Based in the Faculty of Public Health and Policy, the Centre For Health Economics In London (CHIL) acts as the central body for staff and students across the School who study or apply health economics.
Our research spans the field of health economics, including: Economic evaluation and priority setting, Evaluation of complex policy interventions, Health system financing and organization & Preferences and behaviour.
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We are a world-leading group of over 50 academics working on a diverse portfolio of health economics research, with work ranging from the development of innovative methods and empirical research, to policy engagement and impact.
Members have strong national and international partnerships and a wealth of experience in advising UK and other national governments, international agencies, and organisations.
Overview
Based in the Faculty of Public Health and Policy, the Centre For Health Economics In London (CHIL) acts as the central body for staff and students across the School who study or apply health economics.
The Centre’s vision is forward-looking and emphasises cutting edge methodological development, rigorous empirical research, and working alongside policy and decision-makers to achieve policy impact. We seek to improve collaborations among economists and researchers in other disciplines at LSHTM and with research groups and policymakers in the UK and around the world. Centre members’ expertise places them at the forefront in building the capacity of health economists and their policy communities – and embracing respectful collaborations worldwide.
Our teaching programme includes research degrees and multiple masters degree programmes taught in London and through our distance learning programme.
LSHTM economists link to others through IHEA and the UK Health Economics Study Group.
Leadership
Director
| Anna Vassall, Professor of Health Economics |
Deputy Director
| Andrew Briggs, Professor of Health Economics |
Theme Leads
Economic evaluation and priority setting
| Anna Vassall, Professor |
| John Cairns, Professor |
Economics of health systems and organisations
| Pauline Allen, Professor |
| Catherine Goodman, Professor |
| Richard Grieve, Professor |
| Timothy Powell-Jackson, Associate Professor |
| Ties Hoomans, Assistant Professor |
| Fern Terris-Prestholt, Associate Professor |
| Alec Miners, Associate Professor |
Communication Committee
| Melisa Martinez-Alvarez, Assistant Professor |
| Kara Hanson, Professor |
| Rosa LeGood, Associate Professor |
| Matthew Quaife, Research Fellow |
| Sergio Torres-Rueda, Research Fellow |
| Anna Vassall, Professor |
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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.
Read more for overviews, areas of interest, relevant publications, and contact points for each theme:
- Economic evaluation and priority setting
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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
- Policy evaluation
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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
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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
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- 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
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- 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
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- 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
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- 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
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- 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
- Preferences and behaviour
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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. - Using discrete choice experiments and revealed preference studies to design and evaluate interventions to improve health
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 and parameterise uptake in economic evaluation models
- Methods for tracking global and domestic resource flows for health
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Masters
Health Economics courses are a core part of our Masters teaching in public health. Key to our teaching is the use of our research and policy experience within our teaching materials, featuring prominently in the following face-to-face courses in London:
- MSc Public Health (with the option of specialising in Health Economics)
- MSc Public Health for Development
- MSc Health Policy, Planning & Financing (delivered in collaboration with the London School of Economics)
Distance learning
We also have two distance learning courses:
- MSc, PG Diploma & PG Certificate in Public Health
- MSc, PG Diploma & PG Certificate in Global Health Policy
Economics MSc modules include “Introduction to Health Economics”, “Economic Analysis for Health Policy”, “Economic Evaluation”, and “The Economics of Global Health Policy”.
Short courses
We regularly offer short courses which are a great way to sharpen your skills and knowledge within health economics:
Study with us
If you are interested in undertaking research or studies on health economics at LSHTM, further details - including on the application process – are available for the face-to-face, distance learning, and research degree programmes. There is also advice on scholarship funding.
For any other information on studying at LSHTM, please contact the Study Team.
