Health Economics Research Group

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Developing and Applying a Framework for Assessing the Payback from Medical Research

 

Dr Steve Hanney and Prof Martin Buxton Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UB8 3PH (UK)

stephen.hanney@brunel.ac.ukIs it worth spending money on medical research?Increasingly governments and other funders of research are asking what they are getting for the money spent on health research. In response a stream of work to assess the payback from health research started at HERG in 1993. It is now informing the debate on assessing the benefits of medical research in a range of countries, including Canada and The Netherlands and in international bodies such as the World Health Organization.

Reasons for assessing payback from medical researchThree main sets of reasons exist for assessing payback:

 

The payback framework developed at HERG HERG’s payback framework has two elements: a multi-dimensional categorisation of benefits from health research, and a model of how best to assess them (Buxton and Hanney, 1996). The two elements fit together: the model helps to indicate where the various categories of benefit will be most likely to occur. This logic model helps facilitate assessment and taking a detailed approach enables the issue of the counter-factual to be addressed: what would the world have looked like without the specific research being examined? The multi-dimensional categorisation of paybackThe multi-dimensional categorisation of payback consists of 5 main categories and key sub-categories:

Payback model for assessing the outputs and outcomesThe logic model has seven stages and two interfaces with considerable feedback (Hanney et al., 2003). See Figure 1. The framework highlights the interfaces between the research system and both its environment and the stock of knowledge. Here the level of permeability is important; this emphasises the need for activities and mechanisms at the interfaces to enhance the likelihood of research being conducted that meets the needs of potential users and engages the interest of leading researchers, and is then fed back into the wider environment. Whilst the model simplifies reality, it provides a structured way of organising and presenting case studies.

Analysis at the early stages of the model is particularly valuable where the intention is to address the second main aim of conducting payback assessments, i.e. to identify factors associated with different levels of payback in the hope of informing the conduct and management of future research. While in the later stages it is not possible totally to tie the multi-dimensional categories of benefits to certain stages of the model, it is feasible to identify broad correlations: categories a) and b) are together considered to be the primary outputs from research; category c) relates to the secondary outputs; and categories d) and e) are the final outcomes.  Applications of the payback frameworkThe payback framework was originally tested in case studies. Subsequently it was used to assess the impact of various NHS R&D Programmes, and to analyse the long term impact of two bodies of basic and clinical research. It is currently informing the development of an evaluation framework by the Canadian Institutes of Health Research. Internationally there is interest from medical research charities in applying the framework, following its successful application to show the impact of the research funded by the UK’s Arthritis Research Campaign (see separate poster). References  Buxton M and Hanney S (1996) How can payback from health services research be assessed? Journal of Health Services Research and Policy, 1: 35-43.

Hanney S, Gonzalez-Block M, Buxton M and Kogan M (2003) The utilisation of health research in policy-making: Concepts, examples and methods of assessment. Health Research Policy and Systems, 1 (2) http://www.health-policy-systems.com/content/1/1/2.

• to provide accountability for funds spent and justification for future funding;• to inform research policy and management so as to enhance payback;• to assist with prioritising future research

a) Knowledge productionb) Research targeting, capacity building, absorptionc) Informing policy and product developmentd) Health and health sector benefits

- health gain- cost-savings- improvements in processes of

health care- equity

e) Broader economic benefits- benefits from commercial

developments- healthy workforce.

Figure 1: HERG’s Payback Model: Recent Version (Source: Hanney et al, 2003)