Dr Dan Jackson

Senior Research Fellow in Health Economics (part time)

Phone: Work: 01483 68 2947
Room no: 25 AC 04

Further information


Daniel is a graduate of the MSc Health Economics program at the University of York, with over 10 years of experience in Health Economics and Outcomes Research, both for industry and academia. His PhD on ‘Diagnostic technologies for Stroke related events – an economic evaluation’ was awarded in 2012.

Daniel has worked closely with the National Institute of Health and Clinical Excellence (NICE) in the UK since its inception, and has also been closely involved with the Scottish Medicines Consortium (SMC), both in demonstrating the cost-effectiveness of an intervention, but also in developing and analysing patient reported outcomes.  He has extensive experience in reviewing and developing economic models in many healthcare settings, and in conducting systematic reviews and meta analyses. He has served as the Health Economics member of the Joint Committee on Vaccination and Immunisation (JCVI) for the UK.  He is an elected fellow of the Royal College of Medicine, the Royal Society of Public Health, and the Royal Society for the encouragement of Arts, Manufactures and Commerce.

Daniel is the author of an acclaimed text in health economics, an advisor on health economics for the NIHR Research Design Service – SE, and an honorary Fellow in Health Economics at the University of Warwick.


Journal articles

  • Raats MM, Malcolm RN, Lahteenmaki L, Pravst I, Gage H, Cleary A, Karatzia A, Kusar A, Yang W, Jackson DL, Hodgkins CE, Klopcic M. (2016) 'Understanding the impact of legislation on 'reduction of disease risk' claims on food and drinks: the REDICLAIM project'. AGRO FOOD INDUSTRY HI-TECH, 27 (3), pp. 30-32.
  • Carones F, Knorz MC, Jackson D, Samiian A. (2014) 'Influence of co-payment levels on patient and surgeon acceptance of advanced technology intraocular lenses'. Journal of Refractive Surgery, 30 (4), pp. 278-281.


    PURPOSE: To investigate patients' willingness to pay for advanced technology intraocular lenses and surgeons' willingness to recommend them. METHODS: In this study, 370 cataract surgeons and 700 patients undergoing cataract surgery from seven countries underwent online interviews in which they were shown unbranded profiles of three advanced technology intraocular lenses (ie, biconvex toric aspheric optic, symmetric biconvex diffractive optic, and biconvex diffractive aspheric toric) and asked to indicate their willingness to accept (for patients) or suggest (for surgeons) each lens. Acceptance was assessed assuming there was either no co-payment or co-payments of €500 to €1,500 +15%. RESULTS: All three lenses were widely accepted by patients, with 68% to 99% indicating acceptance when there was no co-payment. In contrast, surgeons' willingness to suggest them was markedly lower (20% to 43%). Both patients' acceptance of the lenses and surgeons' willingness to suggest them decreased with increasing co-payment levels to 19% to 74% (patients) and 5% to 31% (surgeons) at the highest co-payment levels. CONCLUSIONS: There is a marked discrepancy between patients' acceptance of the three lenses and surgeons' willingness to suggest them. Although patients' acceptance is high, it decreases with increasing out-of-pocket expenditure. Manufacturers should communicate the relative benefits and costs of their lenses to both surgeons and patients. Copyright © SLACK Incorporated.

  • Jordan J, Dowson H, Gage H, Jackson D, Rockall T. (2014) 'Laparoscopic versus open colorectal resection for cancer and polyps: a cost-effectiveness study.'. Clinicoecon Outcomes Res, New Zealand: 6, pp. 415-422.


