scholarly journals Using Threshold Analysis to Assess the Robustness of Public Health Intervention Recommendations from Network Meta-Analyses: Application to Poison Prevention in Households with Children Under Five

2022 ◽  
Author(s):  
Molly Wells ◽  
Sylwia Bujkiewicz ◽  
Stephanie J Hubbard
Keyword(s):  
Public Health ◽  
Clinical Guidelines ◽  
Evidence Synthesis ◽  
Health Interventions ◽  
Decision Analytic Model ◽  
Synthesis Methods ◽  
Significant Heterogeneity ◽  
Threshold Analysis ◽  
Public Health Interventions ◽  
Poison Prevention

Abstract BackgroundIn the appraisal of clinical interventions, complex evidence synthesis methods, such as network meta-analysis (NMA), are commonly used to investigate the effectiveness of multiple interventions in a single analysis. The results from a NMA can inform clinical guidelines directly or be used as inputs into a decision-analytic model assessing the cost-effectiveness of the interventions. However, there is hesitancy in using complex evidence synthesis methods when evaluating public health interventions. This is due to significant heterogeneity across studies investigating such interventions and concerns about their quality. Threshold analysis has been developed to help assess and quantify the robustness of recommendations made based on results obtained from NMAs to potential limitations of the data. Developed in the context of clinical guidelines, the method may prove useful also in the context of public health interventions. In this paper, we illustrate the use of the method in the study investigating the effectiveness of interventions aiming to increase the uptake of poison prevention behaviours in homes with children aged 0-5.MethodsRandom effects NMA was carried out to assess the effectiveness of several interventions for increasing the uptake of poison prevention behaviours, focusing on the safe storage of other household products outcome. Threshold analysis was then applied to the NMA to assess the robustness of the intervention recommendations made based on the NMA.Results15 studies assessing seven interventions were included in the NMA. The results of the NMA indicated that complex intervention, including Education, Free/low-cost equipment, Fitting equipment and Home safety inspection, was the most effective intervention at promoting poison prevention behaviours. However, the threshold analyses highlighted that this intervention recommendation was not robust.Conclusions In our case study, threshold analysis allowed us to demonstrate that the intervention recommendation for promoting poison prevention behaviours was not robust to changes in the evidence due to potential bias. Therefore, caution should be taken when considering such interventions in practice. We have illustrated the potential benefit of threshold analysis and, therefore, encourage the use of the method in practice as a sensitivity analysis for NMA of public health interventions.

scholarly journals A review of the quantitative effectiveness evidence synthesis methods used in public health intervention guidelines

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ellesha A. Smith ◽  
Nicola J. Cooper ◽  
Alex J. Sutton ◽  
Keith R. Abrams ◽  
Stephanie J. Hubbard
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Health Interventions ◽  
Synthesis Methods ◽  
Public Health Interventions ◽  
Guidance Documents

Abstract Background The complexity of public health interventions create challenges in evaluating their effectiveness. There have been huge advancements in quantitative evidence synthesis methods development (including meta-analysis) for dealing with heterogeneity of intervention effects, inappropriate ‘lumping’ of interventions, adjusting for different populations and outcomes and the inclusion of various study types. Growing awareness of the importance of using all available evidence has led to the publication of guidance documents for implementing methods to improve decision making by answering policy relevant questions. Methods The first part of this paper reviews the methods used to synthesise quantitative effectiveness evidence in public health guidelines by the National Institute for Health and Care Excellence (NICE) that had been published or updated since the previous review in 2012 until the 19th August 2019.The second part of this paper provides an update of the statistical methods and explains how they address issues related to evaluating effectiveness evidence of public health interventions. Results The proportion of NICE public health guidelines that used a meta-analysis as part of the synthesis of effectiveness evidence has increased since the previous review in 2012 from 23% (9 out of 39) to 31% (14 out of 45). The proportion of NICE guidelines that synthesised the evidence using only a narrative review decreased from 74% (29 out of 39) to 60% (27 out of 45).An application in the prevention of accidents in children at home illustrated how the choice of synthesis methods can enable more informed decision making by defining and estimating the effectiveness of more distinct interventions, including combinations of intervention components, and identifying subgroups in which interventions are most effective. Conclusions Despite methodology development and the publication of guidance documents to address issues in public health intervention evaluation since the original review, NICE public health guidelines are not making full use of meta-analysis and other tools that would provide decision makers with fuller information with which to develop policy. There is an evident need to facilitate the translation of the synthesis methods into a public health context and encourage the use of methods to improve decision making.

