Table 1 Methods used in various studies to assess the benefits from health research
Study/features | Mushkin (1979) [[4]] | Funding first (2000) [[6]] | Access economics (2003) [[8]] | Access economics (2008) [[9]] | HERG et al.(2008) [[3]] | Access economics (2011) [[10]] |
|---|---|---|---|---|---|---|
How health gains were assessed | Top-down by disease category: overall gain in each category not linked to specific intervention. Attributed 20 to 30% of total gain to R&D. Reduced morbidity difficult to assess because little reduction in days off work because of sickness. Adjusted the raw data, for example, by applying historical Army and Navy data as an index to record the decline in sickness. | Top-down: overall gain in mortality not linked to specific interventions. Attributed roughly one-third of the total gain to R&D, plus ‘some fraction of the credit for the other two-thirds.’ | Top-down: overall gain in mortality and morbidity not linked to specific interventions. Attributed 50% of the total gain to R&D. | Top-down: as in the 2003 study, overall gain in mortality and morbidity not linked to specific interventions. Attributed 50% of the total gain to R&D. | Bottom-up: identified research-based interventions, then quantified health impact. | Top-down: overall gain in mortality and morbidity for five disease areas not linked to specific interventions. Attributed 50% of the total gain to R&D. |
How health gains were valued | Human capital approach, that is, values attached to lives saved between one period and the next, based on potential future earnings, plus calculation of value of potential working time no longer lost due to sickness. | Used a comparatively high ‘willingness-to-pay’ value derived from labour economics. | Used the same comparatively high ‘willingness-to-pay’ value as Funding First. | Used a higher ‘willingness-to-pay’ estimate than the 2003 study, this time derived from a meta-analysis of international studies. | Used a comparatively low, but arguably realistic, value of health gain by adopting the figure implied by the current level of NHS spending, that is, the opportunity cost of a QALY within the current NHS budget. | Used a lower ‘willingness-to-pay’ estimate than that used in the 2008 study, in line with Department of Finance and Deregulation guidance. |
Proportion of national health gain allocated to national research | Not discussed as a major issue; we assumed it to be 100%. | Not discussed as a major issue in Funding First; we assumed it to be 100%. | Used proportion of global research conducted in Australia (2.5%) to determine the proportion of the total research-based health gain to attribute to Australian research. | Uses bibliometric analysis-based estimate of Australian share of global research output in clinical medicine (3.04%). | An analysis of citations of UK research on UK clinical guidelines suggests average best estimate of 17% linked to UK research. | Uses an updated bibliometric analysis-based estimate of Australian share of global research output in clinical medicine (3.14%). |
Costs of health care considered? | No, at least not as a separate item to net-off against the value of the health gains. | No in initial headline figures, but Yes in later analysis: ‘the gain in the value of life, net what was spent to attain the longer life, is just 15 percent smaller.’ | No, did not net-off the healthcare costs required to achieve the health gains. | No, did not net-off the healthcare costs required to achieve the health gains. | Yes, did net-off the health care costs required to achieve the health gains. | Did not net-off health care delivery costs, but did consider avoided health system expenditure due to gains in wellbeing. |
Considered elapsed time between research and health gains? | Yes: 10Â years. | Acknowledged time lags between research and benefits but this was apparently not brought into calculations. | No, compared research expenditure and health benefits in the same year. This implies the health gains from research are instant. | Yes: 40Â years, with range of 20 to 60Â years used for sensitivity analyses. | Yes: an analysis of citations of UK research on UK clinical guidelines suggested average best estimate of 17Â years lag. | Yes: same assumption of 40Â years as was used in 2008 study. No sensitivity analysis around elapsed time. |
How the overall rate of return calculated | IRR of 47%. | Not brought together to provide an overall IRR. | An overall benefit/costs ratio for health research of 2.40. | An overall benefit/costs ratio for health research of 2.17. | IRR of 9% for CVD research combined with 30% for GDP benefits. | Benefit-cost ratios for five disease areas: 6.1 (CVD); 2.7 (cancer); 1.1 (SIDS); 1.2 (asthma); and 0.7 (muscular dystrophy). |