Exploring the use of economic evidence to inform investment in disease prevention – a qualitative study

Abstract

Objective: In the context of growing financial pressures on health budgets, cost-effective prevention strategies are needed to address the burden from non-communicable disease in Australia. We explored how decision makers use economic evidence to inform such investment and how such evidence generated can more effectively meet the needs of end users.Methods: Thematic analysis of in-depth interviews with 15 high level stakeholders (Treasury, state health departments and the insurance industry), supplemented by documentary analysis.Results: Types of prevention approaches and economic evidence relevant to decision makers differed by organisational perspective. Capacity building in understanding economic evaluations and research evidence that addresses the differing criteria for investment used by different organisations is needed. The task of determining investment priorities in disease prevention comes with significant challenges including ideological barriers, delayed outcome measures, and implementation uncertainties. Conclusions and Implications for public health:Promoting the greater use of economic evidence in prevention requires more work on two fronts: tailoring the methods used by economists to better match the organisational imperatives of end users; and promoting greater consideration of broader societal and health sector perspectives among end users. This will require significant infrastructure development, monitoring and evaluation, stronger national leadership and a greater emphasis on evidence coproduction.

Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study

“…This was highlighted in the questionnaire results where all Health participants agreed that there was inadequate capacity within the department to complete economic evaluations. Building capacity to understand health economics within the NSW Ministry of Health has been previously recommended [ 34 ]. However, in addition to building an understanding of the basics of health economics, this study found that there was a need for more advanced skills that could be fulfilled by a health economics group embedded within the NSW Ministry of Health.…”

“…A previous descriptive study by Liu et al [ 34 ] explored the factors that drive decisions on evidence-based policy-making related to preventive health by Australian governments and private health insurers. A key finding was that perspectives varied between representatives from health and treasury departments.…”

“…Such research could provide recommendations on how health and treasury could work together to establish a framework for the better use of economic evidence. A limitation of the Liu et al study [ 34 ] was that it was ‘a-theoretical’ (a theoretical framework was not used to explain findings). As a result, it arguably does not provide a complete understanding of study findings or a full exploration of the policy environment and its influence on the use of economic evidence in decision-making [ 31 ].…”

Toward the economic evaluation of participatory approaches in health promotion: lessons from four German physical activity promotion projects

“…Finally, this study sheds some light on the challenges that lie ahead when trying to reconcile the different logics of health economics and health promotion. In a recent review of the use of economic evidence to inform disease prevention policy, Liu et al found that capacity in the health sector to understand economic evidence on interventions is limited and that capacity-building is needed to promote the use of this evidence ( Liu et al , 2017 ). The feedback from our partners mirrors these findings, indicating that health promotion research experts may find the logic and methods employed by health economics hard to understand.…”

What does the future hold for chronic disease prevention research?

“…New partnerships and collaborations might also mean applying research methods from other disciplines, such as law, economics, environmental and political science. Some of the Prevention Centre's more recent work includes using public health law to analyse prevention decisions, 34 applying economic tools to measure and assess the value of prevention, 35,36 and researching community attitudes about government intervention for prevention to support and inform decision‐making by the Centre's policy partners 37 …”