HEDS is part of the School of Health and Related Research (ScHARR) at the University of Sheffield. We undertake research, teaching, training and consultancy on all aspects of health related decision science, with a particular emphasis on health economics, HTA and evidence synthesis.
Showing posts with label Policy. Show all posts
Showing posts with label Policy. Show all posts

Monday, 16 March 2020

New research shows alcohol minimum unit price could save almost 8,000 lives in north of England

  • High risk drinkers would cut their consumption by the equivalent of 14 bottles of vodka a year
  • Evidence from the University of Sheffield’s Alcohol Research Group shows a minimum unit price (MUP) would cut drinking by nearly twice the national average in the North of England
  • Introduction of a MUP could also save almost 8000 lives in the North over the next 20 years, almost half of the lives that could be saved as a whole in England
  • The call comes only weeks after the NHS in England saw record numbers of hospital admissions due to alcohol
Image of whisky bottles
Image CC BY 2.0  Matthew http://bit.ly/3aNezje

Civic leaders are calling for the urgent introduction of a minimum unit price (MUP) for alcohol in England after new evidence from the University of Sheffield’s Alcohol Research Group revealed that it could save almost 8,000 lives across the North over the next 20 years.
The call comes just days before MUP is introduced in Wales; almost two years since its arrival in Scotland; and weeks after England saw hospital admissions caused by alcohol reach record levels.
The research from the University of Sheffield reveals that a 50p MUP in England would see alcohol consumption in some areas in the North falling by almost twice the national average, leading to greater reductions in alcohol attributable deaths, hospital admissions and crimes.
Almost half of the deaths and hospital admissions prevented and 39 per cent of the crimes avoided would come from the three Northern regions – the North West, North East and Yorkshire and the Humber.
Professor Alan Brennan from the University of Sheffield’s School of Health and Related Research who led the research team said: “This research is built on a wealth of evidence which shows that the amount we consume is closely linked to the affordability of alcohol. MUP is linked to the strength of the product and works by setting a floor price below which a product cannot be sold. In that way, it increases the price of the cheapest drinks which are most typically consumed by increasing, and higher risk drinkers.
“The North of England has some of the highest levels of alcohol harm in the country and, as we discovered, some of the cheapest prices, so it was no surprise that it would be particularly effective in those areas.”
Alcohol harm is particularly acute in areas of deprivation even if consumption is no higher – something known as the alcohol harm paradox. The research indicates that the benefits of MUP would be particularly felt in these areas and so would help reduce health inequalities.
Key findings from the research indicate that in the North:
  • An estimated 7,816 deaths attributable to alcohol would be prevented over the next 20 years, 48 per cent of the total for England
  • Alcohol consumption would fall by 6 per cent in the North of England, with by far the biggest reductions coming amongst the heaviest drinkers. High risk drinkers would cut their consumption by the equivalent of around 14 bottles of vodka a year, while the average moderate drinker would reduce their drinking by less than half a bottle of vodka a year
  • Alcohol attributable hospital admissions would reduce by an estimated 13,820, reducing pressure on the NHS, with people from the poorest communities seeing the biggest falls
  • The criminal justice system would also benefit, with crimes falling by 21,128 a year
  • Researchers estimate that cost savings to the NHS in the North alone would amount to £37m a year
The Association of Directors of Public Health (ADPH) has welcomed the research, with Alice Wiseman, Director of Public Health for Gateshead and ADPH Alcohol Policy Lead, commenting: “This research provides the most detailed picture yet of the effect of MUP in parts of England. Risky drinkers in England consume more than two-thirds of all the alcohol sold and evidence shows a strong link between consumption and affordability. A measure like MUP will have the biggest impact on the heaviest at-risk drinkers, while leaving the average moderate drinker virtually untouched.
“It would also have a huge impact in the North, which has some of the highest levels of alcohol harm in the country, with rates of alcohol-attributable hospital admissions being higher in many places than those found in Wales, where MUP is scheduled to be introduced next week.
“It would play an important role in reducing health inequalities, including by closing the health gap between the North and South. This is a measure whose time has come and it should be introduced in England without delay.”
David Parr, the Chief Executive of Halton Borough Council, which has been calling for MUP, said: “It is clear from the University of Sheffield’s work that the North of England has much to gain from the introduction of MUP in England. It would save lives, cut crime and reduce the pressure on overstretched public services. Critically, it would improve the health in our most vulnerable communities at a time when they are struggling. If this measure is good enough for our neighbours in Scotland and Wales, it is good enough for the North of England. Further delay simply puts more lives at risk and we urge the Government to introduce it without delay.”
Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said: “As a liver physician based in Liverpool I have seen the increasing harm caused in northern England by the widespread availability of cheap alcohol. MUP targets those products typically bought by those people who end up in our hospital wards.
“This research provides yet more evidence that MUP is an effective and targeted measure which will reduce harm and reduce the pressure on the NHS. Its introduction would undoubtedly be good news for the North, but it would also save lives in communities across England and I urge the Government to introduce it as soon as possible.”

