Certificate inHealth EconomicsOther HERU News

1

ContentsNew Director25th Anniversary

Valuing BenefitsNHS Labour MarketsTARs

Screening forDiabetic retinopathyHealthy LifeExpectancy

2

3

4

H E A L T H E C O N O M I C S R E S E A R C H U N I T

New Director AppointedWelcome

Professor Bob Elliott took up the post of Director of HERU inJanuary 2002. Professor Stephen Logan, Provost of the Universityof Aberdeen and Dean of the Faculty of Medicine & MedicalSciences, said: "I am delighted that we have recruited aneconomist of Professor Elliott's standing for this key position. I look forward to the further development of the excellentHealth Economics Research Unit, under Professor Elliott'sleadership."

Professor Roland Jung, Chief Scientist at the Department ofHealth, said: “We welcome this development and the opportunityit presents to create strong leadership for this importantprofessional group. Experts within this area are in very shortsupply and we are delighted that Professor Elliott has acceptedthis post. We believe that the closer relationship between healtheconomics and the parent discipline will be of mutual benefit.”

Professor Elliott retains his position as Professor in the Departmentof Economics at the University of Aberdeen. He has held visitingpositions at several universities in the USA, Europe and Australia,and acted as consultant and adviser to the Police Federation,HM Treasury, and the OECD. He chaired a Review of the AreaCost Adjustment, an element of Local Government Finance.He was a member of the Committee of Inquiry into ProfessionalConditions for Teachers in Scotland (McCrone Committee) (1999-2000). He has directed a large number of research projects andpublished widely in the field of labour economics. With TonyScott he has recently completed a Study of Labour Markets inNHS Scotland for the Scottish Executive.

Welcome to thesecond edition of HERU

NEWS. This newsletter isdesigned to inform people of

the nature of the work that weare undertaking.

This second edition includes shortsummaries of presentations madeat our recent conference “What canHealth Economics do for the NHS inScotland?” Of particular note, amongmany news items is the launch inOctober by HERU of a new distance

learning course in Health Economics.

For details of this exciting newcourse see the back page.

July 2002 issue 2

25th Anniversary ConferenceOn the 1st April 2002 the Health Economics Research Unit wastwenty-five years old. To celebrate a quarter century of promotingexcellence in health economics the Unit hosted, with financialsupport from the CSO and the Scottish Economic Policy Network,a conference entitled "What can Health Economics do for theNHS in Scotland?" Following a welcome from the Principal, HughHenry, Deputy Minister for Health and Community Care introduceda day showcasing the valuable contribution of health economicsto health care decision making.

The morning sessions chaired by the Chief Scientist ProfessorRoland Jung featured presentations by Dr Mandy Ryan and DrTony Scott on benefit assessment and NHS labour marketsrespectively (see page 2). Two eminent practitioners, Dr DonnieRoss (GUHT) and Mark Butler (SEHD) offered an interestingperspective on the application of these techniques, revealingsome of the ways in which HERU's research had informed currenthealth service decision making in Scotland.

The opening session after lunch comprised three presentationsunder the umbrella of Health Technology Assessment by LukeVale, Anne Ludbrook and Dr Sally Stearns (see pages 2 & 3). Thefinal session chaired by Professor Bob Elliott, brought togetherthree distinguished health economists: Professor Gavin Mooneyfrom Australia; Professor Cam Donaldson from Canada; andAlasdair Munro from the Scottish Executive Health Department.Their theme was the future priorities for Health Economicsin Scotland.

CYAN MAGENTA YELLOW BLACK

Valuing BenefitsThe valuation of benefits represents one of the greatestchallenges facing health economists. The Valuation andImplementation Programme (VIP) is concerned with thedevelopment and application of economic techniques forvaluing benefits in the provision of health care.

The policy relevance of this work was demonstrated by astudy concerned with the delivery of pre-natal screening forDown Syndrome. Women currently wait up to 21 days for theresults from this test. This ‘comprehensive test’ also allowsdetection of gender and any abnormalities. Currentdevelopments mean that it is possible to rapidly detect thepresence of Down syndrome within 2 days of sampling.However, this ‘simple test’ would not identify gender nor anychromosomal conditions.

As the health service faces limited resources there has beensome debate over which test should be offered. A discretechoice experiment was used to inform this question. Assumingequal waiting time, respondents were willing to pay £1,348for ‘simple’ information and £1,581 for ‘comprehensive’information. However even though they valued thecomprehensive information more highly, the longer waitingtime for ‘comprehensive’ information reduced the value ofthe test. The value reduced by £44 per additional day waited,so that women would be better off with the ‘simple result’even if they had to wait anything up to 16 days for the ‘simple’result. These results have important implications for resourcesdedicated to providing a ‘simple’ service.

For more information about VIP contact Mandy Ryan; email:m.ryan@abdn.ac.uk

NHS Labour MarketsThe labour market for health professionals is a key policy areafor NHS Scotland, particularly with the advent of major changesin the pay structure for staff through Agenda for change, aswell as the new GP and Consultants' contracts. It is thereforenecessary to enhance our understanding of the nature of theselabour markets, particularly with respect to the decisions ofhealth professionals to supply their labour to NHS Scotland.

