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Table 1 Summary of UK published guidance

From: Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues

Source of published guidance Key points Theoretical paradigm underpinning guidance
HM Treasury Green Book (2003) [22] Care should be taken to avoid spuriously accurate figures; costs and benefits should be based on market prices where possible; where not possible techniques such as ‘willingness to accept’ (for costs) and ‘willingness to pay’ (for benefits) should be used; wider social and environmental costs should be considered; use previous studies to capture value of benefits (‘benefit transfer method’). The approach used here is a welfarist based approach whereby outcomes relate to a notion of utility.
Joseph Rowntree Foundation (Byford et al. 2003) [23] This is a practical guide to conducting economic evaluation in the social welfare field, but many of the principles can be applied to public health interventions. There is guidance on how to measure costs and benefits along with a standard assessment of the different types of cost-effectiveness techniques (e.g., cost-effectiveness, cost-utility, cost-benefit etc.). A welfarist approach is the theoretical underpinning here. There is no discourse as to the measuring of wider costs and benefits.
Public Health Research Consortium (Drummond et al., 2006) [7] Acknowledges additional challenges of applying traditional techniques of economic evaluation to a public health context. Undertook a methodological review of main challenges and proposed some solutions (underpins Weatherly et al. 2009) i.e. breadth of costs and benefits; need to consider effect on inequalities in health; attribution of costs and outcomes to stakeholders; measuring and valuing outcomes across different sectors. An extra-welfarist approach is taken here where outcomes are not confined to a welfarist utility framework, but rather a specific importance is put upon measuring wider costs and benefits which are wider than QALYs.
MRC Guidance on developing and evaluating complex interventions (2008) [32] Defines complex interventions as “interventions with several interacting components”. Many public health interventions can be described as complex in this sense. Provides a frame work ranging from feasibility, evaluating (including assessing cost effectiveness), implementation and development. Economic evaluation is not dealt with specifically in this guidance which is focused on effectiveness. There is no underlying theory here in terms of economics as the guidance is mainly concerned with effectiveness rather than cost effectiveness, as found in the evidence based medical movement.
NICE Public Health Guidance (2009) [25] Economic evaluation only relevant if there is expected net benefit, taking into account number of individuals affected; uncertainty in the cost-effectiveness literature and the likelihood that economic analysis will clarify matters. Economic evaluation is not needed if: it is not possible to estimate costs and benefits; if it is obvious the resources required are modest in comparison to health gains and if robust economic evaluation is already available. Assumes that objective of public health interventions is to maximise QALY. Cost per QALY calculations recommended using a £20,000-30,000 threshold. Also cost-consequence or cost-benefit analyses recommended. This guidance is based on a conceptual framework for public health which comprises four vectors–population, environment, society and organisations all of which affect human behaviour. An extra-welfarist approach is taken whereby QALYs are viewed from an extra-welfarist perspective.
Cabinet Office Social Return on Investment Guide (2010) [11] There are two types of SROIs: evaluative and forecast; assigning a value to things that do not have a market price: contingent valuation–willingness to pay or accept compensation, revealed preference–hedonic pricing and average household spending–from sources such as the Family Spending Survey; SROI ratio is calculated as the total present value divided by the value of inputs–this gives a ratio of £x of value per £1 of investment; sensitivity analysis needs to be carried out–by how much would the parameters need to be changed to get an SROI of £1:£1. SROI analysis has a microeconomic theoretical underpinning whereby evaluation of specific interventions is done on a one-by-one basis and no attempt is made to aggregate the results into a macro framework.
NICE guidance for assessing cost effectiveness and ROI (2011) [26] A cost impact project set up by NICE in 2010. The aim is to meet public sector demands to demonstrate potential returns on investment of public health interventions. It produces tools for financial planning to support local implementation of NICE’s recommendations. This report assesses the literature in terms of cost-effectiveness analyses and their adherence to NICE guidelines. They provide a number of recommendations to changes to NICE’s methods and processes. Wider costs and benefits are considered here rather than concentrating on QALYs alone. Insofar as this is true it could be said that an extra-welfarist theoretical approach has been taken.
  1. Summary of UK published guidance relevant to the economic evaluation of public health interventions.