Thursday, 1 November 2018

Return On Investment for Cardiovascular Disease Prevention Tool

Image of red glass heart set in clear glass
CC BY 2.0 Marc Falardeau
http://bit.ly/2EKIyNu
A multidisciplinary team from HEDS has created a Cardiovascular Disease (CVD) Prevention Return on Investment (ROI) tool, published on the Public Health England website. The tool provides local commissioners with the potential cost savings and benefits of optimising detection and management of high risk CVD conditions in their local areas. A series of rapid reviews provided evidence into the effectiveness and current usage of a range of interventions for CVD, whilst the modelling was based on an adaptation of the School for Public Health Research Diabetes Prevention Model. The ROI tool together with user guide and associated reports can be found at the following link: https://www.gov.uk/government/publications/cardiovascular-disease-prevention-cost-effective-commissioning

Monday, 17 October 2016

Threshold for NICE Highly Specialised Technologies

NICE and NHS England are consulting on a proposal to introduce a cost effectiveness level of £100,000 per QALY for NICE’s Highly Specialised Technologies (HST) programme.

The consultation, here, is open until 13th January 2017.

New ‘light touch’ appraisal process for NICE?

A consultation is open on a proposal that treatments that are likely to have a cost per QALY (quality adjusted life year) of up to £10,000 would be dealt with more quickly under a ‘lighter touch’ process.

Sir Andrew Dillon, NICE chief executive, said: “We want to be more agile and flexible in the way we make decisions about new drugs, medical devices and diagnostics, so that patients can get access to them more quickly and the NHS can manage its resources fairly and efficiently. NICE and NHS England have worked together to develop these proposals.”

The consultation, here, is open until 13th January 2017.

Image: DSC_0052 by Ajith K


Monday, 15 August 2016

HEDS work in NICE public health guidance

"Give young people and gay men free condoms to reduce STIs" is how the Guardian reports NICE's latest draft guideline on condom distribution schemes.  A ScHARR team carried out the cost-effectiveness analysis used by the NICE public health advisory committee when making its recommendations.

NICE wanted to understand the potential costs and benefits of schemes which distribute condoms in order to prevent sexually transmitted infections (STIs). ScHARR developed an economic model which took into account the effects on both health and savings to the NHS of these schemes in four populations.

For young people, we replicated the C-card scheme, which is already running in many areas of the UK (for example, the pan-London Come Correct scheme) and aims to increase condom use and reduce condom failure among those aged 13-24. Our analysis estimated that a scheme like the C-card would be cost effective, with a cost of around £17,000 per quality adjusted life year (QALY) gained. Averting cases of HIV was particularly beneficial, since HIV not only reduces quality of life and life-expectancy of patients considerably, but also has high costs to the NHS.

There was limited published evidence from trials of condom distribution schemes on which to base these analyses. For MSM, black Africans and the general population there was a lack of evidence for the effectiveness of schemes in these populations. However, threshold analysis suggested that schemes could be cost-effective in both MSM and black Africans even at quite a high cost (£10 per person in the target population), due in the main to the higher prevalence of HIV in these groups.

