Applying methods of economic evaluation to public health: Contemporary solutions to traditional challenges

2019 ◽  
pp. 53-86
Author(s):  
Rhiannon T. Edwards ◽  
Emma McIntosh
Keyword(s):  
Public Health ◽  
Economic Evaluation ◽  
Study Design ◽  
Controlled Trial ◽  
Good Practice ◽  
Health Sector ◽  
Complex Interventions ◽  
Health Interventions ◽  
Natural Experiments ◽  
Public Health Interventions

Chapter 3 opens with a discussion of the role of study design, the gold standard traditionally being a randomized controlled trial, and widens this to consider other types of study design such as cohort studies and natural experiments. Readers are introduced to the idea that many public health interventions are ‘complex interventions’ and there is a need for a ‘systems-based approach’ to understanding their potential effectiveness and cost-effectiveness. The chapter highlights the relevance of behavioural economics to the evaluation of public health interventions. This chapter goes on to summarize a range of challenges faced by economists, used to evaluate healthcare technologies in a healthcare setting, when they start evaluating public health interventions, which are often delivered outside the health sector in, for example, schools and workplaces. UK guidance from NICE is presented on good practice in economic evaluation of public health interventions along with ideas about how such evaluations are best reported in the literature.

Identification, measurement, and valuation of resource use in economic evaluations of public health interventions

2019 ◽  
pp. 107-130 ◽  
Author(s):  
Carys Jones ◽  
Joanna M. Charles ◽  
Rhiannon T. Edwards
Keyword(s):  
Public Health ◽  
Economic Evaluation ◽  
Good Practice ◽  
Public Health Intervention ◽  
Health Interventions ◽  
Economic Evaluations ◽  
Public Health Interventions ◽  
Cost Information ◽  
Worked Example ◽  
Unit Costs

Chapter 5 provides a practical guide to the types of costs relevant to an economic evaluation of a public health intervention, perspective of analysis, and sources of unit costs spanning a range of sectors including health, social care, education, and transport. The chapter covers the important issues of time horizon and discounting in the economic evaluation of public health interventions. Taking account of sources of uncertainty, the chapter sets out good practice in reporting cost information in published economic studies. The chapter concludes with a worked example of a micro-costing of a parenting programme delivered in the community.

Synthesizing evidence for economic evaluations of public health interventions

2019 ◽  
pp. 87-106
Author(s):  
Olivia Wu ◽  
Joanna M. Charles ◽  
Nathan Bray
Keyword(s):  
Public Health ◽  
Economic Evaluation ◽  
Evidence Synthesis ◽  
Good Practice ◽  
Relevant Literature ◽  
Health Interventions ◽  
Economic Evaluations ◽  
Narrative Synthesis ◽  
Public Health Interventions

Reviewing and synthesizing evidence is an important component of the toolkit of methods for the economic evaluation of PHIs. Chapter 4 provides readers with information about good practice in identifying relevant literature, judging the quality of relevant literature, and synthesizing evidence for economic evaluations of PHIs. Narrative synthesis has become a key focus in synthesizing complex PHIs. Readers are also introduced to the idea that logic (conceptual) models can be helpful in describing processes and hence outcomes. The chapter goes on to describe mixed-method reviews, realist synthesis, other forms of evidence synthesis, and equity considerations.

scholarly journals What methods and challenges for taking account of context when transferring complex interventions?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Villadsen ◽  
S Dias
Keyword(s):  
Public Health ◽  
Health Care ◽  
Reproductive Health ◽  
Health Care Providers ◽  
Complex Interventions ◽  
Health Interventions ◽  
Care Providers ◽  
Public Health Interventions ◽  
Reproductive Health Care

Abstract For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.

scholarly journals The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin Hanckel ◽  
Mark Petticrew ◽  
James Thomas ◽  
Judith Green
Keyword(s):  
Public Health ◽  
Comparative Analysis ◽  
Complex Systems ◽  
Qualitative Comparative Analysis ◽  
Complex Interventions ◽  
Health Interventions ◽  
Data Availability ◽  
Future Research ◽  
Public Health Interventions ◽  
Minimum Criteria

Abstract Background Qualitative Comparative Analysis (QCA) is a method for identifying the configurations of conditions that lead to specific outcomes. Given its potential for providing evidence of causality in complex systems, QCA is increasingly used in evaluative research to examine the uptake or impacts of public health interventions. We map this emerging field, assessing the strengths and weaknesses of QCA approaches identified in published studies, and identify implications for future research and reporting. Methods PubMed, Scopus and Web of Science were systematically searched for peer-reviewed studies published in English up to December 2019 that had used QCA methods to identify the conditions associated with the uptake and/or effectiveness of interventions for public health. Data relating to the interventions studied (settings/level of intervention/populations), methods (type of QCA, case level, source of data, other methods used) and reported strengths and weaknesses of QCA were extracted and synthesised narratively. Results The search identified 1384 papers, of which 27 (describing 26 studies) met the inclusion criteria. Interventions evaluated ranged across: nutrition/obesity (n = 8); physical activity (n = 4); health inequalities (n = 3); mental health (n = 2); community engagement (n = 3); chronic condition management (n = 3); vaccine adoption or implementation (n = 2); programme implementation (n = 3); breastfeeding (n = 2), and general population health (n = 1). The majority of studies (n = 24) were of interventions solely or predominantly in high income countries. Key strengths reported were that QCA provides a method for addressing causal complexity; and that it provides a systematic approach for understanding the mechanisms at work in implementation across contexts. Weaknesses reported related to data availability limitations, especially on ineffective interventions. The majority of papers demonstrated good knowledge of cases, and justification of case selection, but other criteria of methodological quality were less comprehensively met. Conclusion QCA is a promising approach for addressing the role of context in complex interventions, and for identifying causal configurations of conditions that predict implementation and/or outcomes when there is sufficiently detailed understanding of a series of comparable cases. As the use of QCA in evaluative health research increases, there may be a need to develop advice for public health researchers and journals on minimum criteria for quality and reporting.

