HEPA seeks to develop and encourage the use of economics in the area of health and healthcare. The methodological expertise of the group is focused on three applied research areas: (1) Health Technology Assessment; (2) Applied Health Econometrics; and (3) Health Policy Evaluation.
1: Health Technology Assessment (HTA)
This area of research focuses on the evaluation of health technologies or health care interventions, examining issues of cost and cost effectiveness, as well as the impact of their potential adoption upon system efficiency and equity. The methodological expertise of the group covers the broad range of evaluation techniques in the discipline of health technology assessment. These include unit cost estimation, burden of disease studies, full and partial evaluations. The latter includes both the conduct of economic evaluation alongside clinical trials and the construction of decision analytic models. The group also has experience in the related techniques of stated preferences including discrete choice experiments and contingent valuation.
Recent evaluations include studies related to heart disease, diabetes, chronic obstructive pulmonary disorder, refractory asthma, mental health and disability as well as sexually transmitted disease. The evaluation of cancer therapies represents an increasing proportion of the group’s research portfolio with the funding of five PhD students, including two National Cancer Institute/Health Research Board Fellows working in this area. The group has recently led a major HRB-funded clinical effectiveness trial on reminiscence for people with dementia in residential care in Ireland.
The HTA group work in collaboration with a range of clinicians at NUI Galway, in addition to economic and non-economic colleagues in other Irish and UK research institutions. The group are currently engaged in funded projects with colleagues from University College Cork, University College Dublin, Trinity College Dublin, Queens University Belfast, the National Cancer Registry Ireland, the Northern Ireland Cancer Registry, the University of Manchester, and the University of Oxford. The group also have contributed to successful research bids under PTRLI with University College Cork, to four HRB ICE research programmes, as well as work funded by Safefood, HRB/NCI fellowships, the UK National Institute of Health Research and GSK. Researchers in this thematic area have provided executive education programmes on HTA and broader civic engagement activities through for example, involvement in the National Cancer Screening Service Expert Advisory Group on HPV Testing, the HIQA Scientific Advisory Group on HTA, the GSK Forum and membership of journal editorial advisory boards such as the Journal of Clinical Therapeutics.
2: Applied Health Econometrics
This area of research focuses on the application of microeconometric techniques to explore empirical questions in the field of health economics. This involves the practical analysis of quantitative, qualitative and categorical data collected as part of national surveys and linked administrative databases. This work typically involves the formulation of hypotheses, the selection of appropriate econometric methods, the estimation of microeconometric models, and the interpretation of the results in a manner intended to test particular hypotheses or inform the development of particular policy instrument. The strengths of the group in this area complement its work in the areas of Health Technology Assessment and Health Policy Evaluation, by contextualising the socioeconomic environment within which new technologies and policies are adopted.
A common feature of the work conducted in this area has been the exploration of socioeconomic inequalities as they relate to health and health care in Ireland. Recent work published by the group has explored inequalities with respect to the uptake of cancer screening services in Ireland and compared the provision of services in Ireland with those in other jurisdictions. Similarly, using econometric and spatial geographic information systems (GIS) techniques, researchers have published work exploring the impact of travel distance on the uptake of screening for gestational diabetes mellitus. Exploring the determinants and impact of obesity on the island of Ireland represents a growing area of interest within the Group at this time. In the area of ageing, members of the group are involved in a wide range of activities which are closely linked to ongoing programmes of work that have their origins in Irish Centre for Social Gerontology and the Lifecourse Institute at NUI Galway. Recently published and ongoing research projects have focused on issues relating to the determinants of costs in dementia, pension and retirement decisions, economics of disability, contingent valuation estimation in relation to community care options for older people, and health inequalities in older populations.
3: Health Policy Evaluation
This area of research focuses on the application of policy evaluation methods in the area of health and health care. While this includes the application of the methods of Health Technology Assessment and Applied Health Econometrics, the focus of analysis is more holistic, moving beyond issues of efficiency and equity, and incorporating a wide range of both quantitative and qualitative methodologies. These techniques are applied in practice both pre and post policy implementation, to inform the design and formulation of policy in the former, and to critically assess the process and impact of policy in the latter. The choice of which evaluation model to adopt in each case depends on the question of interest and the nature of the policy or programme to be evaluated.
Research undertaken by members of HEPA, particularly in areas of ageing, disability and mental health, have played an important role in the design, formulation, and evaluation of health policy in Ireland in recent years. In addition, a number of current projects will contribute to policy discussions across a range of topical areas. In the area of ageing, members of the group are involved in a wide range of policy initiatives which are closely linked to ongoing programmes of work at the Irish Centre for Social Gerontology, the Whitaker Institute for Innovation and Societal Change and the Lifecourse Institute. In particular, health inequalities amongst older people is a major area of interest of the group and qualitative and quantitative studies are currently being conducted to explore the relationship between poverty and life course, with the aim of developing deprivation indicators for older people in Ireland. A major study on social exclusion among older people living in rural areas in Ireland has recently been published by members of the centre, funded by CARDI. The group has also made a significant contribution on the economics of dementia in Ireland which will form part of the national dementia strategy to be published in 2013.
In the area of disability, research undertaken incorporates a lifecycle perspective on disability by considering specific disability-related issues of relevance to children, the working age population and to older people, all in an economic context. In the thematic area of mental health, research by the group has played an important role in policy formulation in Ireland. For example, a report by members of HEPA presented the economic case for investment in mental health services, adding to the discussion and debate of how to ensure provision of efficient and effective mental health services in Ireland. Members of HEPA have also been involved in an evaluation of a specialist nursing service designed to reduce suicidal behaviour. Members of the group are also currently leading the development of a Health System in Transition Report on behalf of the European Observatory as part of an international partnership within the World Health Organization Structure in collaboration with the Kings Fund in the UK.