Advising the ABPI
The OHE provides continuous support, advice and information on prescription statistics, sales index and trade statistics to the ABPI, and on issues of health and pharmaceutical industry economics and statistics. The OHE also provides support for ABPI task forces and projects, including:

• PPRS negotiations
• modelling trends in medicines spend in the UK
• follow-up work on the PICTF indicators, MISG and G10 benchmarking studies
• OFT review
• Original Pack Dispensing
• prescribing indicators – Wales
• new NICE guidance for technology assessment submissions.

OHE’s expertise
The OHE’s programme of publications, conferences, lectures and seminars covered:

• the financing and organisation of healthcare
• competitiveness, regulation and structure of the pharmaceutical industry
• pharmaceutical industry economics
• pricing and reimbursement of pharmaceuticals
• cost-effectiveness evaluation of healthcare technology
• health and health care statistics.

Competitiveness, regulation and structure of the Pharmaceutical industry
In January 2003 the seminar proceedings Institutions for Industrial Competitiveness, edited by Jorge Mestre-Ferrandiz, were published. This collection of papers examines why the US is more competitive in the pharmaceutical and biotechnology industries than Europe and analyses how public institutions can help provide both the correct competencies and the right incentives for the European pharmaceutical industry to become more competitive and innovative.

The economics of health technology assessment and medicine use
The OHE-IFPMA Health Economic Evaluations Database (HEED), on CD-ROM and the internet, continues to be the world’s leading database of its kind and a major aid to research, providing information on cost-effectiveness and other economic evaluation of medicines to the pharmaceutical industry, academic and health care subscribers. By December 2003, HEED contained references for over 27,500 health economics evaluations.

The OHE continues to provide a dedicated web-site for interactive learning about health economics. It is aimed at A-level and equivalent students of economics and business studies, but is a useful introduction to anyone interested in health economics. It can be found at www.oheschools.org.uk.

Predicting Medicines Expenditure was a seminar bringing together speakers from the Prescription Pricing Authority, the Department of Health, IMS Health, the Office of Health Economics and the ABPI to discuss how best to predict future medicines expenditure in the UK.

Health and healthcare statistics
The 15th edition of the OHE’s annual Compendium of Health Statistics, launched in September, received extensive coverage in the national daily press and specialist journals. It is the essential data source for understanding the UK health sector, containing data spanning 50 years, and is the only comprehensive reference tool for statistics on UK health and the health care system, its constituents and selected international data. It is available for the first time in both hard copy and online, at www.compendium.co.uk.

New approaches to health economic evaluation
The 2003 OHE Annual Lecture, Health Systems Performance Assessment, was given by Professor Christopher Murray, then Executive Director of the Evidence and Information for Policy Cluster at the World Health Organisation, reporting directly to its Director General Gro Brundtlandt. Following the controversial analysis published in its 2000 World Health Report, which put France as the top performing healthcare system in the world, with the UK number 18 and the USA number 37, Chris Murray, who pioneered the 2000 exercise and was leading the follow-up research, outlined some of his recent findings, including:

• why the WHO performance criteria are important and how they relate to the UK government’s objectives, and
• lessons that can improve healthcare system performance in the UK and elsewhere.

The book Statistical Methods for Cost Effectiveness Evaluation, by Andy Briggs, was published during 2003, exploring current and new methods in the field of health economic evaluation.

To Heal and to Harm: An Economic View of Drug Safety, by Jonathan Silcock and Clive Pritchard, was published at the end of 2003. The book illustrates how economic analysis can be used to assess whether the costs of implementing preventative measures are justified or how to include them in the design of clinical trials for gathering information on the costs of adverse drug reactions (ADRs).

The financing and organisation of health care
Three aspects of organising healthcare were explored in the OHE’s research and publication programme this year. In Quality in Primary Care, Michael Kuhn used insights from economics to examine the pivotal role of primary care in the quality of health care provision and the potential to encourage primary care providers such as GPs to deliver the optimal quality of service within limited resources.

In December the OHE published the briefing paper Reducing Harm to Patients in the National Health Service: Will the Government’s Compensation Proposals Help? Many adverse medical events occurring in the NHS result in harm or death to patients and many are avoidable. Few patients receive compensation and there is little incentive for the NHS to tackle the causes of harm when valuable information about preventable errors, generated from patient claims, has been lost. The Government report Making Amends includes helpful ways forward. In this publication, the authors discuss how these proposals can be made more effective and set out the case for the NHS to move towards an administrative system of liability based on preventability – in effect, a modified ‘no-fault’ approach.

OHE seminars
The OHE also organised seminars during the year on healthcare financing and organisation issues. Mental health is increasingly of interest among policy makers and academia. The OHE jointly organised a conference with the London School of Economics on Mental Health Economics and Policy in a Global Context, highlighting the role of health economics in mental health policies for low- and middle-income countries. The OHE published the seminar briefing at the end of 2003 and it is available free on the OHE website.

In December, the seminar Measuring Quality Adjusted Productivity Growth in Health Care: Studies in Schizophrenia and Depression was presented by Ernie Berndt, Professor of Applied Economics at Massachusetts Institute of Technology and Director of the National Bureau of Economic Research program on Technological Progress and Productivity Measurement in the US. He outlined his recent research for using a disease-based approach for measuring quality adjusted productivity in health care, which may be of use to the NHS, as it faces mounting accusations of failure as traditional measures of productivity head in the wrong direction.

Professor Peter Zweifel, a foremost expert on the economics of health insurance, spoke at the seminar When Social Health Care Insurers Compete – Innovation or Cream Skimming? in June. The idea being mooted, but not yet discussed in the UK, was that competition should be instigated between NHS purchasers of health care, e.g. by allowing people to choose which Primary Care Trust they wish to be covered by. In Switzerland, competition of this kind between health insurers is already a reality, and Peter Zweifel discussed his and colleagues’ research on the impact of introducing such competition.

Also in June Chris Newdick, barrister and Reader in Law at the University of Reading, led a discussion on Guidelines, Governance and the Future of Clinical Freedom. He explored what patients’ rights to NHS care are, how Primary Care Trusts should manage making difficult choices and whether a GP’s first duty of loyalty is to the patient or the Treasury.

International health care
Spending the Next $ for Global Health – Roles and Priorities for Charities and Governments was a seminar held in November 2003 by Dr Hannah Kettler. She is an economist at the Bill and Melinda Gates Foundation, focusing on the challenges of building up global and sustainable R&D and delivery systems to improve the health of the poor. She assessed the roles to which charitable foundations, national governments and international organisations are respectively suited, and the usefulness of different criteria in prioritising investments in global health improvement.