The Health Economics and Policy Analysis group 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:
- Economic Evaluation
- Applied Health Econometrics
- Health Policy Evaluation
The Health Economics and Policy Analysis group have extensive experience in the methodological area of economic evaluation. Economic evaluation consists of the broad set of techniques for the assessment of health technologies and interventions, examining issues such as costs, preferences, clinical 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 health economic evaluation techniques. These include:
- Health Technology Assessment
- Economic Evaluation based on Randomised Controlled Trials
- Economic Evaluation based on Decision Analytic Models
- Discrete Choice Experiments
- Contingent Valuation
Recent evaluations conducted by the group include studies relating to stroke, dementia, obesity, heart disease, diabetes, chronic obstructive pulmonary disorder, refractory asthma, mental health, disability and 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 in this area, including two National Cancer Institute/Health Research Board Fellows, and the recently established Economics of Cancer Research Group
In the area of health technology assessment, techniques employed by the group include unit cost estimation, burden of disease studies, and full and partial evaluations. The group has particular expertise in the conduct of economic evaluation alongside clinical trials and the construction of decision analytic models.The group has strong methodological experience in the design and conduct of economic evaluation alongside randomised controlled trials. Examples of recently completed trial-based evaluations include studies examining early supported discharge for stroke, reminiscence therapy for dementia, secondary prevention clinics for heart disease, peer support for type 2 diabetes, structured education for type 1 diabetes, pulmonary rehabilitation for chronic obstructive pulmonary disorder, psychological intervention for chronic pain, and screening for gestational diabetes mellitus.
In the area of stated preferences, the group has experience in the techniques of discrete choice experiments and contingent valuation. These methods seek to identify and estimate individual and social preferences as they relate to health and health care. This is currently an underdeveloped but growing area of health economic research.
The Economic Evaluation team work in collaboration with a range of clinicians at NUI Galway, in addition to colleagues in other Irish and UK research institutions. Researchers 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.
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.
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 the Health Economics and Policy Analysis group, 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 the Health Economics and Policy Analysis group 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 the Health Economics and Policy Analysis group 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.