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Abstract
BackgroundIf Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted.MethodsElectronic databases and organisation websites were searched using a 22 year time horizon (1990–2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers.ResultsWe identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist.ConclusionsIn this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader paradigm with respect to public health economics. We offer a 12 point checklist to support government, NHS commissioners and individual health economists in their consideration of economic evaluation methodology with respect to the additional challenges of applying health economics to public health.
Highlights
If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost
Guidance relevant to the economic evaluation of public health interventions was divided into the following categories; United Kingdom (UK) guidance, international guidance and observations of key commentators relevant to the economic evaluation of public health interventions
Guidance relevant to the economic evaluation of public health interventions UK guidance Looking beyond the health economics literature to broad economic and public policy guidance, which may be directly relevant to the evaluation of public health interventions, the HM Treasury Green Book [22] outlines various points related to the treatment of costs and benefits when conducting economic appraisals of public programmes, points which relate well to the area of public health
Summary
If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. Et al [4] offered additional considerations that health economists should build into their evaluations of public health interventions These considerations being the need for other approaches due to the limited availability of randomised controlled trials, measurement of a range of outcomes beyond Quality Adjusted Life Years (QALYs), consideration of inter-sectoral costs and consequences which may include wider benefits and spill over effects, and a focus on equity. Payne et al [5], introduced the idea of some public health interventions having the characteristics of “complex” interventions, and the subsequent need to measure a much broader range of outcomes than focus on QALYs, suggesting that capability theory may offer one way forward as a means for better capturing such wider benefits [6] These three papers focus on, and critique, the traditional toolbox of methods of economic evaluation applied to the evaluation of Public Health interventions [7]. We observe a growing interest and expectation that public health interventions should be “cost saving” [10], an interest by government, local government and the NHS in return on investment analysis as an alternative to cost-effectiveness analysis [11]
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