The Science of Getting Rich by Wallace D. Wattles

M edical Research:
W hat’s it worth?
Estimating the economic benefits
from medical research in the UK
Health Economics Research Group (HERG)
Brunel University
Office of Health Economics (OHE)
RAND Europe
For the Medical Research Council,
the Wellcome Trust and the
Academy of Medical Sciences
November 2008Report produced by Acknowledgements Citing this report
HERG This project was commissioned We suggest that you cite this report as follows:
by the UK Evaluation Forum Martin Buxton Health Economics Research Group, Office of
(MRC, Wellcome Trust and Steve Hanney Health Economics, RAND Europe. Medical
Academy of Medical Sciences).
Steve Morris Research: What’s it worth? Estimating the
We would like to thank: members of the economic benefits from medical research in Leonie Sundmacher
Steering Group for their advice and support the UK. London: UK Evaluation Forum; 2008.
OHE (Liz Allen, Nick Black, David Cox, Jonathan
Haskel, Helen Munn, Briony Rayfield, Jorge Mestre-Ferrandiz
If you have any queries about this report, Martin Roland, Rhiannon Tudor-Edwards, Martina Garau
please contact:Ian Viney and Martin Weale); Thed van Jon Sussex
Leeuwen (CWTS, Leiden) for bibliometric Professor Martin Buxton Report produced by Acknowledgements
services provided; various colleagues in our RAND Europe Health Economics Research Group
respective organisations for their help in a HERG RAND Europe This project was commissioned by UK Evaluation Forum (MRC, Brunel University Jonathan Grant
variety of ways; Tony Culyer, Evi Hatziandreu Martin Buxton Wellcome Trust, and Academy of Medical Sciences).Jonathan Grant Uxbridge Sharif Ismail and Adrian Towse for reviewing an earlier Steve Hanney Middlesex UB8 3PHSharif IsmailEddy Nason draft; and Nicky Dunne for her skill and We would like to thank: members of the Steering Group for Steve Morris Eddy Nason E martin.buxton@brunel.ac.ukSteve Wooding patience in turning our various different their advice and support (Liz Allen, Nick Black, David Cox, Leonie Sundmacher Steve Wooding
contributions and frequent changes into Jonathan Haskel, Helen Munn, Briony Rayfield, Martin Roland,
Institute of Psychiatry a single final document.Rhiannon Tudor-Edwards, Ian Viney and Martin Weale); Thed
OHE Institute of PsychiatryShitij Kapur ISBN 978 1 84129 080 5van Leeuwen (CWTS, Leiden) for bibliometric services provided;
Jorge Mestre-Ferrandiz Shitij Kapur various colleagues in our respective organisations for their help
Martina Garau in a variety of ways; Tony Culyer, Evi Hatziandreu and Adrian
Jon Sussex Towse for reviewing an earlier draft; and Nicky Dunne for her This report is made freely available for non-commercial private study or research. You are free to use or make personal copies in print or electronic format.
skill and patience in turning our various different contributions You may not further reproduce, distribute, or publish any part of the report, except where you have obtained written permission from all the copyright owners.
and frequent changes into a single final document.You must obtain written permission from all the copyright owners if you wish to copy the report or any part of it for a direct or indirect commercial purpose.
a2 Medical Research: What’s it worth? Estimating the economic benefits from medical research in the UKM edical Research:
W hat’s it worth?