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Research staff
| Anna Vassall Director of CHIL, Professor of Health Economics |
Andrew Briggs |
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Kaja Abbas |
Pauline Allen Professor of Health Services Organisation Health systems and organisation |
Katherine Atkins Associate Professor of Infectious Disease Modelling Economic evaluation and priority setting |
| David Bath Research Fellow in Health Economics Economic evaluation and priority setting Preferences and behaviour |
Nicolas Berger Research Fellow Policy evaluation Preferences and behaviour |
Josephone Borghi Associate Professor of Health Economics and Policy Health systems and organisation |
| Fiammetta Bozzani Research Fellow in Health Economics Economic evaluation and priority setting Health systems and organisation |
John Cairns |
Andrew Clark Associate Professor Economic evaluation and priority setting |
| Laura Cornelsen Assistant Professor of Public Health Economics Preferences and behaviour Policy evaluation |
Marc d'Elbee Research Fellow in Health Economics Economic evaluation and priority setting Preferences and behaviour |
Rosalind Eggo |
| Camilla Fabbri Research Fellow Preferences and behaviour Policy evaluation |
Silke Fernandes |
Lucy Gilson Professor of Health Policy and Systems |
| Gabriela Gomez Associate Professor in Economics of Infectious Diseases Economic evaluation and priority setting |
Catherine Goodman |
Giulia Greco Assistant Professor of Health Economics Economic evaluation Policy evaluation |
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Richard Grieve |
Manon Haemmerli |
Kara Hanson Professor of Health System Economics and Dean, Faculty of Public Health and Policy Policy evaluation |
| Pitchaya Indravudh Research Fellow in Health Economics Preferences and behaviour Policy evaluation |
Mark Jit Professor of Vaccine Epidemiology Economic evaluation and priority setting |
Marcus Keogh-Brown Associate Professor in Economic Modelling Policy evaluation Economics of health systems and organisations |
| Jessica King Research Fellow in Health Economics and Impact Evaluation Policy evaluation Health systems and organisation |
Roxanne Kovacs Research Fellow in Health Economics Preferences and behaviour Policy evaluation |
Yoko Laurence Research Fellow in Health Economics Economic evaluation and priority setting |
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Cherry Law |
Rosa Legood Associate Professor of Health Economics Economic evaluation and priority Setting |
Melissa Martinez-Alvarez |
| Alexina Mason Assistant Professor of Medical Statistics Economic evaluation |
Rosalind Miller Research Fellow Health systems and organisation |
Anne Mills Professor of Health Economics and Policy Health systems and organisation Economic evaluation and priority setting |
| Alec Miners Associate Professor of Health Economics Preferences and behaviour Economic evaluation and priority setting |
Valerie Moran Research Fellow Health systems and organisations Policy evaluation |
Nichola Naylor Research Fellow Economic evaluation and priority setting |
| Jason Ong Associate Professor (Hon) Economic evaluation and Preferences and behaviour |
Catherine Pitt Assistant Professor of Health Economics and Policy Health systems and organisation Economic evaluation and priority setting |
Timothy Powell-Jackson Associate Professor of Health Economics Policy evaluation Health systems and organisation |
| Simon Procter Research Fellow Economic evaluation and priority setting |
Matthew Quaife |
Zia Sadique Assistant Professor of Health Economics Economic evaluation and priority setting Policy evaluation |
| Marie Sanderson Research Fellow Health systems and organisations |
Frank Sandmann Research Fellow Economic evaluation and priority setting |
Neha Singh Assistant Professor Health systems and organisation Policy evaluation |
|
Sedona Sweeney |
Stefanie Tan Research Fellow Health systems and organisation |
Henning Tarp-Jensen |
| Fern Terris-Prestholt Associate Professor in Economics of HIV Economic evaluation and priority setting Preferences and behaviour |
Sergio Torres Rueda Research Fellow in Health Economics Economic evaluation and priority setting |
Jack Williams |
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Virginia Wiseman |
Nichola Kitson Research Fellow Economic evaluation and priority setting |
Meghna Ranganathan Assistant Professor Policy evaluation |
| Loveday Penn-Kekana Assistant Professor Health systems and organisation |
Julia Lohmann Research Fellow |
Honoraries
| Hannah-Rose Douglas Associate Professor |
Ulla Griffiths Associate Professor Economic evaluation and priority setting |
Lorna Guinness Associate Professor Economic evaluation and priority setting |
| Aurelia Lepine Assistant Professor Policy evaluation |
Francisco Pozo-Martin Research Fellow Economic evaluation |
Students
|
Nikita Arora |
Henry Cust |
Frederik Federspiel PhD candidate Economics of health systems and organisations |
| Rym Ghouma PhD candidate Preferences and behaviour Policy evaluation |
Darshini Govindasamy PhD candidate Policy evaluation |
Justine Hsu PhD candidate Economic evaluation and priority setting Policy evaluation |
| Heather Ingold PhD candidate |
Prabhdeep Kaur PhD candidate |
Jennifer Ljungqvist PhD candidate |
| Rahab Mbau PhD candidate Economic evaluation and priority setting |
Halima Mohamed PhD candidate |
Dorota Osipovic PhD candidate Economics of health systems and organisations |
|
Suladda Pongutta |
Miguel Pugliese-Garcia PhD candidate |
Ian Ross PhD candidate Economic evaluation and priority setting |
| Ahmad Salehi PhD candidate |
Linda Sande PhD candidate Economic evaluation and priority setting |
Sarah Tougher PhD candidate |
|
Muntaqa Umar-Sadiq
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Takuya Yamanuka PhD candidate |
Economic evaluation and priority setting
- 2020
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ABBAS, KM. ; VAN ZANDVOORT, K. ; Brisson, M. ; JIT, M. ; Effects of updated demography, disability weights, and cervical cancer burden on estimates of human papillomavirus vaccination impact at the global, regional, and national levels: a PRIME modelling study. The Lancet Global Health, (2020).8 (4), DOI: 10.1016/S2214-109X(20)30022-X.
BATH, D. ; GOODMAN, C. ; YEUNG, S. ; Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa. BMJ Global Health, (2020).5 (5), DOI: 10.1136/bmjgh-2019-002138.
JIT, M. ; Ng, DH L. ; Luangasanatip, N. ; Sandmann, F. ; ATKINS, KE. ; Robotham, JV. ; Pouwels, KB. ; Quantifying the economic cost of antibiotic resistance and the impact of related interventions: rapid methodological review, conceptual framework and recommendations for future studies. BMC Medicine, (2020).18 (1), DOI: 10.1186/s12916-020-1507-2.
Li, X. ; Willem, L. ; Antillon, M. ; Bilcke, J. ; JIT, M. ; Beutels, P. ; Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries. BMC Medicine, (2020).18 (1), DOI: 10.1186/s12916-020-01537-6.
