Twenty-five years ago, when the Centre for Health Economics Research and Evaluation (CHERE) was formed, doctors and politicians thought matters of money should not determine what treatments were available.
Today, as CHERE marks its anniversary and a time when our health dollars have to go further, clinicians and policy makers are much more likely — and able — to measure cost effectiveness, in the broadest sense, thanks to the work of the centre.
From small beginnings at Westmead Hospital in 1991, CHERE is now one of the largest health economics research units in Australia and a leader in health economics research internationally.
“Twenty-five years is a significant landmark for any research endeavour,” says Professor Attila Brungs, Vice-Chancellor of the University of Technology Sydney (UTS), where CHERE is now based, as part of UTS Business School. “CHERE continues to make increasingly important contributions to Australian health policy through its high quality research and policy engagement.
“Its focus on the broader health system and how it can be evolved is the single most important thing to ensure our children get at least as good health as we enjoy,” Professor Brungs says. “Twenty-five years is a long time, but CHERE’s impact and activities are accelerating now faster than ever.”
“Twenty-five years is a long time, but CHERE’s impact and activities are accelerating now faster than ever.”
The Dean of UTS Business School, Professor Roy Green, says CHERE has shaped health economics in Australia and health policy internationally, directly and indirectly.
“Its influence is evident not only in policy contributions and research outputs but also in terms of the number of distinguished health economists and health services researchers nationally and internationally who have worked in or with CHERE, or who have benefited from its teaching and outreach,” Professor Green says.
The centre’s Director, Professor Rosalie Viney, says CHERE is proud to have contributed to better-informed health policy and spending decisions, and to lifting the profile of health as an area for study within economics.
“It’s a legacy we plan to build on over the next 25 years."
Across its many projects over the years, CHERE has had an impact on disease diagnosis and treatment, the funding of medicines, the structure of Medicare programs and the inclusion of the patient’s perspective in decision-making, among other things.
“It’s a legacy we plan to build on over the next 25 years, with expansion of our programs and new opportunities to integrate research and education,” Professor Viney says.
Founding Director Professor Jane Hall says that when CHERE started very few people had heard of health economics.
“Today health economics is considered an essential part of health policy analysis and evaluation,” says Professor Hall, who remains at the centre as a researcher and Director of Strategy. “At the policy level there has been widespread impact in changing peoples’ thinking.”
That change in thinking has also permeated the clinical world, she says. “Twenty-five years ago most doctors and politicians thought matters of money should not determine what treatments were available. Now clinicians are very familiar with notions of cost-effectiveness analysis and the need to measure quality of life outcomes.”
Professor Hall says some of CHERE’s most important achievements have been in the sophisticated analysis of “value for money” of new treatments and health care delivery programs.
“It is now common for economic evaluation to be part and parcel of a clinical trial,” she notes.
It has become an essential part of assessing what new drugs are listed on the Pharmaceutical Benefits Scheme – where CHERE provides evaluation services – and what new treatments are added to the Medical Benefits Schedule.
“We want to understand what people want from their health systems."
Importantly, CHERE’s work has helped ensure health-related “quality of life” is measured and evaluated.
“We want to understand what people want from their health systems,” Professor Hall says of CHERE’s work. “This provides insights into what people value – and therefore how they’ll respond to policy changes.” This supports modelling of, say, the take-up of a new vaccine or the effect of a new co-payment, she says.
Incentives are also important to understand, she adds. “While achieving value-based health care needs an understanding of value, it also requires understanding incentives and how funders, providers and consumers will behave.”
Early on, CHERE made an important contribution to the development of a national breast cancer screening program by conducting the first major cost-utility analysis in Australia, taking into account not just the positive outcomes of screening but also the negative effects of anxiety and concern for women.
“CHERE has always been about doing good, doing it well and making a difference.”
The centre continues to lead the development of methods for assessing health care outcomes, in particular by bringing discrete choice experiments (DCEs) to health care. In such experiments, respondents are presented with a series of choices, varied each time, and asked to decide what they would do be in those circumstances.
In this way CHERE has been able to tease out consumer preferences in areas such as immunisation and contraception and breast cancer.
Health care financing is an ongoing theme. CHERE’s work on private health insurance has provided new insights and its reports on the Extended Medicare Safety Net led to redesign of that policy.
“Overall, Medicare is highly valued by the Australian community, and I believe that our work has helped protect this social program,” Professor Hall says.
The basic notion that underlies a health system is equity – ensuring that people don’t miss out on beneficial health care due to lack of means, she says. Yet many of the strategies used to increase efficiency in health care conflict with equity.
CHERE was established 25 years ago because of a need to bring health economists together to generate knowledge that ensured equity was part of policy making, she says. “CHERE has always been about doing good, doing it well and making a difference.”
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