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.

scholarly journals An overview of systematic reviews of economic evaluations of pharmacy-based public health interventions: addressing methodological challenges

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Suzete Costa ◽  
Maria Cary ◽  
Dennis K. Helling ◽  
João Pereira ◽  
Céu Mateus
Keyword(s):  
Public Health ◽  
Economic Evaluation ◽  
Systematic Reviews ◽  
Quality Criteria ◽  
Health Interventions ◽  
Economic Evaluations ◽  
Synthesis Methods ◽  
Public Health Interventions ◽  
Overview Of Systematic Reviews ◽  
Pharmacy Interventions

Abstract Background Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy interventions requires certain considerations which have some similarities to those of public health interventions and to economic evaluations alongside trials. The objective of this research is to perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of both public health interventions and alongside trials. Methods (1) Exploratory review of recommendations on the economic evaluation of public health interventions, (2) exploratory review of recommendations for conducting economic evaluations alongside trials, (3) overview of systematic reviews of economic evaluations of pharmacy interventions (protocol registered with PROSPERO 2016 outlining information sources, inclusion criteria, appraisal of reviews and synthesis methods). Results Fourteen systematic reviews containing 75 index publications were included. Reviews reported favorable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include the following: certain types of risk of bias, wider scope of study designs, and most economic quality criteria met but some issues unresolved or unclear. Triangulation revealed additional gaps. Limitations include choice of critical quality domains and potential biases in the overview process. Conclusions Economic evaluations of pharmacy-based public health interventions seem to follow most economic quality criteria, but there are still some issues in certain key areas to improve. These findings may assist in improving the design of pilot trials of economic evaluations in pharmacy, leading to robust evidence for payers. Based on the findings, we propose a methodological approach for the economic evaluation of pharmacy-based public health interventions. Systematic review registration PROSPERO CRD42016032768

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.

HEALTH TECHNOLOGY ASSESSMENT OF PUBLIC HEALTH INTERVENTIONS: A SYNTHESIS OF METHODOLOGICAL GUIDANCE

2017 ◽  
Vol 33 (2) ◽  
pp. 135-146 ◽  
Author(s):  
Tim Mathes ◽  
Sunya-Lee Antoine ◽  
Peggy Prengel ◽  
Stefanie Bühn ◽  
Stephanie Polus ◽  
...  
Keyword(s):  
Public Health ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Research Question ◽  
Health Technology ◽  
Health Interventions ◽  
Synthesis Methods ◽  
Public Health Interventions ◽  
Advantages And Disadvantages ◽  
Context Factors

Objectives: The evaluation of public health interventions poses some challenges. As a consequence, health technology assessment (HTA) methods for public health interventions (PHI) have to be adapted. This study aimed to summarize the available guidance on methods for HTA of PHI.Methods: We systematically searched for methodological guidance on HTA of PHIs. Our focus was on research synthesis methods to evaluate effectiveness. Relevant information was synthesized narratively in a standardized way.Results: Only four guidance documents were identified specifically for HTAs of PHI. The approaches used for HTAs of PHIs are broader and more flexible than those for medical interventions. For this reason, there is a tendency to identify the intervention components and context factors that influence the effectiveness and transferability of an intervention rather than to assess its effectiveness in general. The details in the guidance vary without justification. Unjustified heterogeneity between the different guidance approaches is most pronounced for quality assessment, assessment of applicability, and methods to integrate qualitative and quantitative evidence. Descriptions for the assessment of integrity, heterogeneity, sustainability, context factors, and applicability are often vague.Conclusions: The heterogeneity in approaches indicates that there is currently no consensus on methods to deal with the challenges of the PHI evaluations. A possible explanation for this may be that the methods are not sufficiently developed, and advantages and disadvantages of a certain method in relation to the research question (e.g., broad/focused) have not yet been sufficiently evaluated.

scholarly journals An analysis of COVID-19 clusters in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pooja Sengupta ◽  
Bhaswati Ganguli ◽  
Sugata SenRoy ◽  
Aditya Chatterjee
Keyword(s):  
Public Health ◽  
Cluster Analysis ◽  
Population Density ◽  
Case Studies ◽  
Compartment Model ◽  
Health Interventions ◽  
Disease Spread ◽  
Second Phase ◽  
Public Health Interventions ◽  
Homogeneous Groups

Abstract Background In this study we cluster the districts of India in terms of the spread of COVID-19 and related variables such as population density and the number of specialty hospitals. Simulation using a compartment model is used to provide insight into differences in response to public health interventions. Two case studies of interest from Nizamuddin and Dharavi provide contrasting pictures of the success in curbing spread. Methods A cluster analysis of the worst affected districts in India provides insight about the similarities between them. The effects of public health interventions in flattening the curve in their respective states is studied using the individual contact SEIQHRF model, a stochastic individual compartment model which simulates disease prevalence in the susceptible, infected, recovered and fatal compartments. Results The clustering of hotspot districts provide homogeneous groups that can be discriminated in terms of number of cases and related covariates. The cluster analysis reveal that the distribution of number of COVID-19 hospitals in the districts does not correlate with the distribution of confirmed COVID-19 cases. From the SEIQHRF model for Nizamuddin we observe in the second phase the number of infected individuals had seen a multitudinous increase in the states where Nizamuddin attendees returned, increasing the risk of the disease spread. However, the simulations reveal that implementing administrative interventions, flatten the curve. In Dharavi, through tracing, tracking, testing and treating, massive breakout of COVID-19 was brought under control. Conclusions The cluster analysis performed on the districts reveal homogeneous groups of districts that can be ranked based on the burden placed on the healthcare system in terms of number of confirmed cases, population density and number of hospitals dedicated to COVID-19 treatment. The study rounds up with two important case studies on Nizamuddin basti and Dharavi to illustrate the growth curve of COVID-19 in two very densely populated regions in India. In the case of Nizamuddin, the study showed that there was a manifold increase in the risk of infection. In contrast it is seen that there was a rapid decline in the number of cases in Dharavi within a span of about one month.

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