MURPHY, A. ; PALAFOX, B. ; Walli-Attaei, M. ; POWELL-JACKSON, T. ; Rangarajan, S. ; Alhabib, KF. ; Avezum, AJ. ; Calik, KB T. ; Chifamba, J. ; Choudhury, T. ; Dagenais, G. ; Dans, AL. ; Gupta, R. ; Iqbal, R. ; Kaur, M. ; Kelishadi, R. ; Khatib, R. ; Kruger, IM. ; Kutty, VR. ; Lear, SA. ; Li, W. ; Lopez-Jaramillo, P. ; Mohan, V. ; Mony, PK. ; Orlandini, A. ; Rosengren, A. ; Rosnah, I. ; Seron, P. ; Teo, K. ; Tse, LA. ; Tsolekile, L. ; Wang, Y. ; Wielgosz, A. ; Yan, R. ; Yeates, KE. ; Yusoff, K. ; Zatonska, K. ; HANSON, K. ; Yusuf, S. ; McKee, M. ; The household economic burden of non-communicable diseases in 18 countries. BMJ Global Health, (2020).5 (2), DOI: 10.1136/bmjgh-2019-002040.
Prinja, S. ; Chauhan, AS. ; Rajsekhar, K. ; Downey, L. ; Bahuguna, P. ; Sachin, O. ; GUINNESS, L. ; Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action. Value in Health Regional Issues, (2020).21, 226-229. DOI: 10.1016/j.vhri.2019.11.003.
Roberts, K. ; Macleod, J. ; Metcalfe, C. ; Hollingworth, W. ; WILLIAMS, J. ; Muir, P. ; Vickerman, P. ; Clement, C. ; Gordon, F. ; Irving, W. ; Waldron, C-A. ; North, P. ; Moore, P. ; Simmons, R. ; MINERS, A. ; Horwood, J. ; Hickman, M. ; Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care. BMJ (Clinical research ed.), (2020).368, m322-m322. DOI: 10.1136/bmj.m322.
SWEENEY, S. ; VASSALL, A. ; GUINNESS, L. ; Siapka, M. ; Chimbindi, N. ; Mudzengi, D. ; Gomez, GB. ; Examining Approaches to Estimate the Prevalence of Catastrophic Costs Due to Tuberculosis from Small-Scale Studies in South Africa. PharmacoEconomics, (2020).38 (6), DOI: 10.1007/s40273-020-00898-3.
Vogelzang, M. ; TERRIS-PRESTHOLT, F. ; Vickerman, P. ; Delany-Moretlwe, S. ; Travill, D. ; QUAIFE, M. ; Cost-Effectiveness of HIV Pre-exposure Prophylaxis Among Heterosexual Men in South Africa: A Cost-Utility Modeling Analysis. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 84 (2), DOI: 10.1097/QAI.0000000000002327.
Yang, J. ; ATKINS, KE. ; Feng, L. ; Baguelin, M. ; Wu, P. ; Yan, H. ; Lau, EH Y. ; Wu, JT. ; LIU, Y. ; Cowling, BJ. ; JIT, M. ; Yu, H. ; Cost-effectiveness of introducing national seasonal influenza vaccination for adults aged 60 years and above in mainland China: a modelling analysis. BMC medicine, (2020).18 (1), DOI: 10.1186/s12916-020-01545-6.
- 2019
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Biddle, L. ; MINERS, A. ; Bozorgmehr, K. ; Cost-utility of screening for depression among asylum seekers: a modelling study in Germany. Health Policy, (2019).123 (9), DOI: 10.1016/j.healthpol.2019.05.011.
Cambiano, V. ; JOHNSON, CC. ; Hatzold, K. ; TERRIS-PRESTHOLT, F. ; Maheswaran, H. ; Thirumurthy, H. ; Figueroa, C. ; Cowan, FM. ; Sibanda, EL. ; Ncube, G. ; Revill, P. ; Baggaley, RC. ; CORBETT, EL. ; Phillips, A. ; For Working Group on Cost Effectiveness of HIV sel,; The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis. Journal of the International AIDS Society, (2019).22 Sup (S1), DOI: 10.1002/jia2.25243.
Chen, C. ; Cervero Liceras, F. ; FLASCHE, S. ; Sidharta, S. ; Yoong, J. ; SUNDARAM, N. ; JIT, M. ; Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis. LANCET GLOBAL HEALTH, (2019).7 (1), DOI: 10.1016/S2214-109X(18)30422-4.
DOWIE, J. ; Kaltoft, MK. ; Uncertainty-Adjusted Translation for Preference-Sensitive Decision Support. Studies in health technology and informatics, (2019).258, DOI: 10.3233/978-1-61499-959-1-174.
Drake, T. ; MEDLEY, G. ; VASSALL, A. ; Gomez, G. ; Equity, economic evaluation, and disease transmission modelling – 26-27th March 2018: Pre-meeting reviews. F1000Research (2019).DOI: 10.7490/f1000research.1116870.1.
Eaton, JW. ; TERRIS-PRESTHOLT, F. ; Cambiano, V. ; Sands, A. ; Baggaley, RC. ; Hatzold, K. ; CORBETT, EL. ; Kalua, T. ; Jahn, A. ; JOHNSON, CC. ; Optimizing HIV testing services in sub-Saharan Africa: cost and performance of verification testing with HIV self-tests and tests for triage. Journal of the International AIDS Society, (2019).22 Sup (S1), DOI: 10.1002/jia2.25237.