Our full report can be viewed here.

Thursday, 30 June 2016

Health care economic information for coverage decisions

From PRNewsWire:

“The Academy of Managed Care Pharmacy (AMCP)…..released a set of recommendations that would allow biopharmaceutical companies to more easily share health care economic information (HCEI) with entities that make formulary and coverage decisions, a move that addresses the growing need to determine the "value" of new medicines.

The recommendations address restrictions in the sharing of product information that does not appear on the drug label, a prohibition that hinders decision makers from accessing HCEI on new therapies.

The recommendations are contained in the forum proceedings, published in the July issue of AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). AMCP now will lead the development of a draft guidance document to share with the FDA. This information also will be shared with Congress as it considers legislative solutions to improve sharing of HCEI.”

Image: Little Brown Bottles by PhotoAteller


Wednesday, 27 April 2016

Developing a method to assist investment decisions in specialised commissioning

NHS England commissions specialist services nationally using a budget of £14bn (>10% NHS budget).  As part of this, it makes reimbursement decisions on service developments and are consulting on a new methodology.  The consultation is open until May 11th.

Image: Investment by Simon Cunningham

As part of the development process, NHS England commissioned HEDS to undertake a review of effectiveness and cost-effectiveness measurement in MCDA, and recommend methods to use in their new methodology.  I’m not sure how much of our report made it into the new method – judge for yourselves, as it is also available on the consultation website.

Tuesday, 26 April 2016

Consultation on Specialised Services. Yet again.

NHS England has launched public consultations on a further two waves of new policies and service specifications for specialised services.

Wave 10

Service Specification
Complex Home Ventilation Services
Weaning From Prolonged Mechanical Ventilation

Clinical Commissioning Policy
Rituximab for Membranous Glomerular Nephritis

Wave 11

Clinical Commissioning Policies
Hyperbaric Oxygen Therapy

Image: Hyperbaric Chamber by  Urban Sea Star


Thursday, 7 April 2016

Consultation on Specialised Services. Again.

NHS England has launched public consultations on a further three waves of new policies and service specifications for specialised services.

Wave 7

Clinical Commissioning Policies:
Obesity surgery for children with severe complex obesity

Service Specifications:
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS-TEN), All Ages
Obesity Surgery for Children
Interstitial Lung Disease
Renal Transplantation Service (Adults)

Wave 8

Service Specifications:
Atypical Haemolytic Uraemic Syndrome (aHUS) (All Ages):
Gender Identity Development Service (GIDS) for Children and Adolescents:
Heart and Lung Transplantations:
Paediatric Onset Multiple Sclerosis:
Rare Hereditary Neuropathies for Children and Young People:
Sarcoma
Penile Cancer
Urological Cancers: Specialised Testicular Cancer Services
Urological Cancers – Specialised Kidney, Bladder and Prostate Cancer Services
Thoracic Surgery

Clinical Commissioning Policies:
Total pancreactectomy with Islet Autotransplant
Eculizumab in the treatment of recurrence of C3 glomerulopathy post-kidney transplant – all ages
Tocilizumab for Takayasu arteritis (adults)
Tocilizumab for Giant cell arteritis (adults)
Proton Beam Therapy for Cancer of the Prostate
The use of Stereotactic ablative Radiotherapy (SABR) in the treatment of Prostate Cancer
The use of Stereotactic Ablative Radiotherapy (SABR) in the treatment of previously irradiated tumours of the pelvis, spine and nasopharynx
The use of Stereotactic Ablative Radiotherapy (SABR) as a treatment option in the management of patients with Spinal Tumours
The use of Stereotactic Ablative Radiotherapy (SABR) as a treatment option for patients with Hepatocellular carcinoma or Cholangiocarcinoma
The use of Stereotactic Ablative Radiotherapy (SABR) in the treatment of Oligometastatic disease
The use of Stereotactic Ablative Radiotherapy (SABR) as a treatment option for patients with Renal Cancer 
Gastroelectrical stimulation for gastroparesis
Stereotactic radiosurgery/radiotherapy for ependymoma, haemangioblastoma, pilocytic astrocytoma and trigeminal schwannoma
Robotic Assisted Surgery for Bladder Cancer
Robotic Assisted Surgery for Kidney Cancer
Deep brain stimulation for Central Post Stroke Pain
Bone conducting hearing implants (BCHIs) for hearing loss (all ages)
Sodium oxybate for symptom control of narcolepsy with cataplexy (children)
Haematopoietic Stem Cell transplantation (HSCT)
Second allogenic haematopoietic stem cell transplant for relapsed disease
Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
Treatment of iron overload for transfused and non-transfused patients with chronic inherited anaemias
Intravenous immunoglobulin for acute disseminated encephalomyelitis and autoimmune encephalitis
Argus II retinal prosthesis
Prescribing of Cross-sex Hormones as part of the Gender Identity Development Service for Children and Adolescents
Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents

