Background

Unfortunately, money doesn’t grow on trees and healthcare budgets are largely fixed. This means we have to make difficult choices about what we can do and who we can treat. As a doctor, you will constantly be dealing with change, a healthcare system with limited resources and will see things that could be potentially improved. To convince healthcare decision makers that a new health technology or intervention is worth doing, it is important to show it is better than all alternatives, whilst also considering the cost (the cost-effectiveness). To understand why certain choices are made, it is necessary to understand the decision-making process in the Swedish healthcare system.

Why you should apply for the CEIE course

Aim

The purpose of the course is to familiarise the student with health economic evaluations: why economic evaluations are performed, how they are designed and carried out, and how the results are presented and interpreted. The concept of causality will be introduced and how randomised trials are the gold standard in providing causal estimates, but also how other methods other than RCTs may help provide causal impacts if they are carefully implemented.

The course will also cover how decisions are made within the Swedish healthcare system and where and when information from health economic evaluations is needed. The course places special importance on the ability to read and assess economic evaluations in the current literature in terms of relevance and methodological rigour.

Our vision is that by the end of the course the student will be able to “describe how new health interventions/technologies are chosen within the Swedish health-care system, explain the role cost-effectiveness analysis plays in the decision-making process and be able to assess an existing cost-effectiveness report.”

Learning outcomes

Knowledge and understanding

On completion of the course, the student shall be able to:

give an account of and explain the purpose of evaluating health interventions and policies,
give an account of how one designs and carries out health economics evaluations.
Give an account of the policy-level decision making process in Swedish healthcare

Competence and skills

On completion of the course, the student shall be able to:

discuss health-related policy and health interventions from a health economics perspective, based on relevant and current evidence,
identify strengths and weaknesses in existing economic evaluations.

Judgement and approach

On completion of the course, the student shall be able to:

reflect on ethical aspects and consequences of evaluations of health-related policy and health interventions.

Course Content

The course constitutes an introduction to methods used to evaluate health interventions, including both broad policies with relevance to public health and targeted healthcare sector-based interventions. The course has a strong focus on health economic evaluations, but also considers the concept of causality. The course also considers how decisions are made in Sweden, considering the institutional decision-making structure.

In this course we introduce economic evaluation (cost-effectiveness analysis). This is the toolset health economists use to provide a structured approach to comparing the costs and outcomes of different interventions/treatments. The purpose is to support policymakers and stakeholders in making informed decisions about resource allocation, i.e., how the available (scarce) resources in the healthcare sector should be used to achieve as much health as possible.

Economic evaluations are crucial for making evidence-based decisions in healthcare and public policy if we want transparent decision making that ensures that implemented treatments and interventions provide good value for money and contribute to the overall well-being of the population.

The course will examine why economic evaluations are performed, how they are designed and carried out, and how the results are presented and interpreted. The course places special importance on the ability to assess existing economic evaluations in the current literature in terms of relevance and methodological rigour.

Course Design

Individual and group assignments are used to practice what is learnt in the course. Throughout the course, three different types of working methods are applied. The first is lectures based on the reading list, with elements of active learning and readiness tests. The second is training sessions where the students are trained to solve specific assignments. The third form is examination seminars. The student is to come well prepared to each timetabled component in order to be able to absorb active learning elements.

Compulsory components include active participation in training sessions and seminars with complementary written assignments for students who for various reasons do not complete the components. Active participation means active and relevant participation in discussions and problem-solving.

Examination

The examination consists of an individual written examination, two written assignments, a course portfolio consisting of documentation of active participation in compulsory seminars and practice sessions and successfully passed multiple-choice readiness tests.

Written examination: 4.5 credits

Written assignments: 2 credits

Course portfolio, 1 credit: Active participation in seminars and training sessions, passed exercises and readiness test.

Language

English and/or Swedish.

Course Literature

Textbook

Fox-Rushby, J. & Cairns, J. (2005) “Economic Evaluation” Maidenhead, Open University Press

Angrist, J. D., & Pischke, J. S. (2014). Mastering 'Metrics: The path from cause to effect. Princeton University Press. (chapters 1 and 2)

Other

Chiolero, A. (2018) Why causality, and not prediction, should guide obesity prevention policy Lancet Public Health 3(10): E461-E462

Drummond, MF., O’Brien, B., Stoddart, GL. & Torrance, GW. (any edition) “Methods for the economic evaluation of health care programmes” Oxford: Oxford Medical Publication. Chapter 3

Husereau, D., Drummond, M., Augustovski, F. et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med 20, 23 (2022). https://doi.org/10.1186/s12916-021-02204-0

Oliver, A., Healey, A. & Donaldson, C. (2002) Choosing the method to match the perspective: economic assessment and its implication for health-service efficiency Lancet 359:1771-74

Tinghög, G. & Västfjäll, D. (2018) Why people hate health economics – two psychological explanations LiU Working Papers in Economics 6:2018

Further (voluntary) reading

Martin, J. E9562 Intro to Health Economics Part 1: https://www.youtube.com/watch?v=ekjxJMzwNEw

Martin, J. E9562 Intro to Health Economics Part 2: https://www.youtube.com/watch?v=uGRbKxskCSI

Hoch, J. & Dewa, C. (2008) A Clinician’s Guide to Correct Cost-Effectiveness Analysis: Think Incremental Not Average Can J Psychiatry 53(4):267–274

Saha, S., Grahn, B., Gerdtham, UG. et al. (2019) Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation European Journal of Health Economics 20:317-327

Wonderling, D., Gruen, R. & Black, N. (2005) “Introduction to health economics” Maidenhead, Open University Press.

Teachers and contact persons:

Johan Jarl (johan.jarl@med.lu.se), Gawain Heckley (Gawain.heckley@med.lu.se)

Preliminary schedule

Logistics

(TBC)