Hippner, P. ; SUMNER, T. ; HOUBEN, RM. ; Cardenas, V. ; VASSALL, A. ; BOZZANI, F. ; Mudzengi, D. ; Mvusi, L. ; Churchyard, G. ; WHITE, RG. ; Application of provincial data in mathematical modelling to inform sub-national tuberculosis program decision-making in South Africa. PloS one, (2019).14 (1), DOI: 10.1371/journal.pone.0209320.
Kaltoft, MK. ; DOWIE, J. ; Risk Classifications Interfere with Preference-Sensitive Decision Support. Studies in Health Technology and Informatics, (2019).261, DOI: 10.3233/978-1-61499-975-1-217.
Mangenah, C. ; Mwenge, L. ; Sande, L. ; AHMED, N. ; D'ELBÉE, M. ; Chiwawa, P. ; Chigwenah, T. ; Kanema, S. ; Mutseta, MN. ; Nalubamba, M. ; Chilongosi, R. ; INDRAVUDH, P. ; Sibanda, EL. ; NEUMAN, M. ; Ncube, G. ; Ong, JJ. ; Mugurungi, O. ; Hatzold, K. ; JOHNSON, CC. ; AYLES, H. ; CORBETT, EL. ; Cowan, FM. ; Maheswaran, H. ; TERRIS-PRESTHOLT, F. ; Economic cost analysis of door-to-door community-based distribution of HIV self-test kits in Malawi, Zambia and Zimbabwe. Journal of the International AIDS Society, (2019).22 Sup (S1), DOI: 10.1002/jia2.25255.
PEARSON, CA B. ; ABBAS, KM. ; CLIFFORD, S. ; FLASCHE, S. ; Hladish, TJ. ; Serostatus testing and dengue vaccine cost-benefit thresholds. Journal of The Royal Society Interface, (2019).16 (157), DOI: 10.1098/rsif.2019.0234.
Pillai, N. ; Foster, N. ; Hanifa, Y. ; Ndlovu, N. ; FIELDING, K. ; Churchyard, G. ; Chihota, V. ; GRANT, AD. ; VASSALL, A. ; Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa. PloS one, (2019).14 (2), DOI: 10.1371/journal.pone.0210622.
PULLAN, R. ; HALLIDAY, K. ; OSWALD, W. ; Mcharo, C. ; BEAUMONT, E. ; KEPHA, S. ; WITEK-MCMANUS, S. ; Gichuki, P. ; ALLEN, E. ; DRAKE, T. ; PITT, C. ; Matendechero, S. ; Gwayi-Chore, M-C. ; Anderson, R. ; Njenga, S. ; BROOKER, S. ; Mwandawiro, CS. ; Effects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial. Lancet, (2019).393 (10185), 2039-2050. DOI: 10.1016/S0140-6736(18)32591-1.
SUMNER, T. ; BOZZANI, F. ; Mudzengi, D. ; Hippner, P. ; HOUBEN, RM. ; Cardenas, V. ; VASSALL, A. ; WHITE, RG. ; Estimating the Impact of Tuberculosis Case Detection in Constrained Health Systems: An Example of Case-Finding in South Africa. American Journal of Epidemiology, (2019).188 (6), DOI: 10.1093/aje/kwz038.
SWEENEY, S. ; Ward, Z. ; PLATT, L. ; GUINNESS, L. ; Hickman, M. ; Hope, V. ; Maher, L. ; Iversen, J. ; Hutchinson, SJ. ; Smith, J. ; Ayres, R. ; Hainey, I. ; Vickerman, P. ; Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs. Addiction (Abingdon, England), (2019).114 (3), DOI: 10.1111/add.14519.
Turner, HC. ; Lauer, JA. ; Tran, BX. ; Teerawattananon, Y. ; JIT, M. ; Adjusting for Inflation and Currency Changes Within Health Economic Studies. Value in Health, (2019).22 (9), DOI: 10.1016/j.jval.2019.03.021.
Wilkinson, T. ; BOZZANI, F. ; VASSALL, A. ; Remme, M. ; Sinanovic, E. ; Comparing the Application of CEA and BCA to Tuberculosis Control Interventions in South Africa. Journal of Benefit-Cost Analysis, (2019).10 (S1), DOI: 10.1017/bca.2019.2.
WILLIAMS, J. ; MINERS, A. ; Harris, R. ; Mandal, S. ; Simmons, R. ; Ireland, G. ; Hickman, M. ; Gore, C. ; Vickerman, P. ; Cost-Effectiveness of One-Time Birth Cohort Screening for Hepatitis C as Part of the National Health Service Health Check Program in England. Value in Health, (2019).22 (11), DOI: 10.1016/j.jval.2019.06.006.
Policy evaluation
- 2020
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LAW, C. ; CORNELSEN, L. ; Adams, J. ; Pell, D. ; Rutter, H. ; White, M. ; Smith, R. ; The impact of UK soft drinks industry levy on manufacturers' domestic turnover. Economics & Human Biology, (2020).37, DOI: 10.1016/j.ehb.2020.100866.