Wave 9

Service Specification:
Primary Ciliary Dyskinesia management service (adults):




Thursday, 18 February 2016

Consultation on Specialised Services

NHS England has launched public consultations on a proposed number of new policies or service specifications for specialised services.  The proposals have been published in 3 waves, each with different consultation dates

1st Wave

Service Specification
Liver Transplantation Service (Adults)

Clinical Commissioning Policies
Dornase alfa inhaled therapy for primary ciliary dyskinesia (all ages)
Pasireotide: An injectable medical therapy for the treatment of Cushing's disease
Personalised External Aortic Root Support (PEARS) for surgical management of enlarged aortic root (adults)
Robotic assisted trans-oral surgery
Rituximab for CIPD
Temperature-controlled laminar airflow device
Palliative radiotherapy for bone cancer
Radiotherapy for breast cancer

2nd Wave

Clinical Commissioning Policies
Renal denervation for Resistant Hypertension
Surgical correction for pectus deformity (all ages)
Robotic assisted surgery for oesophago-gastric cancers
Robotic assisted lung resection for primary lung cancer
Stereotactic Radiosurgery (SRS) for adults with Parkinson's tremor and Familial Essential Tremor
Amifampridine phosphate for the treatment of Lambert-Easton Myasthenic Syndrome
Extra corporeal membrane oxygenation (ECMO) service for adults with cardiac failure
Use of Plerixafor for Stem Cell Mobilisation (Update to include paediatrics)
Plasma-derived C1-esterase inhibitor for Prophylactic treatment of hereditary angioedema (HAE) types I and II

3rd Wave

Clinical Commissioning Policies
Ivacaftor for children aged 2-5 years with cystic fibrosis (named mutations)
Continuous aztreonam lysine for cystic fibrosis (all ages)
Rituximab for the treatment of dermatomyositis and polymyositis (Adults)
Auditory brainstem implant with congenital abnormalities of the auditory nerves or cochleae

Thursday, 14 January 2016

National PROMS Programme Consultation

Cobbled together from the NHS England website:

“Four PROM data collections are currently specified in the NHS Outcomes Framework (3.1), the NHS Mandate and in the NHS standard contract. It is a requirement for organisations performing NHS funded hip replacement, knee replacement, varicose vein or groin hernia surgery to collect PROMs data and submit that data to the Health & Social Care Information Centre (HSCIC).

Predominantly, the data is collected using paper questionnaires. The total cost to the NHS for the collection of the four nationally mandated PROMs is approximately £825K annually (annualised amount for 2014/15 as per spend Management Information from framework suppliers) – borne by provider trusts.

We are now consulting, publicly, on the future content of the national PROMs programme. We wish to consult regarding options around how to utilise our resources most effectively to understand the outcomes which matter to patients, to highlight areas with unwarranted variation in outcome and to consider indicators for service improvement."

The consultation will run from 4th January 2016 until 28th March 2016.

Tuesday, 1 December 2015

Cancer Drugs Fund consultation


Proposals for a complete overhaul of the CDF have been published by NICE and NHS England.
Rather than just handing out money on a ‘first come first served’ approach the CDF will ask for something in return!

