Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges

Hill, Sarah; Vale, Luke; Hunter, David J.; Henderson, Emily; Oluboyede, Yemi

doi:10.1016/j.healthpol.2017.10.003

Cited by 19 publications

(32 citation statements)

References 56 publications

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“…The challenge with a CCA however is that it fails to offer any evidence on opportunity cost, hence the value of what is being displaced from choosing to invest resource in one particular way versus another. This limitation was also noted by Hill, 2017 in a recent review of economic evaluations of alcohol prevention interventions (Hill et al 2017).…”

Section: Discussionmentioning

confidence: 83%

“…In addition, there was a strong theme that the outcomes need to be broader than health with wellbeing revealed as a priority. This broader measure of outcome means that comparisons of cost-effectiveness can be made across different sectors and despite notable developments within health economics on the measurement of ‘capability wellbeing’ (Coast et al , 2008; Smith et al , 2012), recent reviews of economic evaluations of public health interventions report the majority to be cost-effectiveness analysis (White et al , 2018), conducted from a health care perspective (Hill et al , 2017). This is despite decision-making bodies such as NICE recommending greater use of a public sector or government perspective for public health economic evaluation (NICE, 2012).…”

Section: Discussionmentioning

confidence: 99%

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Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Frew

Breheny

2019

HEPL

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Local authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making. The study included both observational methods and in-depth interviews. Key meetings were observed and semi-structured interviews conducted with participants who had a decision-making role to explore views on economics, to understand the barriers to using evidence and to invite suggestions for improvements to methods. Despite all informants valuing the use of health economics, many barriers were cited: including a perception of a narrow focus on the health sector; lack of consideration of population impact; and problems with translating long timescales to short term impact. Methodological suggestions included the broadening of frameworks; increased use of natural experiments; and capturing wider non-health outcomes that resonate with the priorities of multiple stakeholders.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Frew

Breheny

2019

HEPL

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“…Although there are guidance documents available for conducting and reporting of public health economic evaluations (Edwards et al, 2013), there does seem to be a continued lack of availability of economic evidence for public health investment and for those that do exist, a heterogeneity in methods applied (Edwards et al, 2013;Hill, Vale, Hunter, Henderson, & Oluboyede, 2017;Lung et al, 2017). The U.K. NICE in 2014 updated its guidance for the evaluation of public health interventions recommending both a public sector and a societal approach that means that all relevant costs and benefits should be included.…”

Section: Discussionmentioning

confidence: 99%

“…The U.K. NICE in 2014 updated its guidance for the evaluation of public health interventions recommending both a public sector and a societal approach that means that all relevant costs and benefits should be included. However, in a recent review of interventions for alcohol prevention, for example, it was reported that the methodological challenge of including multisectorial costs and effects is still prevalent and not yet resolved due to difficulties of consistently and accurately measuring nonhealth cost (Hill et al, ).…”

Section: Discussionmentioning

confidence: 99%

Methods for public health economic evaluation: A Delphi survey of decision makers in English and Welsh local government

Frew

Breheny

2019

Health Economics

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Standard reference case methods recommended for health technology appraisals do not translate well to a public health setting. This paper reports on a Delphi survey designed to elicit views of public health decision makers in England and Wales, about different methodological elements of economic evaluation. This is important as methods should align with the objective function of decision makers. The Delphi survey comprised two rounds, with round 1 allowing open‐ended recommendations in addition to 5‐point Likert scale responses. The final survey comprised 36 questions, and levels and strength of agreement were assessed using median values and mean absolute deviation of the median. The Delphi panel (n = 66) achieved high levels of agreement for costs, health, well‐being, and productivity impact to be important elements within an economic evaluation. The panel agreed that evaluations should be relevant to the local context and include costs and consequences over a lifetime horizon. There was a call for the transparent reporting of costs and effects for different population subgroups, and for different sectors. Overall, the panel revealed a preference for a flexible approach, understanding that economic evidence fits within a dynamic process of decision making. These results provide empirical evidence to inform guidelines for public health economic evaluation.

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“…NICE suggested that school-based interventions should aim to increase knowledge about alcohol, to explore perceptions about alcohol use and to help develop decision-making skills, self-efficacy and self-esteem. The guideline also highlighted the paucity of evidence from economic evaluations of school-based programmes, although a few additional studies have subsequently emerged (see Hill et al 18 for a recent review).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a combined classroom curriculum and parental intervention: economic evaluation of data from the Steps Towards Alcohol Misuse Prevention Programme cluster randomised controlled trial

et al. 2019

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ObjectivesThis study aimed to assess the cost-effectiveness of the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) compared with education as normal (EAN) in reducing self-reported heavy episodic drinking (HED) in adolescents.DesignThis is a cost-effectiveness analysis from a public sector perspective conducted as part of a cluster randomised trial.SettingThis study was conducted in 105 high schools in Northern Ireland and in Scotland.ParticipantsStudents in school year 8/S1 (aged 11–12) at baseline were included in the study.InterventionsThis is a classroom-based alcohol education curricula, combined with a brief alcohol intervention for parents/carers.Outcome measuresThe outcome of this study is the cost per young person experiencing HED avoided due to STAMPP at 33 months from baseline.ResultsThe total cost of STAMPP was £85 900, equivalent to £818 per school and £15 per pupil. Due to very low uptake of the parental component, we calculated costs of £692 per school and £13 per pupil without this element. Costs per pupil were reduced further to £426 per school and £8 per pupil when it was assumed there were no additional costs of classroom delivery if STAMPP was delivered as part of activities such as personal, social, health and economic education. STAMPP was associated with a significantly greater proportion of pupils experiencing a heavy drinking episode avoided (0.08/8%) and slightly lower public sector costs (mean difference −£17.19). At a notional willingness-to-pay threshold of £15 (reflecting the cost of STAMPP), the probability of STAMPP being cost-effective was 56%. This level of uncertainty reflected the substantial variability in the cost differences between groups.ConclusionsSTAMPP was relatively low cost and reduced HED. STAMPP was not associated with any clear public sector cost savings, but neither did it increase them or lead to any cost-shifting within the public sector categories. Further research is required to establish if the cost-effectiveness of STAMPP is sustained in the long term.Trial registration numberISRCTN47028486; Results.

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Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges

Cited by 19 publications

References 56 publications

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Methods for public health economic evaluation: A Delphi survey of decision makers in English and Welsh local government

Cost-effectiveness of a combined classroom curriculum and parental intervention: economic evaluation of data from the Steps Towards Alcohol Misuse Prevention Programme cluster randomised controlled trial

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