RAND Europe Focus on the burden of disease
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Most research and assessments of the impact of a health condition analyse the direct effect on patient populations, using metrics such as morbidity (years spent living with a disease), mortality (years lost due to the disease) and impacts on patient quality of life. Some research also considers impacts on health service use, for example in the context of consultations with healthcare professionals and hospital admissions.
The wider impacts of disease on society, including impacts on the economy, are considered less often in burden of disease studies.
The wider impacts of disease on society are considered less often in burden of disease studies. This means that most research paints a limited picture of how society more broadly – spanning patients, their carers and families, and the wider economy - is affected.
RAND Europe is at the forefront of efforts to develop a more rounded understanding of the true scale and nature of disease burden and the value of healthcare innovations in mitigating this burden. This is essential to identifying potential unmet patient needs, illuminating healthcare service priorities, and reducing health inequalities, as well as for informing clinical practice and future research and policy.
Traditional health economic evaluations, such as cost-effectiveness or cost-utility analysis, predominantly focus on how health technologies or interventions affect patients’ health, quality of life and healthcare costs, and sometimes on productivity losses or the burden on carers. While useful, these approaches look specifically at the effects on the health sector and often do not capture how changes in population health affect the wider economy.
To assess the broader economic value of health technologies and innovations, RAND Europe applies “Computable general equilibrium (CGE)” macroeconomic models and advanced analyses, which go further by examining how health influences the entire economic system and not just a single sector in isolation. Unlike existing economic evaluation methods, CGE models explicitly capture spillover effects and feedback mechanisms not just between different sectors but across a variety of different economic actors, including households, firms and governments, domestically and abroad.
RAND Europe’s CGE models can assess long-term impacts, making them well-suited to evaluating chronic health conditions, infectious diseases, as well as preventive interventions and the value of classes of therapeutic innovation. CGE models provide policymakers with a clearer picture of the wider economic return on investment in health and allow comparisons with other major public investments, such as in education, defence or infrastructure.
Areas of focus
Clinical burden and patient care pathways
We seek to understand the scale of a disease’s burden and its impact on patients, caregivers, healthcare professionals, and health systems. This includes quantifying the prevalence/incidence of disease, highlighting the experiences and preferences of individuals impacted by disease or those who diagnosis, treat, or manage disease. We conduct mappings of clinical care pathways and identify facilitators and barriers along these pathways to help policymakers arrive at actionable ways to improve access to care and the quality of service delivery.
Economic burden and societal value of healthcare innovations
We seek to understand the economic impact of disease, through a combination of epidemiological modelling and a variety of different health economic evaluation approaches, such as cost-effectiveness or cost of illness analyses. Specifically, we have developed methods to evaluate the value of healthcare innovations by using an economic system modelling approach, which enables the identification of value drivers beyond the healthcare sector, including an assessment of the potential fiscal implications of public health policies. Throughout the process, we proactively disseminate insights from our work.
Our approach
We use a suite of qualitative and quantitative methodologies in our approach to understanding the burden of disease and the societal value of healthcare innovations. These include traditional methods, as well as more innovative, non-traditional methods. Several of these innovative methods were developed by RAND, including Delphi exercises and serious gaming.
Traditional methods
- Literature reviews
- Surveys
- Focus groups
- Impact assessment
- Interviews
- Ethnography
- Observational studies
- Health economics and advanced economic modelling
Innovative methods
- Futures methods
- Technology forecasting
- Horizon scanning
- User-centred co-design
- Serious gaming and red-teaming
- Rapid-cycle and mixed-method evaluations
- Discrete choice experiments
- Consensus building
Examples of our work
The socio-economic value of effectively managing moderate atopic dermatitis in Europe
Atopic Dermatitis (AD) affects nearly every aspect of a person’s life, including physical comfort, sleep quality, psychological well-being and social functioning. AD imposes a substantial economic burden on both healthcare systems and national economies. RAND Europe is evaluating the evidence on the burden of moderate atopic dermatitis to understand how current treatment pathways and guidelines are perceived by patients and healthcare providers, and to examine how novel therapies can reduce patient burden and costs to healthcare systems and national economies.
Estimating the global economic costs of antifungal resistance
RAND Europe has been tasked to estimate the current and future cost of antifungal resistance (AFR) in the global economy between 2025 and 2050 with the aim to highlight the potential economic risks of no further action to tackle the issue of AFR.
The economic impacts of antimicrobial resistance in livestock (EcoAMR)
RAND Europe assessed the economics antimicrobial resistance (AMR) and antimicrobial use in livestock, generating new evidence on the economic pathways and burden of AMR in the food animal production. In addition, researchers presented a series of recommendations to combat the poential economic impact of AMR in livestock.
The importance of general equilibrium in health economic evaluations
Most approaches to quantifying the productivity costs associated with illness only capture partial equilibrium effects, underestimating the true costs. RAND Europe researchers stress the importance of accounting for sizable general evaluation effects when conducting health economic evaluations.
The societal and economic burden of insomnia in adults
Chronic insomnia is associated with reduced productivity in the workplace due to absenteeism and presenteeism, resulting in a loss of an average of 44–54 working days per worker with chronic insomnia every year and reductions to national GDPs, ranging from 0.64% to 1.31%, or approximately $1.8–207.5 billion.
How nocturia affects health and productivity
Nocturia is associated with up to $79 billion lost economic output per year across six countries, indicating that both nocturia and poor sleep quality offer important opportunities for intervention.
Impact of respiratory syncytial virus
The economic impact of respiratory syncytial virus in children under 5 in the UK each year to be about £14 million in lost productivity of parents and carers; £1.5 million of their out-of-pocket costs; and £65 million of healthcare costs. Thus, the total economic cost is estimated to be around £80 million each year.
Estimating the economic costs of antimicrobial resistance
Based on a theoretical model (called a dynamic general equilibrium model) that explored different future global scenarios in order to see what effect they would produce on the global economy, failing to tackle AMR will mean that the world population by 2050 will be between 11 million and 444 million lower than it would otherwise be in the absence of AMR.
COVID-19 and the cost of vaccine nationalism
Vaccine nationalism – a situation in which countries push to get first access to a supply of vaccines and hoard key components for vaccine production – could lead to the unequal allocation of COVID-19 vaccines and cost the global economy up to $1.2 trillion a year in GDP terms.
Societal burden of disease progression in multiple sclerosis
Multiple sclerosis is associated with high economic costs to society that go beyond costs to the healthcare system. However, there is limited evidence on the impact of disease progression on patients, carers, and society as a whole indicating the need for further studies in this area.
Societal impacts of treatment of early breast cancer
The cost of early breast cancer extends beyond the direct cost of care. It includes costs associated with quality of life, out-of-pocket expenses and costs as a result of loss of productivity. Furthermore, existing effective treatment for early breast cancer may lead policymakers and payers to underestimate the need for investment in further improvements and innovation.
The societal and economic burden of seasonal influenza in working-aged adults
An estimated that 2.4 million working adults could be infected with influenza, resulting in 4.8 million working days lost annually in the UK. This equates to a loss of £644 million to the UK’s economy (0.04% GDP). Increasing vaccination rates in working adults by 10-percentage points from current rates within each employment sector could increase the national GDP by £258 million.
Addressing challenges in care for patients with Clostridioides difficile infection
Clostridioides difficile infection (CDI) is associated with challenges in diagnosis,it can be difficult to differentiate between CDI and other conditions presenting with similar symptoms ; difficulties in distinguishing a new CDI from a recurring one; high cost of some CDI treatments, creating barriers to accessing.
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Email us at: healthcareinnovation@randeurope.org