Public Health Interventions, Consensus?

Is there a consensus about which type of economic evaluation is appropriate for public health interventions?

The short answer is 'no'! The appropriate form of economic evaluation will always depend on the questions being addressed and the decision-making perspective adopted. Typically health economists would not recommend cost-minimisation analysis and would advocate at least using cost-effectiveness analysis. The debate tends to polarise between those who advocate the cost-utility analysis approach (usually using the QALY) and those who prefer cost-benefit analysis, incorporating willingness-to-pay type methodologies. Use of cost-consequence analysis, tends to cause significant debate between economists, with some viewing it as a 'fudge' that does not help to produce sufficient quantitative information to aid decision-makers. However, the benefit of applying cost-consequence analysis to public health is that it allows the many impacts of a public health intervention to be captured and presented transparently. Whilst it does not allow the benefits to be presented in a single outcome measure, this may be appropriate in public health settings where benefits may accrue in multiple sectors such as health, social care, education and the environment.

For now it is probably safe to conclude that the 'gold standard' type of economic evaluation is either cost-utility analysis or cost-benefit analysis, and that there remains important debate within the health economics profession regarding which is more appropriate to the analysis of public health interventions. At least for comparability purposes (with the health technology assessment field), NICE has pursued the cost per QALY route in the meantime, whilst recognising that important methodological and practical issues of application remain to be resolved (http://www.nice.org.uk/).