Cost-effectiveness of public health interventions - a new methodological approach

Background: Governments across Europe have attempted to address the obesogenic environment through a variety of policy measures over the last two decades. A growing literature advocates for complex population interventions in public health. Such approaches embrace the need for interventions that can operate within the complexity of real-life situations as well as capturing and tracking interactions between an intervention and its context. Aim: This paper describes the original interdisciplinary methodological approach of a research project. The study was designed to ascertain whether complex public health interventions can be transferred from one local context to another while remaining loyal to their initial objectives. Method: An integrated interdisciplinary qualitative design was established to elaborate and answer the research questions. Three disciplinary strands were involved: Political Science, Public Health and Sociology. The three strands worked together while applying their specific methodological approaches. Results: The Political Science strand analysed the public health nutrition intervention taking a socio-historic policy studies top-down perspective. The Public Health Strand developed a method of analysing the three interventions through a co-construction process with the participants. This allows for the key functions, forms and context of each intervention to be identified and compared. The Sociology strand performed ethnographic methods to observe and analyse the deployment and activities linked with each intervention across sites. Together the three strands provide an interdisciplinary analysis of the length and breadth of the interventional scope with which to answer the research questions. Discussion: Here, we discuss the operational challenges involved in the project, including the difficulties encountered with the interdisciplinary approach, as well as field work challenges.

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Economic evaluations of public health interventions for mental health: A systematic literature review

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.057 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Feldman ◽

M Gebreslassie ◽

F Sampaio ◽

C Nystrand ◽

R Ssegonja

Keyword(s):

Public Health ◽

Mental Health ◽

Cost Effectiveness ◽

Suicide Prevention ◽

High Potential ◽

Health Interventions ◽

Economic Evaluations ◽

Public Health Interventions ◽

High Quality ◽

The Cost

Abstract Background To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. Methods A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between 2000 and 2018. The studies were identified through Medline, PsychINFO, Web of Science. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Results Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and 4 interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Conclusions Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited. Key messages Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society. Evidence on the cost-effectiveness of suicide prevention is limited.

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PSY3 Assessing the Cost Effectiveness of Public Health Interventions to Prevent Obesity: A Systematic Review of the Effectiveness of 16 Obesity Prevention Interventions

Value in Health ◽

10.1016/j.jval.2012.08.448 ◽

2012 ◽

Vol 15 (7) ◽

pp. A678

Author(s):

D. Paech ◽

K. Coleman ◽

P.J. Mernagh ◽

A.R. Weston

Keyword(s):

Public Health ◽

Systematic Review ◽

Cost Effectiveness ◽

Obesity Prevention ◽

Health Interventions ◽

Public Health Interventions ◽

Prevention Interventions ◽

The Cost

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Costing the implementation of public health interventions in resource-limited settings: a conceptual framework

Implementation Science ◽

10.1186/s13012-020-01047-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hojoon Sohn ◽

Austin Tucker ◽

Olivia Ferguson ◽

Isabella Gomes ◽

David Dowdy

Keyword(s):

Public Health ◽

Cost Effectiveness ◽

Conceptual Framework ◽

Budget Impact ◽

Sustainability Assessment ◽

Health Interventions ◽

Public Health Interventions ◽

Resource Limited Settings ◽

Resource Limited ◽

Implementation Costs

Abstract Background Failing to account for the resources required to successfully implement public health interventions can lead to an underestimation of costs and budget impact, optimistic cost-effectiveness estimates, and ultimately a disconnect between published evidence and public health decision-making. Methods We developed a conceptual framework for assessing implementation costs. We illustrate the use of this framework with case studies involving interventions for tuberculosis and HIV/AIDS in resource-limited settings. Results Costs of implementing public health interventions may be conceptualized as occurring across three phases: design, initiation, and maintenance. In the design phase, activities include developing intervention components and establishing necessary infrastructure (e.g., technology, standard operating procedures). Initiation phase activities include training, initiation of supply chains and quality assurance procedures, and installation of equipment. Implementation costs in the maintenance phase include ongoing technical support, monitoring and evaluation, and troubleshooting unexpected obstacles. Within each phase, implementation costs can be incurred at the site of delivery (“site-specific” costs) or more centrally (“above-service” or “central” costs). For interventions evaluated in the context of research studies, implementation costs should be classified as programmatic, research-related, or shared research/program costs. Purely research-related costs are often excluded from analysis of programmatic implementation. Conclusions In evaluating public health interventions in resource-limited settings, accounting for implementation costs enables more realistic estimates of budget impact and cost-effectiveness and provides important insights into program feasibility, scale-up, and sustainability. Assessment of implementation costs should be planned prospectively and performed in a standardized manner to ensure generalizability.

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Economic Evaluation of Public Health Interventions: An Application to Interventions for the Prevention of Violence Against Women and Girls Implemented by the “What Works to Prevent Violence Against Women and Girls?” Global Program

Journal of Interpersonal Violence ◽

10.1177/0886260519885118 ◽

2019 ◽

pp. 088626051988511

Author(s):

Giulia Ferrari ◽

Sergio Torres-Rueda ◽

Christine Michaels-Igbokwe ◽

Charlotte Watts ◽

Rachel Jewkes ◽

...

Keyword(s):

Public Health ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Violence Against Women ◽

Allocative Efficiency ◽

Health Interventions ◽

Public Health Interventions ◽

Middle Income ◽

What Works ◽

Women And Girls

Violence against women and girls (VAWG) has important social, economic, and public health impacts. Governments and international donors are increasing their investment in VAWG prevention programs, yet clear guidelines to assess the “value for money” of these interventions are lacking. Improved costing and economic evaluation of VAWG prevention can support programming through supporting priority setting, justifying investment, and planning the financing of VAWG prevention services. This article sets out a standardized methodology for the economic evaluation of complex, that is, multicomponent and/or multiplatform, programs designed to prevent VAWG in low- and middle-income countries (LMICs). It outlines an approach that can be used alongside the most recent guidance for the economic evaluation of public health interventions in LMICs. It defines standardized methods of data collection and analysis, outcomes, and unit costs (i.e., average costs per person reached, output or service delivered), and provides guidance to investigate the uncertainty in cost-effectiveness estimates and report results. The costing approach has been developed and piloted as part of the “What Works to Prevent Violence Against Women and Girls?” (What Works?) program in five countries. This article and its supplementary material can be used by both economists and non-economists to contribute to the generation of new cost-effectiveness data on VAWG prevention, and ultimately improve the allocative efficiency and financing across VAWG programs.

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