    BACKGROUND: Available evidence that compares outcomes from laparoscopic and open surgery for colorectal cancer shows no difference in disease free or survival time, or in health-related quality of life outcomes, but does not capture the short term benefits of laparoscopic methods in the early postoperative period. AIM: To explore the cost-effectiveness of laparoscopic colorectal surgery, compared to open methods, using quality of life data gathered in the first 6 weeks after surgery. METHODS: Participants were recruited in 2006-2007 in a district general hospital in the south of England; those with a diagnosis of cancer or polyps were included in the analysis. Quality of life data were collected using EQ-5D, on alternate days after surgery for 4 weeks. Costs per patient, from a National Health Service perspective (in British pounds, 2006) comprised the sum of operative, hospital, and community costs. Missing data were filled using multiple imputation methods. The difference in mean quality adjusted life years and costs between surgery groups were estimated simultaneously using a multivariate regression model applied to 20 imputed datasets. The probability that laparoscopic surgery is cost-effective compared to open surgery for a given societal willingness-to-pay threshold is illustrated using a cost-effectiveness acceptability curve. RESULTS: The sample comprised 68 laparoscopic and 27 open surgery patients. At 28 days, the incremental cost per quality adjusted life year gained from laparoscopic surgery was £12,375. At a societal willingness-to-pay of £30,000, the probability that laparoscopic surgery is cost-effective, exceeds 65% (at £20,000 ≈60%). In sensitivity analyses, laparoscopic surgery remained cost-effective compared to open surgery, provided it results in a saving ≥£699 in hospital bed days and takes no more than 8 minutes longer to perform. CONCLUSION: The study provides formal evidence of the cost-effectiveness of laparoscopic approaches and supports current guidelines that promote use of laparoscopy where suitably trained surgeons are available.

  • Dowson HM, Ballard K, Gage H, Jackson D, Williams P, Rockall TA. (2013) 'Quality of life in the first 6 weeks following laparoscopic and open colorectal surgery.'. Value Health, United States: 16 (2), pp. 367-372.


    OBJECTIVES: Evidence of how health-related quality of life (HRQOL) changes following laparoscopic and open colorectal surgery in the first 6 weeks of postoperative recovery is needed to inform cost-effectiveness evaluations. METHODS: Pragmatic prospective cohort study design. Consecutive patients requiring elective colorectal surgery were allocated to either laparoscopic or open surgery by administrative staff in a district general hospital in England, 2006-2007. Patients completed two validated, generic measures of HRQOL at baseline (preoperatively) and on multiple occasions in the first 6 weeks postsurgery using diaries (EuroQol five-dimensional [EQ-5D] questionnaire: 16 times; short-form 36 health survey [SF-36]: 4 times; HRQOL was compared between groups at each time point, and overall using repeated-measures analysis. RESULTS: Of 201 consecutive patients recruited, 32 (15.1%) were unable to complete diaries. Of the remaining 169 patients, 120 (71%) returned completed diaries at 28 days and 105 (62.1%) at 42 days. There was no difference in preoperative HRQOL scores between surgical groups, but the postoperative EQ-5D questionnaire and SF-36 scores were significantly higher in the laparoscopic group (EQ-5D questionnaire P = 0.005, SF-36 P = 0.007). Subgroup analysis showed that patients with a stoma have worse HRQOL than those without. HRQOL did not differ between the laparoscopic and open stoma patients. CONCLUSIONS: This study presents unique prospective data demonstrating that laparoscopic surgery confers HRQOL benefits for patients in the early recovery period following colorectal surgery, compared with open surgery. Consideration of these data in the context of a cost-effectiveness analysis will be reported separately.

  • Dowson HM, Gage H, Jackson D, Qiao Y, Williams P, Rockall TA. (2012) 'Laparoscopic and open colorectal surgery: A prospective cost analysis'. Colorectal Disease, 14 (11), pp. 1424-1430.


