Low- and Middle-Income Countries: Health, Capabilities and Subjective Wellbeing. Health Economics. 25(1):83-94.

Menzies, N.A., Gomes, G.B., et al. (2016) Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. The Lancet Global Health. 4(11):e816-e826.

Sweeney, S., Vassall, A., Foster, N., Simms, V., Ilboudo, P., Kimaro, G., Mudzengi, D. & Guinness, L. (2016) Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evalua tions in Low-income and Middle-income Countries. Health Economics. 25(1):42-52.

Vassall, A., Mangham-Jefferies, L., Gomez, G.B., Pitt, C. & Foster, N. (2016) Incorporating Demand and Supply Constraints into Economic Evaluations in Low-Income and Middle-Income Countries. Health Economics. 25(1):95-115.

Wilkinson, T., Sculpher, M.J., Claxton, K., Revill, P., Briggs, A., Cairns, J.A., Teerawattananon, Y., Asfaw, E., Lopert, R., Culyer, A.J. & Walker, D.G. (2016) The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought. Value in Health. 19(8):921-928.

Fernandes, S., Sicuri, E., Kayentao, K., van Eijk, A.M., Hill, J., Webster, J., Were, V., Akazili, J., Madanitsa, M., ter Kuile, F.O. & Hanson, K. (2015) Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data. The Lancet Global Health. 3(3):e143-53.

Policy evaluation

Overview of theme

We aim to improve methods for policy evaluation, drawing heavily on approaches developed in economics, but also from related disciplines such as biostatistics and management science. The group’s expertise is in the development and application of quasi-experimental methods including matching, difference-in-differences, flexible regression, and synthetic control methods. Our focus is on applying these approaches to large-scale observational data to address questions of international policy-relevance in health.

We work closely with policy-makers in many different countries, and their requirements motivate our interests in methods development, which takes place in collaboration with a cross-disciplinary network of methodological experts.

The theme leads are Timothy Powell-Jackson and Richard Grieve.

Areas of active research

• Investigation of synthetic control methods versus difference in difference estimation
• Application of instrumental variable approaches for evaluating person-level treatment effects
• Policy-relevant evaluations including of integrated care initiatives in the UK Value of implementation approaches
• National evaluation of pay for performance in Brasil using quasi-experimental methods applied to linked administrative datasets
• Large scale randomised controlled trial of a quality improvement and business intervention in private health facilities in Tanzania
• Analysis of household scanner data on food and beverage expenditures to understand dietary behaviours and evaluation of likely health related food policy impacts

Recent publications

Quirmbach, D., Cornelsen, L., Jebb, S.A., Marteau, T. & Smith, R. (2018) Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data. Journal of Epidemiology and Community Health. doi: 10.1136/jech-2017-209791.

Anselmi, L., Binyaruka, P. & Borghi. J. (2017) Understanding causal pathways within health systems policy evaluation through mediation analysis: an application to payment for performance (P4P) in Tanzania. Implementation Science. 12:10.

Lépine, A., Lagarde, M. Le Nestour, A. (2017) How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control. Health Economics. 27:493–508.

Cornelsen, L., Mazzocchi, M., Green, R., Dangour, A.D. & Smith, R.D. (2016) Estimating the relationship between food prices and food consumption – methods matter. Applied Economic Perspectives and Policy. 38(3):546-51.

O’Neill, S., Kreif, N., Grieve, R.D., Sutton, M. & Sekhon, J.S. (2016) Estimating causal effects: considering three alternatives to difference-in-differences estimation. Health Services Research and Outcomes Methodology. 16(1-2):1-21.

Kreif, N., Grieve, R., Hangartner,D., Nikolova,S., Turner,A. & Sutton, M. (2015) Examination of the Synthetic Control Method for Evaluating Health Policies with Multiple Treated Units. Health Economics. 25: 1514–1528.

Powell-Jackson, T., Mazumdar, S. & Mills, A. (2015) Financial incentives in health: New evidence from India's Janani Suraksha Yojana. Journal of Health Economics. 43:154-69.

Steventon, A., Grieve, R. & Sekhon, J.S. (2015) A comparison of alternative strategies for choosing control populations in observational studies. Health Services Research and Outcomes Methodology. 15(3–4): 157–181.

Powell-Jackson, T. & Hanson, K. (2012) Financial incentives for maternal health: impact of a national programme in Nepal. Journal of Health Economics. 31(1):271-84.

Sekhon, J. & Grieve, R. (2012) A Matching Method for Improving Covariate Balance in Cost-Effectiveness Analyses. Health Economics. 21(6):695-714.

Economics of health systems and organisations

Overview of theme

The effective design and management of health systems poses many important economics questions, such as:

• How should we finance health care?
• What role should the government have in health care provision?
• How should we regulate private providers?
• How should we pay health care workers?

