Searching for Cost-Effectiveness Thresholds in NHS Scotland

Office of Health Economics Research Paper 13/07

49 Pages Posted: 15 Aug 2015

See all articles by Sarah Britton (Karlsberg Schaffer)

Sarah Britton (Karlsberg Schaffer)

Office of Health Economics

Jon Sussex

RAND Europe

Nancy Devlin

Office of Health Economics

Andrew Walker

University of Glasgow

Date Written: December 1, 2013

Abstract

Objectives: The objectives of this research were to identify the cost-effectiveness of health care services at the margin in the Scottish NHS; consider the extent to which the thresholds observed in Scottish NHS decision making are consistent with the threshold being used to make judgements about new health care technologies in the UK; and understand expenditure prioritisation decisions and the role that cost per QALY evidence plays in the decision making process. Methods: We used data collected by a committee of the Scottish Parliament on spending decisions at NHS Board level, in combination with telephone interviews with senior NHS finance managers to identify services at the margin(services where investment or disinvestment is planned to, or could, take place). We then performed literature searches for cost per QALY evidence to estimate the threshold. The interviews were also used to explore the factors driving (dis)investment decisions at a local level. Results : The estimated cost per QALY of services at the margin varies widely both between services and across different estimates of cost per QALY for the same service. However, cost per QALY evidence is rarely used as part of the decision-making process at territorial NHS Board level. We find that explicit disinvestments or service reductions are rare and that the majority of savings, when required, are made through increasing technical efficiency.

Conclusions : The assumed maximand — QALYs — that is implied by the use of a cost per QALY threshold by the SMC and other HTA bodies appears not to be the maximand pursued by NHS Boards in Scotland. NHS Boards seek to achieve numerous objectives, including but not limited to health gain, simultaneously.

Suggested Citation

Britton (Karlsberg Schaffer), Sarah and Sussex, Jonathan Mark and Devlin, Nancy and Walker, Andrew, Searching for Cost-Effectiveness Thresholds in NHS Scotland (December 1, 2013). Office of Health Economics Research Paper 13/07, Available at SSRN: https://ssrn.com/abstract=2631021 or http://dx.doi.org/10.2139/ssrn.2631021

Sarah Britton (Karlsberg Schaffer) (Contact Author)

Office of Health Economics ( email )

Southside
105 Victoria Street
London, SW1E 6QT
United Kingdom
02077478862 (Phone)

HOME PAGE: http://www.ohe.org

Jonathan Mark Sussex

RAND Europe ( email )

Cambridge
United Kingdom

Nancy Devlin

Office of Health Economics ( email )

105 Victoria Street
London, SW1E 6QT
United Kingdom
0044 2077478858 (Phone)

Andrew Walker

University of Glasgow ( email )

Adam Smith Business School
Glasgow, Scotland G12 8LE
United Kingdom

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