Evidence on the efficiency, equity and budgetary implications of health and care programmes is needed to information decision-making in the health and social care system. Research in this stream includes the economics of ageing, the economics of public health and links also with other streams which ultimately concern the bases on which decisions about the allocation of public money are made.
Members of the Health Economics Group have continued to collaborate with other researchers in economic evaluation and cost research.  The work includes much direct practical work, involving the tailoring of measurement methods for diverse contexts.  The following section gives examples to illustrate the work in this area of members of HEG.  Further, not only should costs be evaluated, but the costs and benefits of evaluating costs themselves require assessment, and a strand of work in this stream therefore involves considering the best approaches to research.

Examples of current research

Economic Evaluation of Very Brief Interventions.  NIHR Programme Grant.  In collaboration with University of Cambridge, MRC Epidemiology Unit, King's College London & NHS Cambridgeshire.

Physical activity can delay or prevent chronic diseases such as vascular disease, which includes heart disease, stroke, diabetes and kidney disease. The majority of adults in England do not meet the government recommendation of at least 30 minutes per day of moderate-intensity activity on at least five days per week. In this research programme we are developing and testing interventions that aim to promote moderate activity such as brisk walking that could be delivered by a practice nurse in a few minutes. Very brief advice can also be given during routine consultations in primary care and potentially reach many millions of people. Brief advice may involve "advice" of various kinds and to be effective it is likely that participants will actively be involved.As part of this, health economists at UEA are developing a decision model to estimate the long term costs and consequences of changes in physical activity levels in order to estimate the cost-effectiveness of such interventions.  Once the initial model is complete based on current evidence, value of information analysis will be used to inform the design of a clinical trial to be conducted as part of the programme, and the results of that trial fed back into the model to update the estimates of cost-effectiveness and value of information.  (Vijay Singh GC, Ed Wilson, Marc Suhrcke).   Project website

Anglo-Danish-Dutch study of Intensive Treatment of people with Newly diagnosed diabetes in primary care (ADDITION). NIHR Health Technology Assessment.  In collaboration with MRC Epidemiology Unit.

Diabetes is a common chronic condition associated with an increased risk of heart disease, stroke, amputation, visual impairment and kidney damage. Currently most people become diagnosed with diabetes when they develop symptoms or a complication, but there is evidence to suggest that the true onset occurs several years earlier.

This study aims to discover whether earlier detection and subsequent intensive treatment are worthwhile by quantifying the costs and benefits of such an approach. The study was set up in 2001 when 1,026 patients with diabetes were randomised at the practice level to either intensive treatment (a combination of medication and advice on lifestyle changes, for example diet and physical activity) or standard care according to current national guidelines.
Members of HEG are analysing the five year follow-up data to estimate the cost-effectiveness of intensive versus standard care.  (Libo Tao, Ed Wilson).

Establishing a healthy growth trajectory from birth: The Baby Milk Trial.   MRC National Prevention Research Initiative.  In collaboration with University of Cambridge & MRC Epidemiology Unit. 

The prevalence of childhood obesity has increased rapidly over the past two decades. Excess weight in childhood tracks into adult life and causes problems both in the short term and in the long term. However, to date there is little evidence on which to develop effective preventive strategies. Nutrition and growth during infancy may have long term effects by altering eating behaviours and risks of obesity and obesity-related disorders in later life.
We aim to evaluate the cost-effectiveness and acceptability of a theory-based behavioural intervention to avoid excess formula-milk intake and to prevent rapid weight gain during infancy. We will recruit 700 mothers who introduce formula-milk feeds within six weeks of their baby's birth into a randomised controlled trial. 

The intervention group will receive the behavioural intervention delivered by trained and quality-assured facilitators over six months through 3 face-to-face contacts, 2 telephone contacts and written materials. The control group will have the same number of contacts with facilitators and general issues about feeding will be discussed.  (Marc Suhrcke, Ed Wilson)

PASSA: Cognitive Behavioural Therapy (CBT) for people with Asperger syndrome (AS) and anxiety disorders: A pilot randomised controlled trial.  NIHR Research for Patient Benefit . 

The aim of this trial is to determine whether or not modified CBT can successfully reduce the symptoms of anxiety experienced by people with AS, and whether or not this intervention is cost-effective. We will make use of a simple open trial design incorporating pre-, post- and follow-up assessment of anxiety. A mixture of clinician ratings and self-ratings of anxiety will be used. The intervention will be modified individual CBT delivered by trained CBT therapists, and the assessment of anxiety will be completed by research assistants who will be blind to group allocation. (Ed Wilson)

TEST-BP: Trial of the Effectiveness and cost effectiveness of Self-monitoring and Treatment of Blood Pressure in secondary prevention following Stroke or Transient Ischaemic Attack (TIA).  NIHR Research for Patient Benefit. 

This trial will examine whether active participation of patients in their own BP management, self-monitoring with or without self treatment, guided by a treatment algorithm tailored to the individual patient is associated with better control of BP and cost effective in terms of long-term cardiovascular risk compared to treatment as usual.  (Ed Wilson)

Examples of completed research

Cognitive behaviour therapy for improving social recovery in psychosis: Cost-effectiveness analysis (Barton)

Cost effectiveness of a lifestyle intervention in preventing Type 2 diabetes (Irvine, Barton)

Cost effectiveness of a falls prevention programme (Irvine, Sach, Barton)

Cost utility of manual chest physiotherapy techniques in the management of exacerbations of chronic obstructive pulmonary disease (Barton)

Lifestyle Interventions for Knee Pain: Cost-effectiveness analysis (Barton, Sach)

Offering voluntary befriending to carers of people with dementia (BECCA trial). In collaboration with colleagues within MED, we have developed instruments for measuring costs to carers and of the befriending schemes, have been involved in reporting of the trial and are exploring the validity of measurement of informal costs as measured in the trial (Mugford, Thalanany, Wilson, Abdelhamid, Fox).

Review and estimation of costs of illness in cystic fibrosis and other inherited disorders and cost-effectiveness of newborn screening for cystic fibrosis (Jarrett, Mugford, Sims)

Socioeconomic costs of food allergy for households, individuals and the health sector (Fox, Mugford).

The costs of paediatric cochlear implantation, with a particular focus on the costs incurred by families (Sach, Barton).

An assessment of the cost to the NHS of providing non-steroidal anti-inflammatory drugs (NSAIDs) in an attempt to explain why overall cost has increased (Barton).

The implications of different prostheses for costs of hip and knee replacement (Davies, Mugford).