LAW, C. ; CORNELSEN, L. ; Adams, J. ; Penney, T. ; Rutter, H. ; White, M. ; Smith, R. ; An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy. Economics & Human Biology (2020).DOI: 10.1016/j.ehb.2019.100834.
O'Neill, S. ; Kreif, N. ; Sutton, M. ; GRIEVE, R. ; A comparison of methods for health policy evaluation with controlled pre-post designs. Health services research, (2020).55 (2), 328-338. DOI: 10.1111/1475-6773.13274.
Prinja, S. ; Chauhan, AS. ; Rajsekhar, K. ; Downey, L. ; Bahuguna, P. ; Sachin, O. ; GUINNESS, L. ; Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action. Value in Health Regional Issues, (2020).21, 226-229. DOI: 10.1016/j.vhri.2019.11.003.
- 2019
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Bains, I. ; Choi, YH. ; Soldan, K. ; JIT, M. ; Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England. International journal of gynecological cancer, (2019).29 (4), DOI: 10.1136/ijgc-2018-000161.
Choumert‐Nkolo, J. ; CUST, H. ; Taylor, C. ; Using paradata to collect better survey data: Evidence from a household survey in Tanzania. Review of Development Economics, (2019).23 (2), DOI: 10.1111/rode.12583.
GRECO, G. ; Power, Social Exclusion and the “Good Life”: the Importance of Measuring What Really Counts. Journal of human development and capabilities, (2019).19 (4), DOI: 10.1080/19452829.2018.1522043.
Hammond, J. ; Mason, T. ; Sutton, M. ; Hall, A. ; MAYS, N. ; Coleman, A. ; ALLEN, P. ; Warwick-Giles, L. ; Checkland, K. ; Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening. BMJ Open, (2019).9 (4), DOI: 10.1136/bmjopen-2018-024156.
JENSEN, HT. ; KEOGH-BROWN, MR. ; Shankar, B. ; Aekplakorn, W. ; Basu, S. ; Cuevas, S. ; DANGOUR, AD. ; Gheewala, SH. ; GREEN, R. ; JOY, EJ M. ; Rojroongwasinkul, N. ; Thaiprasert, N. ; Smith, RD. ; Palm oil and dietary change: Application of an integrated macroeconomic, environmental, demographic, and health modelling framework for Thailand. Food Policy, (2019).83, DOI: 10.1016/j.foodpol.2018.12.003.
LAW, C. ; GREEN, R. ; KADIYALA, S. ; Shankar, B. ; KNAI, C. ; BROWN, KA. ; DANGOUR, AD. ; CORNELSEN, L. ; Purchase trends of processed foods and beverages in urban India. Global Food Security, (2019).23, DOI: 10.1016/j.gfs.2019.05.007.
RANGANATHAN, M. ; KNIGHT, L. ; ABRAMSKY, T. ; Muvhango, L. ; Polzer Ngwato, T. ; Mbobelatsi, M. ; FERRARI, G. ; Watts, C. ; Stöckl, H. ; Associations Between Women's Economic and Social Empowerment and Intimate Partner Violence: Findings From a Microfinance Plus Program in Rural North West Province, South Africa. Journal of Interpersonal Violence, (2019).34 (7), DOI: 10.1177/0886260519836952.
Economics of health systems and organisations
- 2020
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Anselmi, L. ; Borghi, J. ; Brown, GW. ; Fichera, E. ; Hanson, K. ; Kadungure, A. ; KOVACS, R. ; Kristensen, SR. ; SINGH, NS. ; Sutton, M. ; Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research. International Journal of Health Policy and Management (2020).DOI: 10.34172/ijhpm.2020.23.
Coutrot, IP. ; Smith, R. ; CORNELSEN, L. ; Is the rise of crowdfunding for medical expenses in the UK symptomatic of systemic gaps in health and social care?. JOURNAL OF HEALTH SERVICES RESEARCH & POLICY (2020).DOI: 10.1177/1355819619897949.
Dennis, ML. ; Benova, L. ; GOODMAN, C. ; Barasa, E. ; Abuya, T. ; Campbell, OM R. ; Examining user fee reductions in public primary healthcare facilities in Kenya, 1997-2012: effects on the use and content of antenatal care. International Journal for Equity in Health, (2020).19 (1), DOI: 10.1186/s12939-020-1150-8.
Dingle, A. ; Schäferhoff, M. ; BORGHI, J. ; Lewis Sabin, M. ; Arregoces, L. ; MARTINEZ-ALVAREZ, M. ; PITT, C. ; Estimates of aid for reproductive, maternal, newborn, and child health: findings from application of the Muskoka2 method, 2002-17. The Lancet. Global health, (2020).8 (3), e374-e386. DOI: 10.1016/s2214-109x(20)30005-x.
FRASER, A. ; TAN, S. ; Boaz, A. ; MAYS, N. ; Backing what works? Social Impact Bonds and evidence-informed policy and practice. Public Money and Management, (2020).40 (3), DOI: 10.1080/09540962.2020.1714303.
Kapologwe, NA. ; Kibusi, SM. ; BORGHI, J. ; Gwajima, DO. ; Kalolo, A. ; Assessing health system responsiveness in primary health care facilities in Tanzania. BMC health services research, (2020).20 (1), DOI: 10.1186/s12913-020-4961-9.
