Christopher James Sampson

Office of Health Economics | OHE

There is growing interest in cost-effectiveness thresholds as a tool to inform resource allocation decisions in health care. Studies from several countries have sought to estimate health system opportunity costs, which supply-side cost-effectiveness thresholds are intended to represent. In this paper, we consider the role of empirical estimates of...

Purpose ‘Bolt-on’ dimensions are additional items added to multi-attribute utility instruments (MAUIs) such as EQ-5D that measure constructs not included in the core descriptive system. The use of bolt-ons has been proposed to improve the content validity and responsiveness of the descriptive system in certain settings and health conditions. EQ-5D...

Background Sleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed. Aim We sought to identify t...

Background: Students in higher education often face mental health problems with inadequate treatment options. With COVID-19 only exacerbating the already high levels of mental health problems in the younger adult population, it is imperative policy makers have the relevant evidence to inform resource allocation and investment into student mental he...

Background Sleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia. Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed. In this study, we assessed the impact...

Introduction: Babies born before 30 weeks’ gestation are at increased risk of major clinical complications and have greater nutritional requirements. Where nutritional requirements cannot be sufficiently provided for by the mother’s own milk (MOM), routine care in England uses cow milk-derived fortifiers and formulas. However, the use of cow milk i...

By convention, values for generic ‘preference-based’ measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at ‘dead = 0’ is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions,...

Publicly provided health screening programmes tend to offer standardised screening for a fixed eligible population. Recently, the development of risk calculation engines has introduced the potential for the stratification of screening based on individuals' risks of disease onset. This possibility raises practical, methodological, and ethical challe...

Background The use of 'bolt-on' descriptors has been proposed to improve the sensitivity and responsiveness of the EQ-5D in certain contexts. An Australia/UK collaboration is developing bolt-ons for vision (5L-Vis) and cognition (5L-Cog) for self-and proxy-completion, using qualitative and quantitative methods. The application of qualitative method...

OBJECTIVES Access to non-pharmacological interventions for insomnia is limited, despite evidence for their effectiveness. This is due in part to a shortage of trained providers. Digital cognitive behavioural therapy for insomnia (dCBT-I), which requires less input per session, is there-fore an attractive complement or substitute to face-to-face cog...

OBJECTIVES Access to non-pharmacological interventions for insomnia is limited, despite evidence for their effectiveness. This is due in part to a shortage of trained providers. Digital cognitive behavioural therapy for insomnia (dCBT-I), which requires less input per session, is therefore an attractive complement or substitute to face-to-face cogn...

OBJECTIVES Evidence suggests that, in specific circumstances, the EQ-5D is insensitive to changes or differences in health status. One possible solution is to add 'bolt-on' dimensions to the core EQ-5D dimensions, to provide additional information about the impact of certain conditions or symptoms on health. In this study, we developed EQ-5D-5L bol...

Transparency in decision modelling is an evolving concept. Recently, discussion has moved from reporting standards to open-source implementation of decision analytic models. However, in the debate about the supposed advantages and disadvantages of greater transparency, there is a lack of definition. The purpose of this article is not to present a c...

Introduction Currently, all people with diabetes (PWD) aged 12 years and over in the UK are invited for screening for diabetic retinopathy (DR) annually. Resources are not increasing despite a 5% increase in the numbers of PWD nationwide each year. We describe the rationale, design and methodology for a randomised controlled trial (RCT) evaluating...

Background: By convention, values for the EQ-5D are anchored at 1 = full health and 0 = dead for use in estimating QALYs for cost effectiveness analysis. Consequently, the stated preference methods used to value health states often involve consideration of the state 'dead' or 'immediate death'. Using dead as an anchor also implies that states worse...

Eligibility for national screening programmes can be personalised according to individual risk in order to improve outcomes and reduce costs. Existing methods of economic evaluation can be adapted to identify risk thresholds and help optimise services. We describe the development of a decision model used to evaluate the cost-effectiveness of risk-b...

Introduction There is growing evidence that many people attending annual screening for diabetic retinopathy in the United Kingdom (UK) are at low risk of developing the disease. This has led to new policy statements. However, the basis on which to establish a risk-based individualized variable-recall screening program has not yet been determined. W...

Introduction Interventions and services for people with mental health problems can have broad remits: they are often designed to treat people with a variety of diagnoses. Furthermore, addressing mental health problems can have long-term implications for economic, social, and health outcomes. This represents a challenge for health technology assessm...

Economic evaluation in human health care tends to adopt an ’extra-welfarist’ approach. The key manifestation of extra-welfarism is the maximisation of health within a given budget. We outline the extra-welfarist framework and evaluate its applicability to various contexts of animal welfare. Many of the reasons for the adoption of an alternative to...

Losing a loved dog accidentally or through theft is traumatic. Roads are busier and pet theft increasing in the UK. Owners feel loss akin to human bereavement. Searching for a pet is costly in financial and emotional terms. This work uses the exemplar of Harvey’s Law to illustrate the cost. In 2014 the Highways Agency withdrew routine scanning and...

Evidence regarding the effectiveness of health technologies can be distorted via numerous mechanisms, including publication bias, methodological errors, over- interpretation of findings and fraud. In recent years, popular science writers have brought these issues to the fore, resulting in popular movements to improve the credibility of science. One...