Picture courtesy of
Global Panorama/PublicDomainPictures
In short, they will want data to reduce important uncertainty and a temporary value based price.
The consultation is open until 11 February 2016.  Further information including the consultation documentation is available via the NHS England website.

Monday, 16 November 2015

Health minister blocks cheap drugs bill

From the Independent:

"A Conservative health minister has deliberately blocked a new law to provide cheap and effective
drugs for the NHS by championing medicines whose patents have expired.  Mr Burt deliberately used up the bill’s time by speaking at length for 27 minutes [out of the allotted 30 minutes], despite heckles and jeering from Labour, SNP, and Conservative benches. Because the proposed law is not supported by the Government it only has a limited amount of time to be debated in Parliament, or has to be shelved.
Picture courtesy of Erich Ferdinand
The proposed law would have compelled the Government to seek new licences for medicines that were not covered by patents but which could benefit patients.  Currently, such medicines tend to go un-licensed because there is no profit incentive for pharmaceutical companies to bring forward an application for a license.  Proponents, including charities, say the bill would open up a range of treatments for diseases such as breast cancer, multiple sclerosis and Parkinson’s – and save the NHS millions of pounds."

Tuesday, 3 November 2015

Accelerated Access in the UK

Sir Hugh Taylor’s interim report on the Accelerated Access Review has just been published here.  The interim report describes the review’s progress in preparing proposals to improve the current system for developing, evaluating and adopting innovative medical technology for the benefit of patients, the health system and the life sciences industry.

Building on extensive responses from stakeholders during an initial period of engagement, which is summarised in the supporting evidence documents, the report sets out 5 main propositions which will form the basis of the review’s next phase of engagement. These are summarised below.  The review intends to publish its final report with more detailed recommendations by April 2016.
  • Putting the patient centre stage: Patients should be given a stronger voice at every stage of the innovation pathway.
  • Getting ahead of the curve: A radically new approach is required to accelerate and manage entry into our health system for the emerging products that promise the most significant, potentially transformative impact in terms of patient benefit and overall value.
  • Supporting all innovators: In addition to accelerating access to a select number of the most promising new products, our end-to-end innovation pathway can, and should, also be more responsive to the wider, irrepressible surge of innovation presented at all levels of the system, particularly where its introduction will contribute to better outcomes for patients and more productive and efficient ways of delivering care.
  • Galvanising the NHS: The NHS must be an active partner in promoting innovation, and must be incentivised to adopt new products and systems quickly and effectively.
  • Delivering change: Building on existing health system structures, a new system architecture is required at local and national level to accelerate access to the best new products and related models of care on a sustainable basis, within a framework of collective agreement to ambitions and goals.

Thursday, 17 September 2015

Public Health Outcomes Framework (PHOF) consultation

The PHOF indicators were developed in 2012 to measure the public’s health and wellbeing.  The UK Department of Health at updating the indicators from April 2016.

This consultation is looking for suggestions on:
  • removing ineffective indicators
  • replacing or improving others where improvements in data have taken place since 2012
  • adding new indicators, but only where there are important public health gaps
The consultation runs from 3 Sep 2015 to 2 Oct 2015 and can be accessed here.

Tuesday, 15 September 2015

PPRS to be extended to all companies?

The current Pharmaceutical Price Regulation Scheme (PPRS) is a voluntary scheme that generates a rebate to the DH, with a separate statutory discount scheme for those companies not signing up to the PPRS.  The current statutory scheme operates through a cut of 15% in the maximum price of branded health service medicines on sale on 1st December 2013.

However, it turns out that the statutory scheme produces lower savings relative to the health service sales covered by the scheme than the PPRS and the gap is expected to widen.  So, the DH wants to re-align the statutory scheme savings with the PPRS in order to promote a more level playing field between the two schemes and in order to encourage companies to remain in the PPRS….