KOVACS, RJ. ; POWELL-JACKSON, T. ; Kristensen, SR. ; SINGH, N. ; BORGHI, J. ; How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review. BMC health services research, (2020).20 (1), DOI: 10.1186/s12913-020-05075-y.
MARTINEZ-ALVAREZ, M. ; FEDERSPIEL, F. ; SINGH, NS. ; Schäferhoff, M. ; Lewis Sabin, M. ; Onoka, C. ; MOUNIER-JACK, S. ; BORGHI, J. ; PITT, C. ; Equity of resource flows for reproductive, maternal, newborn, and child health: are those most in need being left behind?. BMJ, (2020).368, DOI: 10.1136/bmj.m305.
SANDERSON, M. ; ALLEN, P. ; Moran, V. ; McDermott, I. ; OSIPOVIC, D. ; Agreeing the allocation of scarce resources in the English NHS: Ostrom, common pool resources and the role of the state. Social Science and Medicine, (2020).250, DOI: 10.1016/j.socscimed.2020.112888.
Wilson, R. ; Fraser, A. ; Kimmitt, J. ; TAN, S. ; McHugh, N. ; Lowe, T. ; Warner, M. ; Baines, S. ; Carter, E. ; Editorial: Whither Social Impact Bonds (SIBs): the future of social investment?. PUBLIC MONEY & MANAGEMENT, (2020).40 (3), 179-182. DOI: 10.1080/09540962.2020.1714287.
- 2019
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Asante, AD. ; Ir, P. ; Jacobs, B. ; Supon, L. ; LIVERANI, M. ; Hayen, A. ; Jan, S. ; WISEMAN, V. ; Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy. Health policy and planning, (2019).34 (Supple), DOI: 10.1093/heapol/czz011.
CORNELSEN, L. ; BERGER, N. ; CUMMINS, S. ; Smith, RD. ; Socio-economic patterning of expenditures on 'out-of-home' food and non-alcoholic beverages by product and place of purchase in Britain. Social Science and Medicine, (2019).235, DOI: 10.1016/j.socscimed.2019.112361.
Fang, H. ; Eggleston, K. ; HANSON, K. ; Wu, M. ; Enhancing financial protection under China's social health insurance to achieve universal health coverage. BMJ (Clinical research ed.), (2019).365, DOI: 10.1136/bmj.l2378.
FRASER, A. ; TAN, S. ; MAYS, N. ; To SIB or not to SIB? A comparative analysis of the commissioning processes of two proposed health-focused Social Impact Bond financed interventions in England. Journal of Economic Policy Reform (2019).DOI: 10.1080/17487870.2019.1572508.
HANSON, K. ; Barasa, E. ; Honda, A. ; Panichkriangkrai, W. ; Patcharanarumol, W. ; Strategic Purchasing: The Neglected Health Financing Function for Pursuing Universal Health Coverage in Low-and Middle-Income Countries Comment on "What's Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review". International Journal of Health Policy and Management, (2019).8 (8), DOI: 10.15171/ijhpm.2019.34.
Ir, P. ; Jacobs, B. ; Asante, AD. ; LIVERANI, M. ; Jan, S. ; Chhim, S. ; WISEMAN, V. ; Exploring the determinants of distress health financing in Cambodia. Health policy and planning, (2019).34 (Supple), DOI: 10.1093/heapol/czz006.
MANDEVILLE, KL. ; Barker, R. ; Packham, A. ; Sowerby, C. ; Yarrow, K. ; Patrick, H. ; Financial interests of patient organisations contributing to technology assessment at England’s National Institute for Health and Care Excellence: policy review. BMJ, (2019).364, DOI: 10.1136/bmj.k5300.
TAN, S. ; FRASER, A. ; McHugh, N. ; Warner, M. ; Widening perspectives on social impact bonds. Journal of Economic Policy Reform (2019).DOI: 10.1080/17487870.2019.1568249.
Preferences and behaviour
- 2020
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Accordion content 1.
- 2019
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Choko, AT. ; CORBETT, EL. ; Stallard, N. ; Maheswaran, H. ; Lepine, A. ; JOHNSON, CC. ; Sakala, D. ; Kalua, T. ; Kumwenda, M. ; HAYES, R. ; FIELDING, K. ; HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial. PLoS medicine, (2019).16 (1), DOI: 10.1371/journal.pmed.1002719.
CORNELSEN, L. ; Mazzocchi, M. ; Smith, RD. ; Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain. Social Science & Medicine, (2019).230, DOI: 10.1016/j.socscimed.2019.04.003.
DOWIE, J. ; Kaltoft, MK. ; Translating the Results of Discrete Choice Experiments into p-/e-/m-Health Decision Support Tools. Studies in health technology and informatics, (2019).261, DOI: 10.3233/978-1-61499-975-1-193.
KOVACS, RJ. ; Lagarde, M. ; CAIRNS, J. ; Measuring patient trust: Comparing measures from a survey and an economic experiment. Health Economics, (2019).28 (5), DOI: 10.1002/hec.3870.
