Department of Economics and Related Studies and Centre for Health Economics, University of York
Karl Claxton is a Professor in the Department of Economics and the Centre for Health Economics at the University of York, UK.
For many years he also held an adjunct appointment at the Harvard School of Public Health. Karl has led the economic evaluation component of the Health Economics MSc at the University of York for a long time, and he is past co-editor of the Journal of Health Economics.
He is author of two of the most widely known textbooks on economic evaluation and decision modeling. He was a founding member of the UK’s NICE Technology Appraisal Committee and has represented the committee in a number of occasions. He is also a member of the NICE Decision Support Unit and continues to contribute to the development of the NICE Guide to the Methods of Technology Appraisal through the NICE Methodology Working Party.
In recent years he led policy relevant projects such as the ‘Methods to estimate NICE's cost effectiveness threshold’ and the ‘Uncertainty, Evidence and Irrecoverable Costs: Informing Approval, Pricing and Research Decisions for Health Technologies’.
He has contributed in a number of ways to recent policy debates such as pharmaceutical pricing and innovation, including as an expert witness at the UK House of Commons Health Select Committee and the Kennedy review of Innovation in Health Technology. As well as NICE he has also advised, Department of Health, HM Treasury, Department of Business Innovation and Skills and the Office for Life Sciences of the UK.
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.
Imperial College Bussiness School, Imperial College London
Marisa Miraldo is Full Professor of Health Economics at the Department of Economics and Public Policy at Imperial College Business School (ICBS). She is Academic Director of the MSc in International Health Management.
Marisa’s expertise is on behavioural interventions to promote health and wellbeing and the economics and policy of healthcare innovation.
She has a track record of leading interdisciplinary research and currently leads several international projects including: the primary prevention workstream of the Global Health Research Unit (GHRU) on Diabetes and Cardiovascular Disease in South Asians, where she leads behavioural change interventions to promote better diets; the workstream on behavioural change interventions within the Jameel Institute-Kenneth C. Griffin Initiative for the Economics of Pandemic Preparedness (EPPI) and the workstream on Incentives for Innovation and Equitable access to Innovation within the Hi-Prix.
She is a fellow of Imperial College Data Science Institute and she currently serves on the academic advisory board of the Centre for Translational Nutrition and Food Research, the advisory committeeof the Global Development Hub, and is a Co-Lead of the ICL Women's Health Initiative.
Marisa is a leading advocate of Equality, Diversity and Inclusion (EDI), has chaired the EDI Committee at the Business School, founded the Gender Equity Committee at the ICBS and has been awarded a Julia Higgins Award for her contribution to EDI.
She is an award-winning educator and has led the executive education Advanced Management Programme in Health Innovation at ICL. In the past she has been Associate Head of the Department of Management at Imperial College Business School and has held academic appointments at the Centre for Health Economics and the Department of Economics and Related Studies both at the University of York.
Innovative Research for Innovative Policy and Better Health
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.
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.