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Evidence-based Public HealthEffectiveness and efficiency$
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Amanda Killoran and Mike P. Kelly

Print publication date: 2009

Print ISBN-13: 9780199563623

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780199563623.001.0001

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Economic evaluation of public health interventions

Economic evaluation of public health interventions

(p.111) Chapter 8 Economic evaluation of public health interventions
Evidence-based Public Health

Susan Griffin

Nigel Rice

Mark Sculpher

Oxford University Press

Economic evaluation is increasingly used to provide a formal, explicit and transparent framework for informing decisions about allocating public funds in the health care sector. By utilizing economic evaluation in the field of public health, it is possible to address questions about the efficiency of allocating resources to fund interventions aimed at improving public health. Economic evaluation of medical interventions and programmes within the health care sector typically utilizes a framework that aims to maximize health outcomes subject to the health sector budget constraint (an ‘extra welfarist’ perspective). This chapter discusses whether this extra welfarist normative framework can be extended to the evaluation of public health interventions, which may have objectives other than health maximization, and may operate across multiple sectors and budget constraints. The extensions to the framework that would enable intersectoral comparisons and a consideration of equity are considered, as well as frameworks used in other areas of policy evaluation (e.g. cost-benefit analysis based on conventional ‘welfarist’ normative principles). The chapter considers how the current elements of economic evaluation — such as statistical analysis of individual patient data, systematic review, evidence synthesis, and decision-analytic modelling — can be applied to evaluate public health interventions with the view to informing policy. Methods for valuing health outcomes are considered in order to determine the need to move beyond the quality adjusted life year (QALY), and to reflect concerns about equity, and the determinants of health and health inequalities. Methods for evaluating the opportunity costs of allocating resources from multiple sectors to a particular intervention are examined, with a view to calculating the net benefits of alternative interventions. The chapter concludes by considering whether methodological standards for the economic evaluation of public health interventions can be established.

Keywords:   economic evaluation, public health interventions, extra welfarist framework, health policy

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