Estimating the economic benefits
from medical research in the UK
Health Economics Research Group (HERG)
Brunel University
Office of Health Economics (OHE)
RAND Europe
For the Medical Research Council, the Wellcome Trust
and the Academy of Medical Sciences
November 2008
Medical Research: What’s it worth? Estimating the economic benefits from medical research in the UK a3Contents
Foreword 3
Executive Summary 5
Chapter One: Introduction 8
Chapter Two: Overview of the existing literature and the issues raised 11
Chapter Three: Expenditure on cardiovascular research 16
Chapter Four: Analysis of cardiovascular guidelines 20
Chapter Five: The value of the health gains in cardiovascular disease and their associated health care costs 24
Chapter Six: R&D spillovers 33
Chapter Seven: Estimating the rates of economic return from public and charitable CVD research 41
Chapter Eight: Applying our methodology to mental health 44
Chapter Nine: Our contribution, our conclusions and main reservations, and a research agenda 51
Annex to Chapter Two 56
Annotated bibliography
Annex to Chapter Three 60
Breakdown of expenditure on cardiovascular research (in £m), by year, 1970–2005
Annex to Chapter Four 61
More detailed, qualitative analysis of the importance of UK research in UK guidelines
Annexes to Chapter Five 64
Annex 5A: Studies used to generate QALYs gained for each intervention in each patient group
Annex 5B: Estimating the numbers of eligible patients in each patient group
Annex 5C: Adjusting for overlapping patient groups
Annex 5D: Estimating the uptake rates for specific interventions in each patient group
Annex 5E: Adjusting for compliance
Annex 5F: Adjusting for polytreatment
Annex 5G: Estimates of total QALYs gained by year used to generate Figure 5.1
Annex 5H: Studies used to generate incremental costs for each intervention in each patient group
Annex 5I: Estimates of total incremental costs by year used to generate Figure 5.2
Annex 5J: Sensitivity analysis
Annex to Chapter Six 77
Literature review on R&D spillovers
Annex to Chapter Seven 92
Lag structures
Annexes to Chapter Eight 93
Annex 8A: Breakdown of public, non-profit and private expenditure on mental health research (in £m),
by year, 1970–2005
Annex 8B: List of mental health guidelines analysed
Annex 8C: Studies used to generate QALYs gained for each intervention in each patient group
Annex 8D: Estimating the numbers of eligible patients in each patient group, the numbers of initial
contacts with community psychiatric nurses and the number of SSRI users
Annex 8E: Estimating the uptake rates for specific interventions in each patient group
Annex 8F: Studies used to generate incremental costs for each intervention in each patient group
Annex 8G: Sensitivity analysis
References 99
Medical Research: What’s it worth? Estimating the economic benefits from medical research in the UK 12 Medical Research: What’s it worth? Estimating the economic benefits from medical research in the UKForeword
The UK Evaluation Forum was first initiated by the So, in late 2006, the Academy of Medical Sciences,
Academy of Medical Sciences, the Medical Research the Medical Research Council and the Wellcome
Council and the Wellcome Trust in 2004. Drawing Trust started a process to commission such research.
together representation from Government, the research The overall aim of the work was to compare the
councils, medical charities and academia, the broad macroeconomic benefits accruing from UK medical
aim of the Evaluation Forum was to co-ordinate activity research with the cost of that research – ultimately
in determining the socio-economic benefits of UK to give a quantitative assessment of the benefit of
medical research. medical research to the UK. It was also expected
that the research would critically appraise both the
Following an initial mapping exercise of evaluation
selected approach and previous attempts to estimate
practices in member organisations, an international
the economic returns from research. In this way,
symposium was convened in 2005 to discuss evaluation
the goal was not to obtain a definitive answer about
needs and expectations amongst UK research
the returns on the investment in UK medical research,
stakeholders and to review what had already been
but to generate a piece of work that would help to move
attempted in demonstrating the socio-economic impact
this young field forward and inform methodologies for
of health research in other countries. The outputs of
future assessments.
the symposium, and the further deliberations of the
Evaluation Forum, were published in the 2006 report The work presented in this report, carried out by a
Medical Research: Assessing the benefits to society. consortium involving the Health Economics Research
Group at Brunel University, RAND Europe and the
Chapter 3 of that report summarised previous
Office of Health Economics, certainly fulfils this hope.
approaches to assessing the economic and financial
We are most grateful to the members of this consortium,
impacts of medical research. Particular attention was
led by Professor Martin Buxton, for the expertise, care
given to the ‘exceptional returns’ work published in
and enthusiasm they have brought to the study. This
the United States, which suggested that investment in
is an enormously valuable contribution to an important
medical research is returned many times over in societal
issue for UK medical science and we look forward
benefits. However, it was emphasised that the US work
to working with our partners in the Evaluation Forum
made a substantial number of important assumptions
and elsewhere to take forward the research agenda
that may not be applicable to the UK situation. One of
presented in this report.
the five recommendations of our report was therefore
“that research funders