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Pragmatic Clinical Trials Unit

Economic Evaluation

Economic evaluation is comparative analysis of health benefits and costs of alternative treatment or management strategies. It is increasingly used in healthcare decision making in the UK and around the world. Economic analyses are often integrated in randomised and other prospective studies and utilise study design as a vehicle of estimation of comparative costs and outcome of the target intervention strategies. In this theme, we work toward development of methodology for these analyses and collaborate with trialists and other methodologists in designing rigorous economic evaluations to inform decisions. We also teach economic evaluation methods in our courses.

Specific topics of our work include:

  • Designing economic evaluation studies
  • Resource use data measurement and analysis
  • Health outcome measurement and analysis
  • Economic evaluations alongside different types of clinical trials
  • Assessing heterogeneity in cost-effectiveness across patient populations
  • Evaluating uncertainty in economic evaluations and presenting results
  • Use of economic evaluations to inform policy

 Ongoing projects


  • CTT
  • East London CVD prevention


  • STOP






  • Point of care antibody testing

Mental Health

  • ERA
  • TACK
  • Self-harm in in Adolescence
  • Remote IMPULSE


  • Fresh St
  • UK Salt reformulation policy 

References to our published papers:

Thorn JC, Davies CF, Brookes ST, Noble SM, Dritsaki M, Gray E, Hughes DA, Mihaylova B, Petrou S, Ridyard C, Sach T, Wilson ECF, Wordsworth S, Hollingworth W (2021). Content of Health Economics Analysis Plans (HEAPs) for trial-based economic evaluations: expert Delphi consensus survey. Value in Health. 24(4):539–547. 10.1016/j.jval.2020.10.002 

François Mach, Colin Baigent, Alberico L Catapano, Konstantinos C Koskinas, Manuela Casula, Lina Badimon, M John Chapman, Guy G De Backer, Victoria Delgado, Brian A Ference, Ian M Graham, Alison Halliday, Ulf Landmesser, Borislava Mihaylova, Terje R Pedersen, Gabriele Riccardi, Dimitrios J Richter, Marc S Sabatine, Marja-Riitta Taskinen, Lale Tokgozoglu, Olov Wiklund, ESC Scientific Document Group (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS), European Heart Journal. 41: 111–188. 

Edwards MR, Forbes G, MacDonald N, Berdunov V, Mihaylova B, Dias P, et al. (2019). Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery. BMJ Open.9(1):e023455. 10.1136/bmjopen-2018-023455

Schlackow I, Kent S, Herrington W, Emberson J, Haynes R, Reith C, Collins R, Landray MJ, Gray A, Baigent C, Mihaylova B, on behalf of the SHARP Collaborative Group (2019). Cost-effectiveness of lowering LDL cholesterol with statins and ezetimibe in chronic kidney disease. Kidney International. 96: 170–179. 10.1016/j.kint.2019.01.028

Castellani J, Mihaylova B, Siribie M, et al. Household costs and time to treatment for children with severe febrile illness in rural Burkina Faso: the role of rectal artesunate (2018). Malar J. 17(1):380. 10.1186/s12936-018-2526-8

Morton RL, Schlackow I, Gray A, Emberson J, Herrington W, Staplin N, Reith C, Howard K, Landray MJ, Cass A, Baigent C, Mihaylova B, on behalf of the SHARP Collaborative Group (2018). Impact of chronic kidney disease on household income, Kidney International Reports. 3: 610–618  10.1016/j.ekir.2017.12.008

Lokuge K, Waard DD, Halliday A, Gray A, Bulbulia R, Mihaylova B (2018). Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time. Br J Surg.105(1):26-36. 10.1002/bjs.10717

Clayton G, Smith I, Higgins JPT, Mihaylova B, Thorpe B, Cicero R, Lokuge K, Forman J, Tierney JF, White IR, Sharples LD, Jones HE (2017). The INVEST project: Investigating the use of evidence synthesis in the design and analysis of clinical trials. Trials. 18:219. 10.1186/s13063-017-1955-y

Castellani J, Nsungwa-Sabiiti J, Mihaylova B, Ajayi IO, Siribie M, Afonne C, Balyeku A, Serme L, Sanou AK, Sombie BS, Tiono AB, Sirima SB, Kabarungi V, Falade CO, Kyaligonza J, Evers SM, Paulus AT, Petzold M, Singlovic J and Gomes M (2016). Impact of Improving Community-Based Access to Malaria Diagnosis and Treatment on Household Costs. Clin Infect Dis.63:S256-S263. 10.1093/cid/ciw623

Kent S, Haynes R, Hopewell J, Parish S, Gray A, Landray M J, Collins R, Armitage J, Mihaylova B on behalf of the HPS2-THRIVE Collaborative Group (2016). The Effects of Vascular and Nonvascular Adverse Events and of Extended-Release Niacin with Laropiprant on Health and Healthcare Costs. Circulation: Cardiovascular Quality and Outcomes. 9:348-354. 10.1161/CIRCOUTCOMES.115.002592

Mihaylova B, Schlackow I, Herrington W, Lozano-Kühne J, Kent S, Emberson J, Reith C, Haynes R, Cass A, Craig J, Gray A, Collins R, Landray M, Baigent C, on behalf of the SHARP Collaborative Group (2016). Cost-effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).  American Journal of Kidney Diseases. 67(4): 576-584. 10.1053/j.ajkd.2015.09.020

Kent S, Schlackow I, Lozano-Kuhne J, Reith C, Emberson J, Haynes R, Gray A, Cass A, Baigent C, Landray MJ, Herrington W, Mihaylova B, on behalf of the SHARP Collaborative Group (2015). What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrol.16(1):65. 10.1186/s12882-015-0054-0

Castellani J, Mihaylova B, Evers SM, Paulus AT, Mrango ZE, Kimbute O, Shishira JP, Mulokozi F, Petzold M, Singlovic J, Gomes M (2015). Out-of-Pocket Costs and Other Determinants of Access to Healthcare for Children with Febrile Illnesses: A Case-Control Study in Rural Tanzania. PLoS One.10(4):e0122386. 10.1371/journal.pone.0122386

Alva M L, Gray A, Mihaylova B, Leal J, Holman R (2014). The impact of diabetes-related complications on healthcare costs: new results from the UK Prospective Diabetes Study. Diabetic Medicine. 32(4):459-466. 10.1111/dme.12647

Alva M, Gray A, Mihaylova B, Clarke P (2014). The effect of diabetes complications on health-related quality of life: the importance of longitudinal data to address patient heterogeneity. Health Economics. 23(4): 487-500. 10.1186/1745-6215-12-s1-a64

Mihaylova B, Briggs A, O'Hagan A, Thompson SG (2011). Review of statistical methods for analysing healthcare resources and costs. Health Economics.20(8):897-916. 10.1002/hec.1653

Mihaylova B, Pitman R, Tincello D, van der Vaart H, Tunn R, Timlin L, Quail D, Johns A, Sculpher M (2010). Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study. Value in Health.13(5):565-72. 10.1111/j.1524-4733.2010.00729.x

Mihaylova B, Briggs A, Hlatky M, Armitage J, Parish S, Gray A, and Collins R (2009). Statin cost-effectiveness in the United States for people at different vascular risk levels. Circulation: Cardiovascular Quality and Outcomes.2:65-72. 10.1161/CIRCOUTCOMES.108.808469

Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R on behalf of the Heart Protection Study Collaborative Group (2005). Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet.365:1779-85. 10.1016/S0140-6736(05)63014-0

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