KUTEESA, MO. ; QUAIFE, M. ; Biraro, S. ; Katumba, KR. ; SEELEY, J. ; Kamali, A. ; Nakanjako, D. ; Acceptability and Predictors of Uptake of Anti-retroviral Pre-exposure Prophylaxis (PrEP) Among Fishing Communities in Uganda: A Cross-Sectional Discrete Choice Experiment Survey. AIDS and behavior, (2019).23 (10), DOI: 10.1007/s10461-019-02418-7.
Luyten, J. ; Kessels, R. ; ATKINS, KE. ; JIT, M. ; VAN HOEK, AJ. ; Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment. SOCIAL SCIENCE & MEDICINE, (2019).228, DOI: 10.1016/j.socscimed.2019.03.025.
ONG, JJ. ; Neke, N. ; Wambura, M. ; Kuringe, E. ; Grund, JM. ; Plotkin, M. ; D'ELBÉE, M. ; Torres-Rueda, S. ; Mahler, HR. ; WEISS, HA. ; TERRIS-PRESTHOLT, F. ; Use of Lotteries for the Promotion of Voluntary Medical Male Circumcision Service: A Discrete-Choice Experiment among Adult Men in Tanzania. Medical Decision Making, (2019).39 (4), DOI: 10.1177/0272989X19852095.
Sibanda, EL. ; D'ELBÉE, M. ; Maringwa, G. ; Ruhode, N. ; Tumushime, M. ; Madanhire, C. ; Ong, JJ. ; INDRAVUDH, P. ; Watadzaushe, C. ; JOHNSON, CC. ; Hatzold, K. ; Taegtmeyer, M. ; HARGREAVES, JR. ; CORBETT, EL. ; Cowan, FM. ; TERRIS-PRESTHOLT, F. ; Applying user preferences to optimize the contribution of HIV self-testing to reaching the "first 90" target of UNAIDS Fast-track strategy: results from discrete choice experiments in Zimbabwe. Journal of the International AIDS Society, (2019).22 Sup (S1), DOI: 10.1002/jia2.25245.
TERRIS-PRESTHOLT, F. ; Neke, N. ; Grund, JM. ; Plotkin, M. ; Kuringe, E. ; Osaki, H. ; Ong, JJ. ; TUCKER, JD. ; Mshana, G. ; Mahler, H. ; WEISS, HA. ; Wambura, M. ; VMMC study team,; Using discrete choice experiments to inform the design of complex interventions. Trials, (2019).20 (1), DOI: 10.1186/s13063-019-3186-x.
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On this page we will post links health economics work related to COVID-19 involving members of CHIL.
In this post, Kaja Abbas outlines why routine immunisation remains essential, even during the COVID-19 pandemic and provides links to ongoing work.
- Routine immunisation is essential, even during the COVID-19 pandemic
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Kaja Abbas
Assistant Professor of Disease Modelling
May 15, 2020The COVID-19 pandemic has brought human activity to a standstill and now threatens to undermine routine immunisation programmes. On March 26, 2020, the World Health Organization recommended that while routine immunisation programmes should continue, mass vaccination campaigns should be temporarily suspended because they could increase the spread of the virus in communities. A benefit-risk analysis was conducted to weigh up the health benefits of continued routine infant immunisation delivery against the excess risk of COVID-19 infections in Africa.
The results are striking – if routine immunisation was continued, for each excess COVID-19 death (predominantly among elderly household members) due to an infection acquired during the vaccination visit and spread to household members of vaccinated children, around 14 to 267 future child deaths could be prevented. Without vaccination, these deaths could result from a range of diseases including measles, yellow fever, pertussis, meningitis, pneumonia, and diarrhoea.
If countries do decide to continue with routine immunisation during the COVID-19 pandemic, they will need to work out ways to reduce human contact. For example, between other families waiting or health care workers, or on public transport when travelling to the site. Vaccinators will be at high risk of infection because of the sheer numbers of people they will be coming into contact with and will need to maintain stringent standards of infection prevention such as wearing suitable personal protective equipment and frequent hand washing.
In addition, whether or not a country suspends immunisation services, it will be critical for it to provide catch-up immunisations for any children who missed their vaccines due to the disruption caused by the COVID-19 pandemic.
Please find the links below for the full report (currently under peer-review) and related dissemination.
- Benefit-risk analysis of health benefits of routine childhood immunisation against the excess risk of SARS-CoV-2 infections during the COVID-19 pandemic in Africa.
- Routine immunisation is essential, even during the COVID-19 pandemic.
- Can routine immunisation be carried out safely during COVID-19 pandemic?
- 5 crises that could worsen under COVID-19.
- Here, Andrew Briggs discusses moving beyond ‘lives-saved’ from COVID-19 and provides links to a spreadsheet tool that can be used to calculate QALYs lost.
- Moving beyond ‘lives-saved’ from COVID-19
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Andrew Briggs
Professor of Health Economics
May 15, 2020Epidemiological models of the COVID-19 pandemic have largely focused their efforts on exploring the effectiveness of different policies to prevent deaths and to avoid overloading the ability of health care systems to handle the onslaught of cases. As we move from an extended period of lockdown to easing restrictions, it is a good time to think about moving beyond the simple metric of ‘lives-saved’. In other less challenging times, years of life lost (YLL) and Disability-Adjusted Life Years lost (DALYs) or Quality-Adjusted Years of Life lost (QALYs) are the more usual policy tool.