“We are therefore consulting on the following options, in order to ensure that the cost of branded medicines to the NHS stays within affordable limits:
Option 1: A further cut in maximum price.
Option 1a: A further cut in maximum price including new products.
Option 2: A percentage payment by companies replacing the existing price cut.
Option 2a: A percentage payment by companies including new products.

In order to align relative savings better with those from the PPRS, and to encourage companies in the PPRS to remain there and not join the statutory scheme, we need to consult on a range of price cuts of between 20% to 30% and on a range of payment percentages of between 10% and 17%.

The Government’s preferred option is Option 2a, a payment system with the payment set between 10% and 17%, applying to new as well as old products.

All of this is open to consultation until 4th December.

Wednesday, 25 March 2015

Patent Purchase as a Policy for Pharmaceuticals

…by Ben van Hout, Jolian McHardy and Aki Tsuchiya has just been published as part of the Sheffield Economic Research Paper Series (SERPS).  The abstract is below:

Photo by the italian voice via Flickr CC BY 2.0
We consider a proposal for pharmaceutical patenting policy: namely, for society to grant and purchase the patent of the first of a new class of drug, instead of purchasing the drug, and award no further patents to runner-up drugs, producing or licensing production with price set to maximise welfare subject to cover costs. It is often observed that when the first of a new class of drugs is patented, it does not necessarily halt the development of a second and a third drug of the same class. The result may be a number of rugs with similar efficacy at similar prices well above the production costs. Where this happens, society could substantially reduce the cost of duplicated R&D and the price of the drug by buying the first patent. This would benefit more patients and produce larger health gains. Under this policy social welfare is increased, the winner is fully compensated, while the runner-up firm incurs possible losses - but there are viable conditions under which firms would not lose on average. We take a drug life-cycle approach to the welfare gains of a patent purchase policy. The results are generated based upon a number of stylised facts regarding R&D in the pharmaceutical industry.

It can be downloaded here.

Monday, 23 March 2015

National uptake of EUnetHTA’s outputs

This is now being reported on the EUnetHTA website.  "National uptake" is defined as the general implementation of any EUnetHTA output (i.e. joint assessments, submission templates, guidelines, POP Database, HTA Core Model®, etc.) in a local (national/regional) setting. No instances are listed.

They are also monitoring "National adaptation", defined as a specific type of national uptake, i.e. the use of the EUnetHTA joint assessment results in national/regional setting. The purpose of national adaptation is to avoid duplication, to promote good practices in HTA processes and to effectively use time and financial resources.  The minimum requirement for a national adaptation is inclusion of a explicit reference to the EUnetHTA joint assessment on which the local report was based.  There are six instances listed; 3 in Austria, 1 in Croatia, 1 in Norway and 1 in The Netherlands.

Is this a cost-effective use of resources?

Wednesday, 18 March 2015

NHS Constitution consultation

The NHS Constitution sets out:
  • rights to which patients, public and staff are entitled
  • responsibilities owed to each other to ensure the NHS operates fairly and effectively.

This consultation proposes to amend the NHS Constitution to respond to recommendations made by
Sir Robert Francis QC and to:
  • give greater prominence to mental health
  • reflect the importance of access to transparent and comparable data
  • include the Armed Forces Covenant
  • reflect the new fundamental standards in April 2015
It closes on the 8th April.

Thursday, 5 March 2015

Specialised Services - Policy and Specification Consultation


NHS England has launched a public consultation on proposed changes to a number of new and existing service specifications and clinical commissioning policies for specialised services.
Commissioning policies:
  • Treatment of Digital Ulceration in Systemic Sclerosis
  • Dialysis Away From Base
  • Cytoreductive surgery and hyperthermic intraoperative chemotherapy for peritoneal mesothelioma
  • Biological Therapies for Treatment of Juvenile Idiopathic Arthritis
  • Management of Foetal Anaemia Secondary to Red Cell Alloimmunisation
Service specifications:
  • Hep C Networks
  • Adult Critical Care
  • Gynaecological Anomalies
  • Foetal Medicine
  • Recurrent Urinary Incontinence
The consultations close on 30th April 2015.