The cost-effectiveness of public health interventions

Owen, Lesley; Morgan, Antony; Fischer, Asja; Ellis, Simon; Hoy, Andrew; Kelly, Michael P.

doi:10.1093/pubmed/fdr075

Cited by 109 publications

(100 citation statements)

References 7 publications

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“…However, previous research indicates that the great majority of public health interventions meet NICE's criteria for cost-effectiveness. 127 Alternative approaches to encouraging uptake of preschool vaccination…”

Section: Cost and Cost-effectivenessmentioning

confidence: 99%

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

100

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BackgroundUptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK.ObjectiveTo provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations.DesignSystematic review, qualitative study and discrete choice experiment (DCE) with questionnaire.SettingCommunity, health and education settings in England.ParticipantsQualitative study – parents and carers of preschool children, health and educational professionals. DCE – parents and carers of preschool children identified as ‘at high risk’ and ‘not at high risk’ of incompletely vaccinating their children.Data sourcesQualitative study – focus groups and individual interviews. DCE – online questionnaire.Review methodsThe review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to ‘universal’ services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted.ResultsSystematic review – there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study – there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire – universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted incentives. Those reporting that they would need an incentive to vaccinate their children completely required around £110. Those who did not felt that the maximum acceptable incentive was around £70.LimitationsSystematic review – a number of relevant studies were excluded as they did not meet the study design inclusion criteria. Qualitative study – few partially and non-vaccinating parents were recruited. DCE and questionnaire – data were from a convenience sample.ConclusionsThere is little current evidence on the effectiveness or economic costs and consequences of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus quasi-mandatory interventions may depend on the context in which these are elicited.Future workFurther evidence is required on (i) the effectiveness and optimal configuration of parental financial incentive and quasi-mandatory interventions for preschool vaccinations – if effectiveness is confirmed, further evidence is required on how to communicate this to stakeholders and the impact on acceptability; and (ii) the acceptability of parental financial incentive and quasi-mandatory interventions for preschool vaccinations to members of the population who are not parents of preschool children or relevant health professionals. Further consideration should be given to (i) incorporating reasons for non-vaccination into new interventions for promoting vaccination uptake; and (ii) how existing services can be optimised.Study registrationThis study is registered as PROSPERO CRD42012003192.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Cost and Cost-effectivenessmentioning

confidence: 99%

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

100

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“…A review of 'cultures of evidence' 27 showed, for example, that decisions in non-health sectors are more likely to be framed by political or legal constraints. Limitations of a public health evidence base, skewed towards cost-effective lifestyle interventions 28 become increasingly evident given the 'healthy placemaking 29 role of local government. Policies were developed following a process of option appraisal for achieving agreed policy priorities, which was iterative and developmental and it was not clear how decision-support methods developed for prioritising between different interventions fitted into the wider decision-making processes of the local authority or the role of elected members.…”

Section: Discussionmentioning

confidence: 99%

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

et al. 2015

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. The return of public health to local government in England: changing the parameters of the public health prioritisation debate? Abstract ObjectivesTo explore the influence of values and context in public health priority-setting in local government in England. Study designQualitative interview study. MethodsDecision-makers' views were identified through semi-structured interviews and prioritisation tools relevant for public health were reviewed. Interviews (29) were carried out with Health and Wellbeing Board members and other key stakeholders across three local authorities in England, following an introductory workshop. ResultsThere were four main influences on priorities for public health investment in our case study sites: an organisational context where health was less likely to be associated with health care and where accountability was to a local electorate; a commissioning and priority-setting context (plan, do, study, act) located within broader local authority priority-setting processes; different views of what counts as evidence and, in particular, the role of local knowledge; and debates over what constitutes a public health intervention, triggered by the transfer of a public health budget from the NHS to local authorities in England. ConclusionsThe relocation of public health into local authorities exposes questions over prioritising public health investment, including the balance across lifestyle interventions and broader action on social determinants of health and the extent to which the public health evidence base influences local democratic decision-making. Action on wider social determinants reinforces not only the art and science but also the values and politics of public health.

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“…Funding constraints such as these do not provide an encouraging environment for new, robust collaborative relationships to develop (Coleman and Glendinning 2015). The announcement of a £200 million cut in public health funding, constitutes a 7.4% reduction in the public health budget (Barr and Robinson 2015) potentially costing the Treasury much more than £200 million in the long term (Owen et al 2012).…”

Section: Health and Wellbeing Boards: Developing Their Rolesmentioning

confidence: 99%

Health and Wellbeing Boards: The new system stewards?

Coleman¹,

Dhesi

Peckham

2016

Dismantling the NHS?

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Health and Wellbeing Boards (HWBs) emerged from debates about the Health and Social Care Bill (2011) as a key coordinating mechanism or steward for local health and social care systems. For many this is yet a further attempt to improve coordination between health and social care services which historically has been a mixed experience. The rationale for HWBs, however, includes a broader coordinating function across local authority services with a role in addressing the wider social determinants of health such as housing, education and planning, as well as social care. This chapter examines the development of HWBs and draws on the findings of studies conducted by the authors and considers whether or not HWBs are emerging as system stewards. By this the authors mean HWBs acting at a strategic level to coordinate and set the direction of health and social care developments at the local level, as well as encouraging integrated working.

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The cost-effectiveness of public health interventions

Cited by 109 publications

References 7 publications

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

Health and Wellbeing Boards: The new system stewards?

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