Background. Systematic reviews of health state utility values (HSUVs) are recommended for the identification of parameters in decision modelling. However, most models adopt a single source and are susceptible to biased estimates. Diabetic retinopathy is a leading cause of blindness and earlier stages of disease may affect quality of life. A synthes...

Background Diabetic retinopathy is a leading cause of blindness in the working age population in Europe. Effective treatment is available that can slow disease progression and prevent vision loss and its associated costs. However, it is important to detect retinopathy in the early stages of disease before patients experience symptoms. Therefore, al...

Background Persistent moderate or severe unipolar depression is common and expensive to treat. Clinical guidelines recommend combined pharmacotherapy and psychotherapy. Such treatments can take up to 1 year to show an effect, but no trials of suitable duration have been done. We investigated the efficacy and cost-effectiveness of outpatient-based,...

In this commentary, we consider the recent recommendation by the UK National Screening Committee (NSC) that people with diabetes at low risk of sight loss should be invited to screening every 2 years rather than annually [1]. We broadly support this recommendation but believe that there are important outstanding questions that require attention bef...

Design: Observational cohort study. Purpose: Data on incidence and prevalence of diabetic retinopathy is largely from studies performed in the 1980s, since when important changes in treatment and diagnosis have occurred. We aim to estimate long term changes in patient related outcomes of sight threatening retinopathy and treatment rates in a curren...

Design of study Health-related quality of life questionnaire study. Purpose To estimate generic health-related quality of life for a cross-section of attenders within the UK screening programme for sight threatening diabetic retinopathy (DR), in order to inform calculation of quality-adjusted life years for model-based economic evaluation. Methods...

Design of study Microcosting study with collection and analysis of primary and secondary data on resource use and costs. Purpose To estimate the cost of screening within the NHS Diabetic Eye Screening Programme from a health service and societal perspective. Findings will inform future cost-effectiveness analyses of screening programmes for diabeti...

Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use. Aim: To explore the feasibility and acceptability of cognitive-behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence r...

NICE guidelines recommend a stepped care approach for the identification and management of children with, or at risk of, Attention-Deficit / Hyperactivity Disorder (ADHD). We investigated the effectiveness, cost-effectiveness and acceptability of a group parenting intervention programme (+/- a teacher session) for children at risk of ADHD. Methods...

Background. Interventions and services for people with mental health problems can have broad remits: they are often designed to treat people with a variety of diagnoses. Furthermore, addressing mental health problems can have long term implications for economic, social and health outcomes. This represents a challenge for economic evaluation, where...

Background. Interventions and services for people with mental health problems can have broad remits: they are often designed to treat people with a variety of diagnoses. Furthermore, addressing mental health problems can have long term implications for economic, social and health outcomes. This represents a challenge for economic evaluation, where...

End-of-life care has a number of characteristics that make economic evaluation particularly challenging. These include proximity to death, the improbability of survival gain, individuals’ changing priorities, declining cognition and effects on close persons. In view of these particularities of end-of-life care, some researchers have determined that...

Personalised medicine presents the opportunity to improve outcomes by accounting for patient heterogeneity and providing individualised care. However, this raises practical and ethical dilemmas and is a challenge for health economists. We argue that there is one form of personalised medicine risk-­based screening ­ that can be practically and ethic...

Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status. Objective....

Background: Combined psycho- and pharmacotherapy has been found to offer greater effectiveness than single interventions, though evidence from randomised controlled trials remains limited. Individuals with resistant depression have limited treatment options in the UK. Aim of the Study: This study sought to determine the cost-effectiveness of a spec...

Personalised medicine can raise practical and ethical dilemmas. We argue that there is one form of personalised medicine — risk-based screening — that can be practically and ethically implemented. There is necessarily a relationship between an individual’s risk of disease onset and the cost-effectiveness of screening them for that disease. The expe...

Background People with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial...

Background: Three-dimensional laser scanning has been used for patient measurement for cranial helmets and spinal braces. Ankle–foot orthoses are commonly prescribed for children with orthopaedic conditions. This trial sought to compare ankle–foot orthoses produced by laser scanning or traditional plaster casting. Objectives: Assessment of the effe...

This is where the 'Drop Dead' project properly started for me, with a seminar to my colleagues. In it, I focus on the idea that the states we use for anchors in health state valuation aren't well-chosen. It took six years for these ideas to make their way into the wider world. Looking back, I knew very little about health state valuation in 2014, b...

Occupational therapy interventions, such as home visits, have been identified as being resource-intensive, but cost-effectiveness analyses are rarely, if ever, carried out. We sought to estimate the cost-effectiveness of occupational therapy home visits after stroke, as part of a feasibility study, and to demonstrate the value and methods of econom...

Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC). Method: Pre...

A high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive...

Resources are always scarce, but the possible uses of these resources are limitless. This simple observation underlies much of what economists do. It leads to competing demands from different parties and requires individuals and organisations to make choices about their use of scarce resources. The primary purpose of economics is to help us underst...

Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual's level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information...

Objective: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. Design: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled tri...

Introduction Early intervention for childhood behavioural problems may help improve health and educational outcomes in affected children and reduce the likelihood of developing additional difficulties. The National Institute for Health and Clinical Excellence guidelines for attention deficit/hyperactivity disorder (ADHD), a common childhood behavio...

Objectives Treatment non-completion is identified as a major problem for those who provide care for personality disorder. In particular the cost of non-completion may be significant. A review of the literature demonstrates a lack of research in this area. This paper uses the literature, combined with a model based on data from an existing service,...