Is economic evaluation and care commissioning focussed on achieving the same outcomes? Resource-allocation considerations and challenges using England as a case study.


Outcomes-based commissioning (i.e., paying services for pre-agreed outcomes) shares a common goal with economic evaluation: achieving value-for-money for relevant outcomes (e.g., health) achieved from a finite budget. However, economic evaluation often focusses on a single end-point health-focused maxim and, e.g., quality-adjusted life years (QALYs). Whereas commissioning often focusses on activity-based surrogate outcomes (e.g., health monitoring), as easier to measure key performance indicators which are more acceptable (e.g., by clinicians) and amenable to being linked with payment structures.

Accounting for and explaining direct links from commissioners’ payment structures to surrogate and then end-point economic outcomes is a vital step to bridging a gap between economic evaluation approaches and commissioning. Decision-analytic models could aid this, but they must be designed to account for relevant surrogate and end-points outcomes, the payments assigned to such outcomes, and their interaction with the system commissioners purport to influence. Paper under-review with Applied Health Economics and Health Policy.

Our next study will:

  • This study builds from a previous study funded by NIHR Public Health Research with in-kind support from the NIHR ARC-YH: The Unlocking Data to Inform Public Health Policy and Practice study.
  • Two other related papers were published on the topic of bridging the gap between current economic evaluation frameworks and the evidence-needs of local decision makers: one focussed particularly on cost considerations and the other focussed on health inequalities.
  • Work is ongoing to understand how to make economic evaluations more relevant to local decision-making priorities and evidence-needs, so that economic evidence can better inform localised resource-allocation decision making.


Currently Underway

Team Contact:

Senior Health Economist Research Fellow

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