Our work involves the use of economic concepts, theories and insights to address these types of dilemmas. We use quantitative, qualitative and mixed methods to understand and analyse specific aspects of health system performance, and to support the design and evaluation of health system strategies and interventions. We study health care markets (e.g. competition and choice); non-market approaches (e.g. planning and regulation); healthcare financing (e.g. purchasing and provider payment), and resource allocation (e.g. rationing mechanisms). We draw on a wide range of economic theories, including principal-agency theory, transaction costs theory, new institutional economics, theory of yardstick competition, and theories of regulation.

Our work encompasses low, middle and high income countries and humanitarian settings. We investigate the variation across these health systems and their contexts, while also striving to identify common insights, and facilitate cross-country learning.

Theme members are also convenors of iHEA’s Special Interest Group on Financing for Universal Health Coverage.

The theme leads are Pauline Allen and Catherine Goodman.

Areas of active research

Healthcare markets and competition

• New organisational forms in healthcare markets e.g. analysis of the growth of pharmacy chains in India
• The nature of competition for private delivery providers in India
• Competitive strategies used by private providers e.g. the role of kick-backs and commission payments by Indian hospitals and clinics
• Use of competition in the English NHS
• Market entry into the English NHS by non-state organisations

Health system financing

• Methods for tracking donor aid and domestic expenditure in low- and middle-income countries
• Political economy of health system financing in low- and middle-income countries
• Equity of health care financing in low- and middle-income countries
• Evaluation of health systems’ financing impact on equity in Indonesia

Governance and regulation

• Evaluation of innovative regulatory reforms in Kenya’s health facilities
• New regulatory needs in the face of evolving healthcare markets in India, Kenya and Nigeria
• Evaluation of social franchising programmes in Uganda and India
• Evaluation of a quality improvement programme in Tanzanian private facilities
• System regulation by governments to improve provider performance and contain costs in England
• Network and collaborative approaches for planning and delivering healthcare in England
• New models of contracting in the English NHS, such as alliancing

Purchasing and provider payment

• Evaluation of pay-for-performance for health facility staff in Tanzania
• Health system effects of pay-for-performance in Zimbabwe, Mozambique, Tanzania, Zambia and Brazil
• Social Impact Bonds to fund innovative services in England
• Financial incentives to improve quality of care in English healthcare providers
• Different methods of pricing and risk allocation in the English NHS

Intra-organisational issues

• How senior managers instil appreciation of organisational goals in front line staff
• Staff motivation in not-for-profit organisations in England
• Intra-agency incentives

Recent publications

Pitt,C., Grollman, C., Martinez-Alvarez, M., Arregoces, L., Borghi, J. (2018) Tracking aid for global health goals: a systematic comparison of four approaches applied to reproductive, maternal, newborn, and child health. Lancet Global Health. 6: e859-74.

Haemmerli, M., Santos, A., Penn-Kekana, L., Lange, I., Matovu, F., Benova, L., Wong, K.L.M. & Goodman, C. (2018) How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India. Health policy and planning. 33(3):411-419.

ACTwatch Group, Tougher, S., Hanson, K. & Goodman, C. (2017) What happened to anti-malarial markets after the Affordable Medicines Facility-malaria pilot? Trends in ACT availability, price and market share from five African countries under continuation of the private sector co-payment mechanism. Malaria Journal. 16(1):173.

Allen, P., Osipovic, D., Shepherd, E., Coleman, A., Perkins, N. & Williams, L. (2017) Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: Evidence from a qualitative study of four clinical commissioning groups. BMJ Open. 7(2):e011745.

Miller, R. & Goodman, C. (2017) Do chain pharmacies perform better than independent pharmacies? Evidence from a standardised patient study of the management of childhood diarrhoea and suspected tuberculosis in urban India. BMJ Global Health. 2(3):e000457.

Moran, V., Allen, P., McDermott, I., Checkland, K., Warwick-Giles, L., Gore, O., Bramwell, D. & Coleman, A. (2017) How are Clinical Commissioning Groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis. BMJ Open. 7(11): e018422.

Moran, V. & Jacobs, R. (2017) Costs and Performance of English Mental Health Providers. Journal of Mental Health Policy and Economics. 20(2):83-94.

Sanderson, M., Allen, P., Gill, R. & Garnett, E. (2017) New models of contracting in the public sector: a review of alliance contracting, prime contracting and outcome based contracting literature. Social Policy and Administration DOI: 10.1111/spol.12322.

Sanderson, M., Allen, P. & Osipovic, D. (2017) The regulation of competition in the NHS - what difference has the Health and Social Care Act 2012 made? Health Economics Policy and Law. 12(1):1-19.

Tougher, S., Dutt, V., Pereira, S., Haldar, K., Shukla, V., Singh, K., Kumar, P., Goodman, C. & Powell-Jackson, T. (2017) Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study. The Lancet Global Health. 6(2):e211–e221.

Allen, P. & Petsoulas, C. (2016) Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts. Public Money and Management. 36(5):341-348.

Montagu, D. & Goodman, C. (2016) Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector? The Lancet. 388:613-621.

Osipovic D. Allen P. Shepherd E. Coleman A. Perkins, N. Williams L. Sanderson M. Checkland K. (2016) Interrogating institutional change: actors’ attitudes to competition and cooperation in commissioning health services in England. Public Administration. 94(3): 823–838.