Development and evaluation of complex multicomponent interventions in public health

2021 ◽  
pp. 351-364
Author(s):  
Rona Campbell ◽  
Chris Bonell
Keyword(s):  
Public Health ◽  
Qualitative Research ◽  
Systems Theory ◽  
Health Inequalities ◽  
Complex Interventions ◽  
Health Interventions ◽  
Intervention Design ◽  
Public Health Interventions ◽  
Quantitative And Qualitative Research ◽  
Multicomponent Interventions

This chapter examines the issues to consider when developing and evaluating complex public health interventions and signposts where more detailed guidance can be found. It starts by considering what complexity means in this context, including the contribution that systems theory has made. When developing complex interventions we suggest: (i) reading quantitative and qualitative research on similar interventions, preferably within systematic reviews; (ii) consulting stakeholders, including those that the intervention is intended to benefit, to help ensure its relevance, acceptability and ownership; (iii) considering using theory to inform the intervention design and hypotheses to assess in evaluations; (iv) assessing whether the intervention could operate at more than one level (from individual through to policy) to increase its chances of success; and (v) reflecting on issues of equity and how the intervention could reduce health inequalities.

The use of modelling approaches for the economic evaluation of public health interventions

2019 ◽  
pp. 248-278
Author(s):  
Hazel Squires ◽  
Kathleen Boyd
Keyword(s):  
Public Health ◽  
Health Economic ◽  
Economic Evaluation ◽  
Health Economic Evaluation ◽  
Health Interventions ◽  
Primary Data ◽  
Public Health Interventions ◽  
Modelling Framework ◽  
Decision Analytic Modelling ◽  
Complex Relationships

This chapter considers the use of modelling for public health economic evaluation. The approach to decision analytic modelling within health economic evaluation is described and five key challenges relating to modelling public health interventions are highlighted: incorporating equity; extrapolating multi-component intervention effectiveness beyond study data; capturing relevant complex relationships and feedback loops of a dynamically complex system; modelling human behaviour; and capturing relevant non-health costs and outcomes and the relationship between individual and social determinants. The chapter describes current practice and the latest methodological research in these areas. It outlines two general approaches which could help to address these challenges by (i) adopting an iterative approach to the evaluation by using early-stage decision modelling to guide primary data collection, and (ii) a conceptual modelling framework to guide the model development process.

scholarly journals Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head

2019 ◽  
Vol 74 (2) ◽  
pp. 203-208 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward W. Gregg ◽  
Jenna Panter ◽  
...  
Keyword(s):  
Public Health ◽  
Population Health ◽  
Controlled Trial ◽  
Experimental Studies ◽  
Health Interventions ◽  
Evidence Based ◽  
Natural Experiments ◽  
Public Health Action ◽  
Randomised Study ◽  
Health Action

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.

scholarly journals Making the most of natural experiments: What can studies of the withdrawal of public health interventions offer?

2018 ◽  
Vol 108 ◽  
pp. 17-22 ◽  
Author(s):  
Peter Craig ◽  
Marcia Gibson ◽  
Mhairi Campbell ◽  
Frank Popham ◽  
Srinivasa Vittal Katikireddi
Keyword(s):  
Public Health ◽  
Health Interventions ◽  
Natural Experiments ◽  
Public Health Interventions

Applied Health Economics for Public Health Practice and Research

2019 ◽  
Keyword(s):  
Public Health ◽  
Economic Evaluation ◽  
Health Economics ◽  
Case Studies ◽  
Population Health ◽  
Evidence Synthesis ◽  
Health Interventions ◽  
Public Healthcare ◽  
Economic Modelling ◽  
Public Health Interventions

Public health has been described as the organized activities of society to improve and protect the health of the population. Health economics applied to public health is the study of how we allocate our scarce societal resources to meet our public health wants and needs in the best way possible. This book presents current thinking on health economics methodology and application to the evaluation of public health interventions (PHIs). It is for health economists working in higher education and public healthcare systems, challenged with the economic evaluation of PHIs, when they have been used to applying health economics and the methods of economic evaluation to narrower clinical interventions in primary or secondary care settings. This book will also be of interest to public health practitioners wanting to incorporate health economics into their daily work. This book covers the history of economics of public health and the economic rationale for government investment in prevention; principles of health economics including scarcity, choice, and opportunity cost; evidence synthesis; key methods of economic evaluation with accompanying case studies; economic modelling of public health interventions; return on investment analysis with national and international case studies; and application of programme budgeting and marginal analysis (PBMA) to the prioritization of PHIs. It concludes with priorities for research in the field of public health economics, spanning an acknowledgement of the role played by the natural environment in promoting better health, through to precision public health, recognizing the role of genetics, the environment, and socioeconomic status in determining population health.

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