Abstract
BackgroundA large proportion of the burden of disease is preventable, yet investment in health promotion and disease prevention programmes remains a small share of the total health budget in many countries. The perception that there is paucity of evidence on the cost-effectiveness of public health programmes is seen as a barrier to policy change. The aim of this scoping review is to conduct a census of economic evaluations in primary prevention in order to identify and map the existing evidence.MethodsThis review is an update of a prior census and will include full economic evaluations of primary prevention programmes conducted in a community-based setting that were published between 2014 and 2019. The search of electronic databases (MEDLINE and Embase, and NHS-EED for 2014) will be supplemented by a search for grey literature in OpenGrey and a search of the reference lists of reviews of economic evaluations identified in our searches. Retrieved citations will be imported into Covidence® and independently screened in a two-stage process by two reviewers (abstracts and full papers). Any disagreements on the eligibility of a citation will be resolved by discussion with a third reviewer. Included studies will then be categorised by one independent reviewer according to a four-part typology covering the type of health promotion intervention, the risk factor being tackled, the setting in which the intervention took place and the population most affected by the intervention. New to this version of the census, we will also document whether or not the intervention sets out specifically to address inequalities in health.DiscussionThis review will produce an annotated bibliography of all economic evaluations plus a report summarising the current scope and content of the economic evidence (highlighting where it is plentiful and where it is lacking) and describing any changes in the type of economic evidence available for the various categories of disease prevention programmes since the last census. This will allow us to identify where future evaluative efforts should be focused to enhance the economic evidence base regarding primary prevention interventions.Systematic review registrationRegistration is being sought concurrently.
Highlights
A large proportion of the burden of disease is preventable, yet investment in health promotion and disease prevention programmes remains a small share of the total health budget in many countries
This is true in some instances, such as the cost-effectiveness of preventive interventions in lowand middle-income countries [9], but there is a substantial body of evidence summarising the cost-effectiveness of numerous public health interventions, including seminal work in the World Health Organization (WHO)’s ‘Best Buys’ document [10], Public Health England’s work on the return on investment and costeffectiveness of public health programmes [11] and the Assessing Cost-Effectiveness in Prevention (ACE-Prevention) study [12]
We found that 90% of the economic evidence examined interventions that addressed the biological or behavioural determinants of health
Summary
A large proportion of the burden of disease is preventable, yet investment in health promotion and disease prevention programmes remains a small share of the total health budget in many countries. The perception that there is paucity of evidence on the cost-effectiveness of public health programmes is seen as a barrier to policy change The aim of this scoping review is to conduct a census of economic evaluations in primary prevention in order to identify and map the existing evidence. Despite the evidence that much of the burden of disease is preventable [5,6,7], spending on prevention remains a small proportion of the total health budget in many OECD countries [8] This phenomenon is exacerbated by the perception that economic evidence to support investment in disease prevention interventions is lacking. An update covering the historic period 2002 to 2013 is in progress
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