Economic appraisal in the British National Health Service: implications of recent developments.

This paper discusses the role of economic appraisal in the U.K. National Health Service, with particular emphasis on the impact of the recent reforms. A number of agencies, including the Department of Health, research councils, health authorities and industry, fund appraisals, the majority of which are carried out by academic researchers. To date there is little formal documentation of the impact of appraisals. The recent reforms should, in principle, increase the opportunities and demand for economic appraisal. The reforms establish an internal market for health care with separate roles for purchasers and providers. There are opportunities for using appraisals in deciding whether or not to place a contract, in deciding on the contract specification and in monitoring the prescribing budgets of general medical practitioners. The new NHS research and development strategy also places particular emphasis on research into the effectiveness and cost-effectiveness of health technologies, and on getting the results of research used in decision making.