Methods for assessing the cost-effectiveness of public health interventions:
Key challenges and recommendations
Helen Weatherly a, Michael Drummond a, Karl Claxton a,b, Richard Cookson c, Brian Ferguson d, Christine Godfrey e, Nigel Rice a, Mark Sculpher a, Amanda Sowden f
a Centre for Health Economics,
b Department of Economics and Related Studies,
c Department of Social Policy and Social Work,
d Yorkshire and Humber Public Health
e Department of Health Sciences,
f Centre for Reviews and Dissemination,
Health Policy 93 (2009) 85–92
Website: http://www.sciencedirect.com/science/journal/01688510
Journal homepage: www.elsevier.com/locate/healthpol
Rationale:
Increasing attention is being given to the evaluation of public health interventions. Methods for the economic evaluation of clinical interventions are well established. In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them.
Methods:
To identify the methodological challenges, five reviews that explored the economics of public health were consulted. From these, four main methodological challenges for the economic evaluation of public health interventions were identified. A review of empirical studies was conducted to explore how the methodological challenges had been approached in practice and an expert workshop convened to discuss how they could be tackled in the future.
Results: The empirical review confirmed that the four methodological challenges were important. In all, 154 empirical studies were identified, covering areas as diverse as alcohol, drug use, obesity and physical activity, and smoking. However, the four methodological challenges were handled badly, or ignored in most of the studies reviewed.
Discussion:
The empirical review offered few insights into ways of addressing the methodological challenges. The expert workshop suggested a number of ways forward for
overcoming the methodological challenges.
Conclusion:
Although the existing empirical literature offers few insights on how to respond to these challenges, expert opinion suggests a number of ways forward. Much of what is suggested here has not yet been applied in practice, and there is an urgent need both for pilot studies and more methodological research
Contents
1. Introduction
2. Methods
2.1. Key methodological challenges
2.1.1. Attribution of effects .
2.1.2. Measuring and valuing outcomes
2.1.3. Identifying intersectoral costs and consequences.
2.1.4. Incorporating equity considerations .
2.2. Review of empirical studies
2.3. Inclusion criteria
2.4. Data extraction
2.5. Review of findings
3.Results
3.1. Attribution of effects.
3.2. Measuring and valuing outcomes
3.3. Intersectoral costs and consequences . .
3.4. Equity considerations.
4. Discussion
4.1. Attribution of effects
4.2. Measuring and valuing outcomes
4.3. Intersectoral costs and consequences .
4.4. Equity considerations
5. Conclusions
References
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