    Aim Cost has been perceived to be a factor limiting the development of laparoscopic colorectal surgery. This study aimed to compare the costs of laparoscopic and open colorectal surgery. Method Patients undergoing laparoscopic or open elective colorectal surgery were recruited into a prospective study to evaluate the healthcare costs of each operative procedure in a district general hospital in England. All healthcare resources used (operation, hospital and community) were recorded and converted to costs in British pounds, 2006-2007. Costs of laparoscopic and open surgery were compared. Results In all, 201 consecutive patients consented and were recruited (131 laparoscopic, 70 open). Operative costs were greater in the laparoscopic group (£2049 vs£1263, P<0.001) due to the costs of disposable instruments, but the hospital costs were less (£1807 vs£3468, P<0.001) due to longer lengths of stay in the open group. Community costs were similar in the two groups and had little impact on the overall costs, which were not significantly different (£3875 laparoscopic vs£4383 open, P=0.308). In the subgroup of patients with a stoma, overall costs in the laparoscopic group are higher (not significant). Conclusion The costs of laparoscopic and open colorectal surgery are broadly equivalent. If there is an associated improvement in patient benefit, then laparoscopic colorectal surgery may be considered to be cost effective compared with open surgery. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  • Earnshaw SR, McDade C, Chapman AM, Jackson D, Schwamm L. (2012) 'Economic Impact of Using Additional Diagnostic Tests to Better Select Patients With Stroke for Intravenous Thrombolysis in the United Kingdom'. Clinical Therapeutics, 34 (7), pp. 1544-1558.


    Background: Eligibility for thrombolysis as an acute stroke treatment is determined through the use of unenhanced noncontrast computed tomography (CT), time since stroke onset, and patient history. Assessing penumbral patterns, which can be examined only through the use of diagnostic technologies such as magnetic resonance imaging (MRI) and perfusion CT (CTP), may be able to better select patients for thrombolysis. However, trade-offs in terms of administration time and cost may affect the value of using these diagnostic studies. Objective: We examined the trade-offs among patient selection via usual care with CT, usual care plus MRI using diffusion-weighted and perfusion imaging, and usual care plus CTP for their effect on costs and outcomes when diagnosing stroke and selecting candidates for thrombolysis in the United Kingdom. Methods: A decision-analytic model was developed. Efficacy and utilities were obtained from published studies. Costs were obtained from standard UK costing sources and were supplemented with data from the published literature. Outcomes included a favorable outcome (modified Rankin Scale score <2), costs, life-years, quality-adjusted life-years, and incremental cost-effectiveness ratios. Results: Compared with usual care selection, adding CTP or MRI to better select patients for thrombolysis reduced the number of patients receiving thrombolysis by 9 and 14.6 per 1000 patients treated, respectively, while improving favorable outcome (19.2 and 17.6 per 1000 patients treated, respectively). In both scenarios, costs were decreased slightly. Both CTP and MRI selection were cost saving (more efficacious and less costly) compared with unenhanced CT selection; CTP selection was found to dominate MRI selection. Conclusions: Adding diagnostic tests such as CTP and MRI to select UK patients for thrombolysis may be a good value for the money and may improve patient outcomes. If a preferred diagnostic test had to be chosen based on economic value, CTP might be the best compromise between unenhanced CT selection and MRI selection. © 2012.

  • Agresta B, Knorz MC, Kohnen T, Donatti C, Jackson D. (2012) 'Distance and near visual acuity improvement after implantation of multifocal intraocular lenses in cataract patients with presbyopia: A systematic review'. Journal of Refractive Surgery, 28 (6), pp. 426-435.


    PURPOSE: To evaluate uncorrected distance visual acuity (UDVA) as well as uncorrected near visual acuity (UNVA) as outcomes in treating presbyopic cataract patients to assist clinicians and ophthalmologists in their decision-making process regarding available interventions. METHODS: Medline, Embase, and Evidence Based Medicine Reviews were systematically reviewed to identify studies reporting changes in UDVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any studies not reporting uncorrected visual acuity in a presbyopic population with cataracts implanted with multifocal intraocular lenses (IOLs). Relevant outcomes (UDVA and UNVA) were identified from the studies retrieved through the systematic review process. RESULTS: Twenty-nine studies were identified that reported uncorrected visual acuities, including one study that reported uncorrected intermediate visual acuity. Nine brands of multifocal IOLs were identified in the search. All studies identified in the literature search reported improvements in UDVA and UNVA following multifocal IOL implantation. The largest improvements in visual acuity were reported using the Rayner M-Flex lens (Rayner Intraocular Lenses Ltd) (UDVA, binocular: 1.05 logMAR, monocular: 0.92 logMAR; UNVA, binocular and monocular: 0.83 logMAR) and the smallest improvements were reported using the Acri.LISA lens (Carl Zeiss Meditec) (UDVA, 0.21 decimal; UNVA, 0.51 decimal). CONCLUSIONS: The results of this systematic review show the aggregate of studies reporting a beneficial increase in UDVA and UNVA with the use of multifocal IOLs in cataract patients with presbyopia, hence providing evidence to support the hypothesis that multifocal IOLs increase UDVA and UNVA in cataract patients.

