The Use of Economic Evaluation for Public Health Interventions' Desert or Oasis? A Systematic Review of the Literature
Year: 2007
Type: preprint
Study design: Systematic Review
Abstract: Aims: A systematic review was conducted to determine the extent to which different methods of economic evaluation have been applied to public health interventions. Methods: A wide range of databases covering health and non health disciplines were searched over a forty year period. This was augmented by a journal hand-search and analysis of grey literature. English and non English language search terms were used. Identified studies were coded and mapped in a relational database to allow for more flexible analysis. Innovative approaches to evaluation outside the scope of traditional economic evaluation, such as the use of taxation and price controls were included where identified. Results: In excess of 7000 unique references were initially retrieved, of which nearly 1,700 were eventually included. Over 75% took the form of cost effectiveness analyses or cost consequence analyses.Only 13% of evaluations measured outcomes using Quality Adjusted Life Years (QALY) and only 5% were cost benefit analyses. Less complex screening and immunisation interventions were common but evaluations in most areas of public health could be identified. Few studies looked at the economic case for tackling the wider socio-economic determinants of health. Conclusions: The view that few public health intervention economic evaluations have been conducted cannot be sustained. There has been a rapid expansion of the evidence base in recent years coupled with a growing interest of policy makers in the economic case for prevention and/or promotion. The dominance of US studies does however raise significant questions over generalisability of findings. Methodological and practical challenges remain in evaluating many areas of public health where complex community interventions are the norm. The reliance on modelling (rather than experimental trials) to generate information on potential long term outcomes by studies was clear. Furthermore there is still much to be done to look at how different frameworks which can more easily deal with normative perspectives on evaluation may inform economic evaluation in this area. Economic evaluations that make better use of qualitative methods to understand more about why interventions have differing success rates in different contexts remain few. Realistic evaluation, or so called holistic economic evaluation that includes contextual analysis is one approach that may merit wider application. NICE and other bodies may also need to place more emphasis on assessing the impact of economic incentives such as taxes, subsidies and regulations on both individual and population-level behaviours.
Source: SSRN Electronic Journal
Authors: David McDaid, Justin J. Needle
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W154595869