Yet even conditional life-expectancy is poorly understood. Examples abound where supposed life expectancy is ‘estimated’ by subtracting current age from life expectancy at birth (not to pick on anyone in particular – but see this tweet about an article by Vince Cable which raises useful issues but falls into this exact trap). This is surprising, as conditional life expectancy (by age and sex) are routinely compiled by almost all countries in the world using standard life table methods.
In this short blog we outline a policy tool that can be easily employed to generate YLL and (discounted) QALYs lost due to deaths from COVID-19 in a way that facilitates adjustment for comorbidities, while putting pay to the conventional wisdom that suggests that victims who are old and with long term conditions ‘would have died anyway’ (see for this article for example).
The approach itself involves a three-step process to adapt a standard life table:
- Add a Standardised Mortality Ratio (SMR) parameter to allow for increased mortality due to existing long-term conditions (LE).
- Adjust survival for background quality of life and the additional quality of life decrement associated with the long-term conditions (QALE).
- Discount to a net-present value (dQALY).
Full details of the method can be found in this accompanying technical note and the method is implemented for (currently) five countries in this spreadsheet tool.
Some results from the approach are below. Table 1 shows the estimates based on UK data and Table 2 shows the equivalent estimates for US data. The underlying life tables come from ONS and CDC. The age distributions at death for COVID-19 victims also comes from ONS and CDC (these are being updated on a weekly basis and so the results below may not be the most contemporary estimates). Finally, the background norm quality of life data comes from chapter 3 of the book published by members of the EuroQol Group.
What we see from the comparison of the UK and US results is that the conditional life expectancies are broadly comparable and it is clear that even with a SMR of 2 and a 10% reduction on quality of life for the remainder of life to adjust for comorbidities, the life expectancy and (discounted) QALY losses remain substantial for all age groups. Small differences between the UK and the US relate to the data sources, but by far the most important difference is the pattern of age at death from COVID-19 between the two countries. These are illustrated in Figure 1 showing that the UK has a relatively higher proportion of older victims of COVID-19.
How might this approach be utilised? Apart from showing that it is unlikely, at least for most victims, that they would have succumbed to their long-term conditions in any case, the approach outlined can be used to explore the wider implications of the COVID-19 pandemic. For example, excess deaths have been widely reported and this approach could be used to explore whether the burden of excess deaths is greater than those from COVID itself.
An earlier version of this blog was highlighted in the linked article from the WSJ, although the focus of the article was on years of life lost without quality adjustment. More recently, a presentation based on this material was given as part of the ISPOR pre-conference plenary session on HEOR in the era of COVID-19 which was held on 14 May 2020. The video for the full session, including the panel of which this presentation was a part, can be found on the ISPOR website and you can also download a copy of the slides presented.
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Adam Wagstaff was a valued colleague, mentor and friend to many at the School. Here colleagues reflect on what made their acquaintance with Adam so special.
“I have known Adam for many years, but had the pleasure of working closely with him when I was Past President of iHEA, and he was President elect. Along with Terkel Christiansen, the President, we planned and managed the transition of iHEA from their Founding Executive Director to a new Executive Director and new arrangements for the secretariat function.
It was a huge pleasure to work with Adam – he had the ability to go to the heart of an issue, and to ask the hard questions. More generally, he was a giant in the field of health economics, contributing cutting edge analysis but always with an eye to policy implications. He will be very much missed.”
Anne Mills, Deputy Director and Provost
“I became familiar with Adam’s work when I was a PhD student, but I think the first time I met him was at a meeting on Health Equity, which took place at an eco-resort in Patagonia in 1999 and requiring an epic journey by plane, bus and boat. He was an exceptional researcher, visionary in his application of health economics to real world problems, but unfailingly kind and generous with his time and ideas. No request for help would ever go unreplied. Our world is emptier without him.”
Kara Hanson, Dean, Faculty of Public Health & Policy
“Adam was my tutor at Sussex, and his genuine interest in students, the clarity of his teaching and his expectations, meant that I was privileged to get a decent economics education. A year or so after I left university, at a time where there were few opportunities, he spent the time to listen to my confused ambitions, guide me and write me a great reference, that started my health economics career. So thanks to him I had my chance and my motivation. A very kind man.”
Anna Vassall, Director, CHIL
“When I joined Sussex University as an undergraduate, I was assigned Adam as my personal tutor. He was the youngest member of faculty, and truly embodied the ‘hip to be square’ philosophy. While we were having fun enjoying the ‘social’ side of undergraduate life, he was advocating 40-hour weeks and turning up to his classes on time (“Briggs, you need to buy yourself an alarm clock”). Adam inspired hard work and dedication to your subject, the sort of inspiration I desperately needed as an 18 year-old starting university.”
Andy Briggs, Deputy Director, CHIL
“Over the years I’ve been hugely inspired and influenced by Adam’s work. He was a superb communicator. Apart from his academic work, I used to enjoy reading his World Bank blogs, in which he would unpick difficult issues in a forensic and easy-to-understand manner. On the few occasions I met him, he was always supportive of my work, going out of his way to offer constructive advice. Above all else, he came across a decent person.”
Tim Powell-Jackson, Associate Professor
More tributes can be read in Adam's obituary.