Two studies were used to illustrate HERU’s research in thisarea. The first was a discrete choice experiment of GP’spreferences for the characteristics of their job. UK GPs weresurveyed and asked to make choices between a number ofpairs of scenarios describing different jobs. Analysis of thisdata suggested that the most important factor was out ofhours care. Interestingly, time spent on administration wasnot important in explaining job preferences.

A second study examined the effect of higher wages onrecruitment and hours worked for nurses. This suggested thatan increase in their relative wages of 2% would attract backaround 700 nurses in Scotland who are currently out of thelabour force. It was estimated that there were 29,000 whoheld nursing qualifications but were working in other jobs in1999. Further research is needed, however, on how to attractthese nurses back into NHS Scotland employment. Suchresearch is crucial to the formation of evidence-based policyon workforce planning.

For more information about research on NHS Labour Marketscontact Tony Scott, Director of Behaviour, Performance andOrganisation of Care Programme; email: a.scott@abdn.ac.uk

Health Technology AssessmentAlong with other collaborators, HERU performs technologyassessment reviews for the NHS Health TechnologyAssessment programme. This presentationillustrated the type of work undertakenin these reviews of (i) laparoscopicinguinal hernia repair and (ii) metalon metal hip resurfacing arthroplasty(MOM) – an alternative to total hipreplacement (THR) undertaken byHERU.

Both reviews followed a detailedprotocol outlining: the objectives;interventions to be compared;study population; and methods tobe used. Cost-effectivenessestimates relied on information onrelative effectiveness, preferencesfor the health outcomes, and cost.Systematic review methods were usedto identify the required information.

In comparison with open mesh hernia repair,laparoscopic repair was associated with an earlier return tousual activities and less long term pain. However, this wasachieved with an increased risk of rare, serious complicationsand increased cost. For MOM the evidence base was limitedbut short-term results appeared encouraging. If maintainedthen MOM may be superior to the current policy of delayedand selective use of THR.

On the basis of these reviews policy makers concluded thatfor repair of primary inguinal hernia, open mesh should bethe preferred procedure and that MOM appears a viable optionbut should be performed only in the context of ongoingevaluation.

For more information about these reviews or about HERU’sinvolvement in Technology Assessment Reviews contact LukeVale; email: l.vale@abdn.ac.uk

Screening for diabeticretinopathy

Diabetic retinopathy is the singlelargest cause of registered blindnessamongst people of working age.Treatment is effective in arresting,but not in reversing, vision loss.While screening is accepted as aworthwhile activity the bestmethod of screening is uncertain.This presentation reported on the

cost effectiveness of an organisedscreening programme for sight

threatening diabetic retinopathy usingdigital imaging photography, with and

without dilation of pupils, compared withexisting opportunistic screening methods.

The best estimate of cost per true positive detected was £429for retinal photography with dilation, £490 for retinalphotography without dilation and £317 for opportunisticscreening. The organised screening programme had highercosts and higher effectiveness. The additional cost of detectingadditional cases was £886 based on comparing photographywith dilation and opportunistic screening.

Photography without dilation was more costly and slightly lesseffective but the difference in effectiveness was not statisticallysignificant. Organised screening for diabetic retinopathy mayincrease costs but will detect more cases of sight threateningdiabetic retinopathy. The justification for investing additionalresources depends upon the value of detecting additionalcases.

For more information about this study contact Anne Ludbrook,Director of the Evaluation of Health Improvement programme;email: a.ludbrook@abdn.ac.uk

Healthy Life ExpectancyRecent policy reviews including the Wanless report and, withinScotland, the Care Development Group highlight the importanceof estimates of healthy life expectancy. This presentationaddressed the extent to which lifetime expenditures perperson are likely to increase.

The compression of morbidity theory posits that chronicdisease is confined to a fixed time period at the end of life,so that the increase in lifetime expenditures may be quitemodest. Alternatively, increases in life expectancy may simplyextend the period of risk for onset of various diseases, resultingin a substantial increase in lifetime expenditures.

Estimates from the USA show significant declines in age-adjusted disability. Results for the UK have been mixed,showing increases in prevalence of self-reported disability butdeclines in more severe forms of disability as well as declinesin broad measures of disability. The differences in theestimates reflect continuing uncertainty regarding futuretrends in healthy life expectancy. Even if improvements haveoccurred in the past, healthy life expectancy may decreasefor future cohorts, especially given evidence such as increasingrates of obesity among the young.

From a policy perspective, it is important not only to knowthe net prevalence of disability but also to be able to relatedisability levels to health and social service use. Futureresearch needs include the development of longitudinal datasets to track transitions between health states over time aswell as data for the elderly in all residential settings. Furtherwork is also needed on establishing valid and broadly recognisedmeasures of disability.

For further information on this research contact Paul McNamee;email: p.mcnamee@abdn.ac.uk

Presenters at the 25th Anniversary Conference

entationakenic

.sedation.

Sc

thdigi

withou

Some contributionsfrom the HERU’s 25th

Anniversary Conference“What can Health

Economics do for theNHS in Scotland?”