  • Dowson H, Gage H, Jackson DL, Qiao Y, Williams P, Rockall T. (2012) 'Laparoscopic and Open Colorectal Surgery: A Prospective Cost Analysis'. Colorectal Disease,


    H. Dowson, H. Gage, D. Jackson Y. Qiao, P. Williams, T. Rockall

  • Agresta B, Donatti C, Knorz MC, Jackson D. (2012) 'Visual acuity improvements after implantation of toric intraocular lenses in cataract patients with astigmatism: 2 systematic review'. BMC Ophthalmology, 12 (1)


    Background: Cataracts are a common and significant cause of visual impairment globally. We aimed to evaluate uncorrected distance visual acuity (UDVA) as an outcome in treating astigmatic cataract patients to assist clinicians or ophthalmologists in their decision making process regarding available interventions. Methods. Medline, Embase and Evidence Based Reviews were systematically reviewed to identify relevant studies reporting changes in UDVA, UIVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any non-relevant studies. Relevant outcomes (UDVA, UIVA and UNVA) were identified from the studies retrieved through the systematic review process. Results: The systematic review identified 11 studies which reported UCVA. All 11 studies reported UDVA. Four brands of toric intraocular lenses (IOLs) were reported in these studies. All studies identified in the literature search reported improvements in UDVA following surgical implant of a toric IOL. The largest improvements in VA were reported using the Human Optics MicroSil toric IOL (0.74 LogMAR, UDVA) and the smallest improvements were also reported using the Human Optics MicroSil toric IOL (0.23 LogMAR, UDVA) in a different study. Conclusions: The results of this systematic review showed the aggregate of studies reporting a beneficial increase in UDVA with the use of toric IOLs in cataract patients with astigmatism. © 2012Agresta et al.; licensee BioMed Central Ltd.

  • Zhang Y, Plested M, Chapman A-M, Jackson D, Purroy F. (2012) 'The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: A literature review'. Stroke Research and Treatment,


    Background. Although the burden of stroke in terms of mortality and disability has been well documented in previous years, data after 2000 are limited. Therefore, the aim of this paper was to identify the epidemiology of stroke in the US and EU5 nations from data published in 2000 and later. Methods. Data from literature databases and online sources were collated to identify information relating to the incidence, prevalence, and mortality of stroke from the year 2000 onwards. Results and Conclusions. Twenty-three data sources were identified. The incidence of and mortality due to stroke both increase with age and are greater in males compared to females. Stroke is a common problem and likely to worsen in the US and EU5 as their populations age. However, pre-2000 trends of decreasing stroke mortality over time have continued after 2000, reflecting a consistent improvement in the treatment and care of patients with stroke. Copyright 2012 Younan Zhang et al.

  • Jäkel A, Plested M, Chapman A-M, Jackson D, Purroy F. (2012) 'Management of patients with transient ischemic attack: Insight from real-life clinical practice in Europe and the United States'. Current Medical Research and Opinion, 28 (3), pp. 429-437.
  • Jackson D, Earnshaw SR, Farkouh R, Schwamm L. (2010) 'Cost-effectiveness of CT perfusion for selecting patients for intravenous thrombolysis: A US hospital perspective'. American Journal of Neuroradiology, 31 (9), pp. 1669-1674.
  • Jackson DL, Proudfoot CW, Cann KF, Walsh T. (2010) 'A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety.'. Crit Care, England: 14 (2)


    Patients in intensive care units (ICUs) often receive sedation for prolonged periods. In order to better understand the impact of sub-optimal sedation practice on outcomes, we performed a systematic review, including observational studies and controlled trials which were conducted in sedated patients in the ICU and which compared the impact of changes in or different protocols for sedation management on economic and patient safety outcomes.

