Elsevier

Health Policy

Volume 52, Issue 3, July 2000, Pages 179-192
Health Policy

The influence of economic evaluation studies on decision making.: A European survey

https://doi.org/10.1016/S0168-8510(00)00076-2Get rights and content

Abstract

Despite the growing activity in the field of health economics very little is known about the influence of economic evaluation studies on health care decision making in the EU member states. Several investigations about the impact of health economic studies on decision making have been performed, but most of them did not involve decision makers themselves. In this paper the results of the EUROMET survey are reported and discussed. Different types of decision makers in nine European countries were surveyed by postal questionnaires, semi-structured interviews and focus group discussions. Questions include issues about the extent of knowledge about economic evaluation, the actual and potential use of study results as well as barriers and incentives in the use of studies. It is concluded that despite the general positive attitude knowledge about the formal methodology is rather limited. Accordingly, results of economic evaluation studies are not widely used in decision making. The results show that institutional dimensions, such as difficulties in transferring budgets, are viewed as important barriers. Also, the lack of credibility of studies is assigned a high relevance. Moreover, decision makers wish for a better explanation of the practical relevance of studies and feel that there is a need for more training in health economics. Considering these requirements a number of recommendations for enhancing the value of health economic studies are given.

Introduction

In recent years the number of economic evaluation studies of health care technologies has increased greatly. However, given the growing activity in the field of health economics and the encouragement of decision makers to consider the results of those studies, very little is known about the influence of economic evaluation studies on health care decision making in EU member states. There have been several studies exploring the impact of health economic studies on decision making, but most of these investigations did not allow for the attitude of decision makers themselves, but those of researchers only [1], [2], [3], [4], [5].

A two-phase-study by Duthie et al. also involved decision makers themselves. Apart from general practitionners, research focused on a wider group of decision makers, including purchasers, hospital physicians, etc., and focused on the relevance and appeal of diverse health economic measures to different decision makers [6], [7]. The main conclusion was that economists need to demonstrate a better understanding of the contracting and budgetary processes of the National Health Service so that the arguments which are presented in the studies are more realistic and applicable. Decision makers perceived the inability to vire funds between primary and secondary care sectors as the major barrier in the use of economic information.

Michael Drummond conducted a postal questionnaire survey in the UK, in which he surveyed three groups of decision makers: medical and pharmaceutical advisers, hospital directors of pharmacy, and directors of public health [8]. The general conclusion was that there is a well-established tradition of economic evaluation and that there is a high potential for using economic evaluation in the UK. However, the usage depends on certain conditions: the studies have to be undertaken in a timely fashion and have to be made accessible to decision makers. Major barriers limiting the use are the lack of validity of studies, the multiple objectives being pursued by decision makers and the difficulties of freeing resources from existing services.

The review of existing research shows that most of the surveys concluded that economic studies do not have any systematic effect on the decision making process in health care. Since health economists aim at learning more about the impact of health economic studies on decision making, they have to involve the decision makers themselves. This was the starting point of the EUROMET survey which investigated the impact of health economic studies on decision making in nine European countries2 by surveying different types of decision makers. The main objective of this investigation was to enquire if decision makers are sensitive to economic evaluation study results and if they admit to changing their decisions based on these results. Although this objective appears to be rather limited, it allows one to review the usefulness of economic evaluation studies in the countries concerned and to compare the attitudes of the different decision makers towards it. The influence of health economic studies has been reported for single EU countries [9], [10], [11]. As the EUROMET survey involved decision makers from several European countries in one comprehensive survey, it allows a comparison of the situations in different EU countries. This is an essential first step in making suggestions for improvements in the future.

Study questions were in detail:

  • 1.

    To what extent are the methods of economic evaluation known among the health care decision makers?

  • 2.

    To what extent are results of economic evaluation being used in health care decision making?

  • 3.

    What are regarded as the main barriers in the use of economic evaluation in decision making?

  • 4.

    What factors might encourage the use of economic evaluations?

According to these questions four dimensions of the sensitivity of decision makers to economic evaluation had been assessed:
  • 1.

    extent of knowledge about economic evaluation;

  • 2.

    actual use of the results of studies;

  • 3.

    potential use of economic evaluation and attitudes towards it;

  • 4.

    barriers and incentives in the use of economic evaluation studies.

The survey was designed to be comprehensive in scope-all types of technologies were considered, not just pharmaceuticals. Health care technology is considered to include all instruments and ‘conditions’ under which medical practice is exercised. It includes drugs, devices, medical and surgical procedures used in medical care, and the organisational and supportive systems within which such care is provided [12].

Section snippets

Study design

Most of the previous studies were postal questionnaire surveys. For the further understanding of motivations and attitudes of decision makers the EUROMET study also used alternative interview methods. Since the study by Duthie et al. showed that by carrying out, e.g. semi-structured interviews rich qualitative data can be provided, three approaches of investigation could be adopted:

  • 1.

    postal questionnaire survey;

  • 2.

    semi-structured interview;

  • 3.

    focus group approach.

The use of these different methods also

Results

Among the participating countries there was a strong preference for the postal questionnaire survey. Finland, Germany and Norway carried out a postal questionnaire survey only. The other participating countries applied a combination of all three methods. In Austria, the Netherlands and Portugal postal questionnaires and semi-structured interviews were applied. In Spain, a postal questionnaire survey, focus group discussions and semi-structured interviews were carried out. In the United Kingdom

Discussion

When analysing and comparing each country’s results one has to bear in mind that the survey has been carried out in different surroundings with different traditions of economic evaluation in health care. In particular, one has to consider that the types of decision makers interviewed as well as the representativeness and the response rates differ in the countries surveyed. Also decision makers in different countries have a different set of incentives and constraints. Therefore, a sound basis

Acknowledgements

Research for this paper was supported by the EU-BIOMED II-project ‘European Network on Methodology and Application of Economic Evaluation Techniques’ (project no.: BMH4-CT96-1666). The authors are grateful to the anonymous referees for their valuable comments.

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Members of the group: J.-Matthias Graf v.d. Schulenburg, Christiane Hoffmann (Centre for Health Economics and Health System Research (HSR), University of Hannover, Germany), Frans Rutten (Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands) in cooperation with Jeannette van Rijkom (Department of Pharmaco-epidemiology and Pharmacotherapy, University of Utrecht), Reiner Leidl (Department of Health Economics, University of Ulm, Germany), Erik Nord (National Institute of Public Health, Norway), Harri Sintonen (Department of Health Policy and Management, University of Kuopio, Finland), Bengt Jönsson (Centre for Health Economics, Stockholm School of Economics, Sweden), Carlos Pinto (Instituto Superior de Economia e Gestao, Technical University of Lisboa, Portugal), Michael Drummond (Centre for Health Economics, University of York, United Kingdom), Paul Dolan, (Department of Economics, University of Sheffield, United Kingdom), Joan Rovira (SOIKOS, Spain), Robert Launois (Departement de Santé Publique et d’Economie de la Santé, Université de Paris, France), Claude LePen, Emile Levy (Laboratoire d’Economie et de Gestion des Organisations de Santé, Université de Paris-Dauphine, France), Brigitt Abbühl (ECOIN, Austria), Arno Brandt (Institute for Medical Informatics and Biostatistics, Switzerland).

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