 

Preferences and behaviour

Overview of theme

Understanding people’s preferences as well as what determines the choices they make is critical for an efficient and effective healthcare system. This theme brings together researchers using classical and behavioural economic techniques to investigate and explain health decisions.

Discrete choice experiments (DCEs) are a method to understand preferences for products and services. They can be used to estimate user valuations and predict uptake prior to implementation. These experiments are being adapted for rapid application within the formative research phase, in order to optimise trials and programming. Their uptake predictions are also being incorporated into cost-effectiveness models, as an improvement on mathematical modelling which has traditionally relied on expert opinion to estimate uptake in projecting the impact of new technologies.

Our group is undertaking DCEs to estimate these parameters in order to improve projections of uptake, and better understand how product attributes such as efficacy affect epidemiological impact and cost-effectiveness directly, and indirectly through increasing attractiveness.

Behavioural economics combines theories from economics and psychology to investigate and understand how people make choices. We are undertaking research that examines how cognitive biases, such as overconfidence, affect decisions made by healthcare providers. We also make use of randomised experiments to study how behavioural interventions can be used to improve quality of care. In addition, we are using it to optimise implementation science research, through changing choice architecture in HIV self-testing.

We are also convenors of iHEA’s Special Interest Group on Health Preference Research.

The theme leads are Fern Terris-Prestholt and Alec Miners.

Areas of active research

• Using discrete choice experiments and revealed preference studies to design and evaluate interventions to improve health
  • Behavioural change interventions to reduce sexually transmitted infections
  • Taxes on sugar-sweetened beverages
  • HIV self-testing in the UK, Malawi, Zambia, and Zimbabwe
  • Comparison of stated and revealed preferences for blood donation using big data and data adaptive model estimation
• Assessing the role of discrete choice experiments and revealed preference studies in parametrising user uptake in economic evaluations
  • Pre-Exposure Prophylaxis for HIV
  • HIV self-testing

Recent publications

Miners, A., Llewellyn, C., King, C., Pollard, A., Roy, A., Gilson, R., Rodger, A., Burns., F. & Shahmanesh, M. (2018). Designing a brief behaviour change intervention to reduce sexually transmitted infections: a discrete choice experiment. International Journal of STD & AIDS, 0956462418760425.

Quaife, M., Terris-Prestholt, F., Di Tanna, G.L. & Vickerman, P. (2018) How well do discrete choice experiments predict health choices? A systematic review and meta-analysis of DCE external validity. European Journal of Health Economics. 1-14.

Quaife, M., et al. (2018) The cost-effectiveness of multipurpose HIV and pregnancy prevention technologies in South Africa. Journal of the International AIDS Society. 21:e25064.

SESH Study Team. (2017) Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial. Trials.18:447.

Quaife, M., Eakle, R., Cabrera-Escobar, M.A., Vickerman, P., Kilbourne-Brook, M., Mvundura, M., Delany-Moretlwe, S. & Terris-Prestholt, F. (2018). Divergent Preferences for HIV Prevention: A Discrete Choice Experiment for Multipurpose HIV Prevention Products in South Africa. Medical Decision Making. 38(1):120-133.

Indravudh, P.P., Sibanda, E.L., d'Elbée, M., Kumwenda, M.K., Ringwald, B., Maringwa, G., Simwinga, M., Nyirenda, L.J., Johnson, C.C., Hatzold, K., Terris-Prestholt, F. & Taegtmeyer, M. (2017) 'I will choose when to test, where I want to test': investigating young people's preferences for HIV self-testing in Malawi and Zimbabwe. AIDS. 31(3):S203-S212.

Wambura, M., Mahler, H., Grund, J.M., Larke, N., Mshana, G., Kuringe, E., Plotkin, M., Lija, G., Makokha, M., Terris-Prestholt, F., Hayes, R.J., Changalucha, J., Weiss, H.A. & VMMC-Tanzania Study Group. (2017) Increasing voluntary medical male circumcision uptake among adult men in Tanzania. AIDS. 31(7):1025-1034.

Quaife, M., Eakle, R., Cabrera, M., Vickerman, P., Tsepe, M., Delany-Moretlwe, S., Vickerman, P. & Terris-Prestholt, F. (2016) Preferences for ARV based HIV prevention methods among adult men and women, adolescent girls and female sex workers in Gauteng Province, South Africa: A protocol for a discrete choice experiment. BMJ Open. 6:e010682.

Tang, W. et al. (2016) Crowdsourcing HIV Test Promotion Videos: A Non-Inferiority Trial in China. Clinical Infectious Diseases. 62(11):1436-42.

Terris-Prestholt, F. & Windmeijer, F. (2016) How to Sell a Condom? The impact of demand creation tools on male and female condom sales in resource limited settings. Journal of Health Economics. 48:107-20.

Terris-Prestholt F, Quaife M, Vickerman P. (2016) Parameterising user uptake in economic evaluations: the role of discrete choice experiments. Health Economics. 1:116-23.