  • Jackson DL, Proudfoot CW, Cann KF, Walsh T. (2010) 'A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety'. CRITICAL CARE, 14 (2) Article number ARTN R59
  • Earnshaw SR, Jackson D, Farkouh R, Schwamm L. (2009) 'Cost-effectiveness of patient selection using penumbral-based mri for intravenous thrombolysis'. Stroke, 40 (5), pp. 1710-1720.
  • Jackson D, Moshinsky J, Begg AJ. (2009) 'Addressing shortfalls in TIA care in the UK: An economic perspective'. Journal of Medical Economics, 12 (4), pp. 331-338.
  • Laughlan K, Jayne DG, Jackson DL, Rupprecht F, Ribaric G. (2009) 'Staplerhämorrhoidopexie im Vergleich zur Milligan-Morgan-und Ferguson-Hämorrhoidektomie: ein systematisches Review'. Coloproctology, 31, pp. 81-92.


    Fragestellung: Ziel dieser Studie war, ein systematisches Review und eine Metaanalyse der Kurz- und Langzeitergebnisse der Staplerhämorrhoidopexie durchzuführen. Patienten und Methodik: Mit einer Literatursuche wurden randomisierte, kontrollierte Studien zum Vergleich von Staplerhämorrhoidopexie und Milligan-Morgan-/ Ferguson-Hämorrhoidektomie abgefragt. Die Daten wurden für jede Studie einzeln entnommen und die Unterschiede mit Fixed- und Random-Effects-Modellen analysiert. Ergebnisse: Es wurden 34 randomisierte Studien und zwei systematische Reviews gefunden; hiervon wurden 29 Studien eingeschlossen. Die Staplerhämorrhoidopexie erwies sich in Bezug auf den Klinikaufenthalt (p < 0,001) als statistisch signifikant überlegen und hinsichtlich der postoperativen Schmerzen (perioperativ und früh-postoperativ), der Operationsdauer sowie der Blutungen (postoperativ und spät-postoperativ) als numerisch überlegen. Nach der Staplerhämorrhoidopexie waren Prolapsrezidive und wiederholte Eingriffe aufgrund von Rezidiven häufiger. Bei den Komplikationsraten wurden keine Unterschiede beobachtet. Schlussfolgerung: Die Staplerhämorrhoidopexie reduziert die Dauer des Krankenhausaufenthalts und könnte einen Vorteil im Sinne einer kürzeren Operationsdauer, weniger postoperativer Schmerzen und geringerer Blutungen bieten, ist jedoch mit einer erhöhten Rate von Prolapsrezidiven assoziiert.

  • Laughlan K, Jayne DG, Jackson DL, Rupprecht F, Ribaric G. (2009) 'Stapled haemorrhoidopexy compared to Milligan–Morgan and Ferguson haemorrhoidectomy: a systematic review'. International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery, 24 (3), pp. 335-344.


    Purpose The aim of this study was to perform a systematic review and meta-analysis of the short- and long-term outcomes of stapled haemorrhoidopexy.Methods A literature search identified randomised controlled trials comparing stapled haemorrhoidopexy with Milligan–Morgan/Ferguson haemorrhoidectomy. Data were extracted independently for each study and differences analysed with fixed and random effects models.Results Thirty-four randomised trials and two systematic reviews were identified, and 29 trials included. Stapled haemorrhoidopexy was statistically superior for hospital stay (p < 0.001) and numerically superior for post-operative pain (peri-operative and mid-term), operation time and bleeding (post-operative and long-term). Recurrent prolapse and re-intervention for recurrence were more frequent following stapled haemorrhoidopexy. No difference was observed in the rates of complications.Conclusions Stapled haemorrhoidopexy reduces the length of hospital stay and may have an advantage in terms of decreased operating time, reduced post-operative pain and less bleeding but is associated with an increased rate of recurrent prolapse.

