Karl Claxton é Professor no Departamento de Economia e no Centro de Economia da Saúde da Universidade de York, no Reino Unido e deteve também uma posição honorária na Escola de Saúde Pública de Harvard.

Durante muitos anos liderou a componente de avaliação económica do Mestrado em Economia da Saúde da Universidade de York, e foi co-editor do Journal of Health Economics. Karl é autor de dois dos mais conhecidos livros em avaliação económica e modelos de decisão.

É membro fundador do Comité de Avaliação de Tecnologias do NICE, no Reino Unido, representando esta instituição em inúmeras ocasiões. É também membro da Unidade de Apoio à Decisão do NICE e até aos dias de hoje contribui para o desenvolvimento das Orientações Metodológicas para a Avaliação de Tecnologias desta instituição, fazendo parte do Grupo de Trabalho Metodológico do NICE.

Liderou recentemente projectos de relevância política tais como 'Métodos de estimação do limiar de custo-efectividade do NICE’ e ‘Incerteza, Evidência e Custos Irrecuperáveis: Informando a Aprovação, Preco e Decisões de Investigação de Tecnologias de Saúde'. Karl tem contribuído de várias formas nos debates políticos relacionados com inovação e preço de medicamentos, incluindo como especialista convidado no Comitê de Saúde da Câmara dos Comuns do Reino Unido e na revisão Kennedy para a Inovação de Tecnologias de Saúde.

Para além das suas posições no NICE, foi também conselheiro do Ministério da Saúde Inglês, Tesouro de Sua Majestade, Departamento de Inovação Empresarial e Competências e o Departamento de Ciências da Vida do Reino Unido.

Establishing accountable, ethical and sustainable health care decision making and pharmaceutical pricing policies in Portugal: the importance of estimating health opportunity costs.

Difficult but unavoidable decisions about access to new drugs can be made in an accountable and ethical way by asking whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other health care activities that would benefit other patients.  

For over a decade research in the UK has estimated the effects of changes in NHS expenditure on the health of all NHS patients.  This research shows that the NHS and other health care systems are currently paying too much for new drugs even when full account is taken of the dynamic effects on incentives for innovation. It means that more harm is being done to other current and future patients when new drugs are approved for use. The increasing pressure to approve new drugs more quickly at prices that are too high will only increase the harm done to all health care systems and the patients they serve. The political pressure to support a multinational pharmaceutical sector cannot justify the real harm that has and will continue to be done.  The existing evidence on the likely scale of health opportunity costs in Portugal will be reviewed before discussing how these estimates might be improved with additional research using Portuguese data while drawing on the experience in the UK.

Once an empirical estimate of health opportunity costs is available a feasible, practical and evidence-based approach to pharmaceutical pricing policy and payment mechanisms to achieve dynamic efficiency becomes possible.  Such mechanisms and pricing policies would offer substantial benefit to health care systems and a better and more sustainable alignment of incentives for the pharmaceutical sector. Identifying the payment required to deliver an optimal share of the long term value of pharmaceuticals to manufacturers will be explained before discussing how this can be delivered in a number of ways including: pricing policies based on modulation of HTA approval norms, subscription models, commitments to post-patent prices, as well as National portfolio based rebate mechanisms to address the current discrepancy between the prices charged and how much health care systems can afford to pay for pharmaceutical innovation and the long term benefits that it offers.

Marisa Miraldo é Professora de Economia da Saúde no Departamento de Economia e Políticas Públicas da Imperial College Business School (ICBS), e Diretora Académica do Mestrado em International Health Management. Entre as suas áreas de expertise encontram-se a intervenção comportamental para promover a saúde e o bem-estar, e a economia e política de inovação em saúde.

Marisa tem vindo a liderar vários projetos internacionais e interdisciplinares dos quais se destacam, atualmente: uma workstream sobre prevenção primária da diabetes e doenças cardiovasculares no Sul da Ásia, parte da Global Health Research Unit (GHRU); uma workstream sobre intervenções de mudança comportamental no âmbito da iniciativa Economics of Pandemic Preparedness (EPPI) do Instituto Jameel-Kenneth C. Griffin; e uma workstream sobre incentivos e acesso equitativo à inovação no âmbito do Consórcio Hi-Prix.

É ainda fellow do Imperial College Data Science Institute e parte do conselho consultivo académico do Centre for Translational Nutrition and Food Research, do comité consultivo do Global Development Hub, e co-líder da ICL Women's Health Initiative. Marisa é uma forte defensora de causas de Igualdade, Diversidade e Inclusão, tendo presidido ao comité por estas causas no ICBS e fundado o comité para Igualdade de Género na mesma Instituição. O seu trabalho nesta frente foi reconhecido pelo prémio Julia Higgins.

Por fim, destacam-se ainda as suas contribuições para a educação, tendo liderado o Programa de Gestão Avançada de Educação Executiva em Inovação em Saúde do Imperial College London e sido diretora associada do Departamento de Gestão da ICBS. Antes de se juntar ao ICBS Marisa desempenhou cargos no Centro de Economia da Saúde e no Departamento de Economia e Estudos Relacionados, ambos da Universidade de York.

Innovative Research for Innovative Policy and Better Health
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Historically, health policy has largely evolved around a biomedical model focusing on siloed approaches to population health, failing to account for multimorbidity, the complexity of the drivers of disease risk factors, their intertwined nature, and the differential impact they have on the population. When health economics emerged as a discipline most health systems were at their infancy and therefore research agendas mirrored key policy priorities at the time: how to organize service provision, fund those services, pay providers, ensure universal coverage and access to services including associated equity considerations. With increased health care expenditure, and the realization that efficient resource allocation is key to universal health coverage, policy and research agendas have broaden to include cost containment models, research allocation and financial incentives, health technology assessment, pricing, and regulation. Following Arrow’s seminal contribution, a substantial body of health economics research has therefore focused on addressing market failures, the role of government and its effective intervention in health systems either as funder, provider or regulator. 
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Threats to health have then evolved from infectious and acute care needs to chronic diseases. The biomedical model of understanding population health has been therefore generalized to non-biologic causes of disease and broadened to include the “social determinants of health”.  

With that expansion came also the realization that: i) the assessment of individual decision making, on both the supply and demand side, is paramount to better promote population health; ii) alongside with individual behaviour and treatment provision, social, economic, environmental, and structural dynamics are critical to population health.

Yet, while researchers and policy-makers emphasize the role of social determinants of health, they remain guided by a biomedical model that is incompatible with innovative policies to address population health needs. Research has extensively documented the persistent outcomes and access disparities (e.g. by race, sex and income) and the wide-ranging impacts of social, health and economic policy. Yet, this evidence has failed to improve population health in a sustained way. Interventions to date tend to focus on narrow targets disregarding the multiplicity of factors which synergistic interaction affects behaviours. Interventions tend to be static, and one-size fits all type of interventions, failing to capture: i) the heterogeneity across subgroups of the population in exposure to the complexity of factors that shape behaviours and needs; ii) the fact that exposure to behaviour-shaping factors varies spatially and temporally, and the action of pervasive feedback and spillover mechanisms. There is also little systematic evidence on whether and how interventions targeting one behaviour also affect non-targeted outcomes, as well as on the carryover longer-term effects of health interventions, that is, of whether and how long their effects persist over time on the same targeted outcomes. 

This talk discusses how policy innovation requires shifting research paradigms to: i) account more organically for heterogeneity in decision-making and risk exposure that shape health and the effectiveness of policies; ii) take holistic approaches to health; iii) pursue interdisciplinary research, with smarter data as well as embracing methodologies beyond “all else equal” causal inference methodologies.