title: UNDERSTANDING VARIATIONS IN RELATIVE EFFECTIVENESS: A HEALTH PRODUCTION APPROACH.
abstract: BACKGROUND
  Relative effectiveness has become a key concern of health policy. In Europe, this is because of the need for early information to guide reimbursement and funding decisions about new medical technologies. However, ways that effectiveness (does it work?) and efficacy (can it work?) might differ across health systems are poorly understood.
  
  
  METHODS
  This study proposes an analytical framework, drawing on production function theory, to systematically identify and quantify the determinants of relative effectiveness and sources of variation between populations and healthcare systems. We consider how methods such as stochastic frontier analysis and data envelopment analysis using a Malmquist productivity index could in principle be used to generate evidence on, and improve understanding about, the sources of variation in relative effectiveness between countries and over time.
  
  
  RESULTS
  Better evidence on factors driving relative effectiveness could: inform decisions on how to best use a new technology to maximum effectiveness; establish the need if any for follow-up post-launch studies, and provide evidence of the impact of new health technologies on outcomes in different healthcare systems.
  
  
  CONCLUSIONS
  The health production function approach for assessment of relative effectiveness is complementary to traditional experimental and observational studies, focusing on identifying, collecting, and analyzing data at the national level, enabling comparisons to take place. There is a strong case for exploring the use of this approach to better understand the impact of new medicines and devices for improvements in health outcomes.
authors.affiliation: Office of Health Economicsatowse@ohe.org.
authors.forename: Adrian
authors.initials: A
authors.lastname: Towse
authors.affiliation: Stockholm School of Economics.
authors.forename: Bengt
authors.initials: B
authors.lastname: Jonsson
authors.affiliation: AstraZeneca.
authors.forename: Clare
authors.initials: C
authors.lastname: McGrath
authors.affiliation: University of York.
authors.forename: Anne
authors.initials: A
authors.lastname: Mason
authors.affiliation: Servei Català de la Salut (CatSalut).
authors.forename: Ruth
authors.initials: R
authors.lastname: Puig-Peiro
authors.affiliation: Office of Health Economics.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mestre-Ferrandiz
authors.affiliation: Office of Health Economics.
authors.forename: Michele
authors.initials: M
authors.lastname: Pistollato
authors.affiliation: Office of Health Economics.
authors.forename: Nancy
authors.initials: N
authors.lastname: Devlin
mesh_terms: D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004526:Efficiency; D005060:Europe; D006291:Health Policy; D013673:Technology Assessment, Biomedical / Q000379:methods*
keywords: Drug evaluation; European Union; Relative effectiveness
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