From left to right:

Professor Mandy Ryan, VIP Director;

Professor Bob Elliott, Director HERU;

Dr Anthony Scott, BPOC Programme Director;

Professor John Cairns, EE Programme Director;

Professor Roland Jung, Chief Scientist,Scottish Executive;

Ms Jennifer Waterton, Research Manager,Chief Scientist Office, Scottish Executive;

Dr Donnie Ross, Clinical Director,Grampian Directorate of Health Informatics;

Ms Anne Ludbrook, EHI Programme Director:

Professor Gavin Mooney, Curtin University,Australia (former HERU Director);

Dr Sally Stearns, Senior Research Fellow.

CYAN MAGENTA YELLOW BLACK

other issue 2Edited by Professor John Cairns

Details of Recent Research Grants AwardedThe Economic & Social ResearchCouncil (ESRC) recently awardedProfessor Bob Elliott & Dr Anthony Scotta 30 month grant entitled “Competition& Reform: Devolved Government &Public Sector Pay Setting” This grantwill examine the effect of devolutionand public sector pay. The grantamounts to £142K

Department of Health awardedadditional “training” funds towards thework being undertaken by theTechnology Assessment Reviews (TAR’s)team at HERU. These funds will financea training fellow post and advancetraining for the TAR’s team. Fundingfor this amounts to £50,000 initially

PPP Foundation awarded Professor Mandy Ryan £250,000over 5 years to look at the extension of themethodological/theoretical work within the Valuationand Implementation Programme (VIP) to the policy arena.The PPP Senior Research Fellow position is currentlybeing advertised and it is hoped that the successfulcandidate will be in post on 1st October 2002. Furtherdetails of this position are available on HERU’s website:

www.abdn.ac.uk/heru

Presentations...HEPATITIS CLuke Vale spoke at The silent epidemic -the implications for the NHS Scotland ofHepatitis C. His presentation was entitled:The cost: an economist's view. Theconference held in July was organised by theScottish Executive and the Royal College ofPhysicians of Edinburgh.

GONE TO TEXASMoira Napper, Information Officer at HERU,attended the Annual Meeting of the MedicalLibrary Association in Dallas in May 2002,where she taught a continuing educationcourse on effective searching for economicinformation in health care. The course alsosought to enhance the professional role ofthe health librarian through teaching thebasic principals of quality assessment ofeconomic evaluation studies. The event wassponsored by the US National Library ofMedicine and a web-based tutorial based ontopic covered will be available on the NLMwebsite later in the year.

For more information contact:m.napper@abdn.ac.uk

New ResearchProgramme...A new programme Evaluating HealthImprovement has recently been introduced. This programme reflects the current policyfocus on the wider determinants of health,rather than just the effect of health care onhealth. The programme aims to develop andapply methods to evaluate the cost-effectiveness of non-health care interventionsin policy areas.

For further information contact AnneLudbrook, Programme Director; email:a.ludbrook@abdn.ac.uk

Postgraduate Certificate in Health Economics by Distance LearningProfessor Mandy Ryan

HERU is an internationally acknowledged centre of excellence with over 23 years experiencein running courses for the distance learner and is launching a new course for October2002.

Health Economics is concerned with the optimal use of scarce health care resources. Thecourse introduces and develops economic techniques for determining the optimal allocationof scarce resources for competing interventions and considers economic arguments foralternative ways of financing and providing health care. The course offers flexibility andis structured into 4 modules:

• Introduction to Economics and Health Economics;

• Economic Evaluation - Principles and Frameworks;

• Economic Evaluation - Applications;

• Policy and Health Care Systems.

Course material has been specially written by senior members of HERU staff. The courseis accredited by the University of Aberdeen and has PGEA approval for 100 hours (ServiceManagement) from the RCGP.

We provide a web-based virtual learning environment. Here students can take advantageof a course Discussion Board, make use of an online glossary, access course materials,assessment and seminar programmes and take part in self-assessment which will beinstantly marked and returned to the student.

To discover more about the course visit our website or contact Professor Mandy Ryan,Course Director, Health Economics Research Unit, University of Aberdeen, Foresterhill,Aberdeen AB25 2ZD. Email: m.ryan@abdn.ac.uk Tel: 01224 553480

Academic Achievements…PROMOTIONSIn June the University Court approved theappointment of Dr Mandy Ryan and JohnCairns to Personal Chairs and the appointmentof Dr Tony Scott to the post of reader witheffect from October.

SCOTTISH PARLIAMENTJohn Cairns recently acted as adviser to theHealth and Community Care Committee withrespect to their review of the spending plansof the Scottish Executive.

CONTACT US..HEALTH ECONOMICS RESEARCH UNITInstitute of Applied Health SciencesPolwarth Building,ForesterhillAberdeen AB25 2ZDTel: +44 (0) 1224-553480/553733Fax: +44 (0) 1224-662994Email: heru@abdn.ac.uk

HERU is supported by the ChiefScientist Office (CSO) of the ScottishExecutive Health Department(SEHD) The views expressed hereare those of the authors and notnecessarily those of CSO.

www.abdn.ac.uk/heru

CYAN MAGENTA YELLOW BLACK