  • Jackson DL, Proudfoot CW, Cann KF, Walsh TS. (2009) 'The incidence of sub-optimal sedation in the ICU: a systematic review.'. Crit Care, England: 13 (6), pp. R204-R204.


    Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs.

  • Cheng H, Rupprecht F, Jackson DL, Berg T, Seelig MH. (2007) 'Decision analysis model of incisional hernia after open abdominal surgery'. Hernia : the journal of hernias and abdominal wall surgery, 11 (2), pp. 129-137.


    Background The incidence rate of incisional hernias after open surgery has been reported to be higher than that of port site hernias after laparoscopic surgery. No studies have compared the costs for the health care system in treating those two types of hernia. Methods A systematic review was conducted to obtain the baseline data, and a decision analysis model was created to simulate the occurrence and recurrence of incisional and port site hernias. Results The overall risk of having incisional hernias was eight-times higher than that of having port site hernias (7.4% vs 0.9%). A cost savings of £93 per patient can be generated for the health care system in the UK. Similar results were obtained for Germany, Italy and France. Conclusions The additional treatment costs for incisional hernia should be taken into account when the costs of a surgery performed by open approach are compared with by laparoscopy.

  • Cunningham D, Falk S, Jackson DL. (2002) 'Clinical and economic benefits of irinotecan in combination with 5-fluorouracil and folinic acid as first line treatment of metastatic colorectal cancer'. British Journal of Cancer, 86 (11), pp. 1677-1683.


    The combination of irinotecan plus 5-fluorouracil and folinic acid has clinical and survival benefits over 5-fluorouracil and folinic acid alone in the setting of first line treatment of metastatic colorectal cancer. The aim of this cost-effectiveness analysis was to compare the economic implications, from a UK health commissioner perspective, of the two treatment arms (de Gramont regimen) in this setting. Resource utilisation data collected prospectively during the study were used as a basis for estimating cumulative drug dosage, chemotherapy admistration, and treatment of complications during first line therapy. Resource utilisation associated with further chemotherapy in patients who had progressed during the study was derived from a retrospective case note review. Drug acquisition costs were derived from the British National Formulary (September, 2001) and unit costs for clinical consultation and services were taken from the latest relevant cost database. Cumulative costs per patient associated with further chemotherapy were lower in the irinotecan plus 5-fluorouracil and folinic acid treatment arm. Based on incremental costs per life-year gained of £14794, the combination of irinotecan plus 5-fluorouracil and folinic acid can be considered cost-effective by commonly accepted criteria compared with 5-fluorouracil and folinic acid alone. Thus, clinical and economic data demonstrate that irinotecan, either in combination with irinotecan plus 5-fluorouracil and folinic acid in the first line setting or as monotherapy in the second line setting, has a major role in the management of metastatic colorectal cancer.

  • Tran G, Burrell AD, Jackson DL. (2000) 'Costs of failure of 1st line chemotherapy for advanced breast cancer in the UK'. BRITISH JOURNAL OF CANCER, 83, pp. 49-49.
  • Cunningham D, Falk S, Jackson DL. (2000) 'Irinotecan and infusional 5-fluorouracil as first line treatment of metastatic colorectal cancer: improved survival and cost-effective compared with infusional 5-FU'. Proc Am Soc Clin Oncol, 19, pp. 981A-981A.


  • Harris M, Taylor G, Jackson D. (2014) Clinical Evidence Made Easy. Scion Pub Limited


    Clinical Evidence Made Easy will give those working in healthcare the tools to understand the information available to them from clinical data sources, which can otherwise be hard to decipher.

  • Jackson D. (2012) Health Economics Made Easy. Scion


    If you are left bemused by terms such as QALY, health utility analysis and cost minimisation analysis, then this is the book for you!


Health Economics module leader for the Masters in Pharmaceutical Science, Faculty of Health and Medical Science.

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