In this ‘Patti’s People’ episode, Patti Peeples of The Peeples Collaborative speaks with Mark Sculpher (Director, Centre for Health Economics, University of York) about why the biggest challenge in cost-effectiveness analysis is political rather than methodological, and why opportunity cost must sit at the heart of how health systems value and price new medicines.
Questions:
00:00: Introduction
01:13 Has cost-effectiveness lost authority, or is it simply being selectively applied?
06:52: What does the disconnect between marginal productivity and thresholds reveal about how value is actually determined?
12:35: Why is opportunity cost still so poorly internalized in decision-making?
15:04: Is the inability to say no to new technologies a failure of method, political will, or something structural?
20:21: Are we building sophisticated models for systems that don’t behave as assumed?
25:48: What would a fair distribution of value between manufacturers and health systems look like?
32:49: Why are advanced methods for uncertainty still underused?
37:47: How should systems balance maximizing health versus reducing inequality?
42:35: Has NICE adapted appropriately, or compromised its core logic?
46:08 What role should ISPOR realistically play in shaping policy?
49:50: Rapid Fire Questions
Mark Sculpher
Director, Centre for Health Economics, University of York
Mark Sculpher is Professor of Health Economics and Head of Department for CHE. He is also Co-Director of the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU). He has been based at the University of York since 1997.
Between 1988 and 1997, he worked at the Health Economics Research Group at Brunel University; during 1998 he was a visitor in the Department of Clinical Epidemiology and Biostatistics at McMaster University in Canada.
Mark has worked extensively in the field of economic evaluation in health, with experience in areas including heart disease and various cancer. He has also contributed to methods in the field, in particular relating to decision analytic modelling and handling uncertainty. He has over 300 peer-reviewed publications and is a co-author of two major text books in the field: Methods for the Economic Evaluation of Health Care Programmes (OUP, 2015 with Drummond, Claxton, Torrance, and Stoddart) and Decision Modelling for Health Economic Evaluation (OUP, 2006 with Briggs and Claxton). He was also a member of the Second Panel on Cost-Effectiveness in Health and Medicine.
Mark was a member of the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee (2004-8), the NICE Public Health Interventions Advisory Committee (2006-9) and the NICE Diagnostics Advisory Committee (2010-20). He chaired NICE's 2004 Task Group on methods guidance for economic evaluation and was a member of the Methods Working Party for the 2008 update of this guidance. He was a member of the Commissioning Board for the UK NHS Health Technology Assessment Programme (2007-10), the UK National Institute for Health Research (NIHR)/Medical Research Council (MRC) Methodology Research Panel (2008-11) and the MRC-NIHR Methodology Research Advisory Group (2016-20). He was a member of the NIHR Policy Research Programme’s Commissioning Panel (2011-14). Mark is a NIHR Senior Investigator (Emeritus) and is a former President of the International Society of Pharmacoeconomics and Outcomes Research. In 2024, Mark was elected as a Fellow of the Academy of Medical Sciences.
Recent national and international advisory roles include the Singapore Agency for Care Effectiveness International Advisory Panel (2017-18); UK Health Select Committee Availability of Orkambi on the NHS inquiry (2018-19); Portuguese National Authority of Medicines and Health Products (2018-20).
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