Economic evaluation of changes to the organisation and delivery of health services

Abstract: New health technologies seeking NHS funding in England are subject to rigorous evaluation of cost-effectiveness using established economic evaluation methods. Changes to the organisation and delivery of health services, including changes to health policy, are funded from the same budget as these health technologies, yet undergo no such mandatory cost-effectiveness assessment. This has resulted in a lack of methodological development and evidence on the cost-effectiveness of large-scale changes to the organisation and delivery of health services.

I will present recent methodological developments in this area, attempting to bridge this gap. I will first present a method to quantify the impact of such service changes in terms of QALYs in the absence of primary data collection on health-related quality of life. This method is then extended, focusing on improvements to estimates of the length of life component of the QALY gains. I will demonstrate how survival analysis techniques commonly employed in clinical trials analysis can be used to improve treatment effect estimates associated with policy initiatives. A cost-effectiveness analysis of the Advancing Quality pay-for-performance programme is used as a motivating example upon which to illustrate these methodological developments.

The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that covering health technologies. Advancements in the economic evaluation of changes to health services organisation and delivery have the potential to improve the allocation of scarce NHS resources.