United Kingdom, health care systems

The precise role of economic evaluation varies among countries. In the vast majority of jurisdictions the role is confined to decisions about pharmaceuticals only, although the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom also considers devices, medical procedures, and public health interventions. Even among those countries considering only pharmaceuticals, there are variations in policy. In some, all new pharmaceuticals are considered, whereas in others only those drugs having a premium price, or likely to have a major impact on the health care system, are evaluated. 

The WHO report noted that many countries are falling far short of their potential and that expenditures per se do not necessarily produce the best system. This is exemplified by the fact that the United States, which is ranked 37th, spends 13.7% of its gross domestic product on health care, while the United Kingdom, which is ranked 18th, spends only 5.8%. 

We recently surveyed pharmaceutical companies producing antidepressant medication or central nervous system (CNS) stimulants for the European market. Approval for use of such drugs in children and adolescents is limited worldwide. Sertraline, clomipramine, and flu-voxamine have been approved for use in children (for some drugs down to the age of 6 years) for OCD in some European countries (the most wide spread approval being for sertraline in Austria, France, Hungary, Italy, Latvia, Norway, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and Denmark) and countries outside Europe. Methyl-phenidate has been approved for the treatment of children with ADHD in a number of European and non-European countries (Novartis Health care A/S, personal communication). 

Hannigan, B. Allen, D. 2006, Complexity and change in the United Kingdom s system of mental health care, Soc. Theory Plealth, vol. 4, pp. 244-263. 

These databases have been utilized in pharmacoepidemiology research for several decades in North America and Europe. Most reflect the underlying qualities of the health-care delivery system. For example, EHR databases for a particular physician in the United States may not capture health care provided to the same patient outside of that practice, while databases from general practitioner (GP) gatekeeper systems (as in the United Kingdom) generally capture most of the patient s interactions because they must be referred and have care coordinated through the GP. 

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