Key assumptions underlying the economic analysis (original) (raw)
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Health Research Policy and Systems, 2021
Background: Australian governments are increasingly mandating the use of cost-benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations. Methods: We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers. Results: Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making. Conclusions: This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes.
When the population approach to prevention puts the health of individuals at risk
International Journal of Epidemiology, 2004
The population approach to prevention has been described as one of the 'absolute truths' of preventive medicine. However, when the relationship between risk factor exposure levels and associated risk is J-shaped the population approach can increase risk in a small number of individuals. There is evidence that the relationship between a variety of exposures and all-cause morbidity and mortality is J-shaped. However, such relationships are often overlooked by epidemiological investigations which focus on cause-specific morbidity and mortality. Although the overall beneficial effect of population interventions may outweigh any negative effect seen, the effect on the individuals concerned should not be overlooked-especially when they can be easily identifiable before the intervention. Procedures, akin to gaining informed consent in clinical situations, may be required to ensure that individuals who are at high risk of being negatively affected by population interventions understand the risks involved and have the opportunity to opt out.
Introduction of article-processing charges for Population Health Metrics
Population health metrics, 2003
Population Health Metrics is an open-access online electronic journal published by BioMed Central - it is universally and freely available online to everyone, its authors retain copyright, and it is archived in at least one internationally recognised free repository. To fund this, from November 1 2003, authors of articles accepted for publication will be asked to pay an article-processing charge of US$500. This editorial outlines the reasons for the introduction of article-processing charges and the way in which this policy will work.Waiver requests will be considered on a case-by-case basis, by the Editor-in-Chief. Article-processing charges will not apply to authors whose institutions are 'members' of BioMed Central. Current members include NHS England, the World Health Organization, the US National Institutes of Health, Harvard, Princeton and Yale universities, and all UK universities. No charge is made for articles that are rejected after peer review. Many funding agenci...
Prioritizing risk factors to identify preventive interventions for economic assessment
Bulletin of the World Health Organization, 2011
rant CEA (and, in some instances, on evidence stemming from existing CEAs); and (iii) a final re-ranking based on the extent to which these risk factors contribute to health inequalities. By way of illustration we use health inequalities between Māori and non-Māori population groups in New Zealand. Methods Disease burden contributed by risk factors Comparative risk assessment methods make it possible to compare to what extent different risk factors contribute to the disease burden. Briefly, a burden of disease study is performed to quantify the DALYs contributed by all selected disease conditions. The DALY is a composite of years of life lost due to a particular disease or disability and a morbidity component represented by the number of years lived in a state of disability (e.g. if living with stroke has a disability weight of 0.4 and the average number of years lived with stroke is 10, this amounts to a loss of 4 years of life). With this information in hand, one can then calculate the disease burden attributable to specific risk factors. For example, in a comparative risk assessment of the burden of disease attributable to tobacco, all diseases that are caused by tobacco smoking are identified, the relative risks for the association between smoking and each disease are assembled, and the population distribution of smoking is determined from surveys. One then posits a counterfactual (but theoretically feasible) distribution for each risk factor. Such a counterfactual distribution would be nil in the case of a dichotomous variable such as smoking, but for a continuous variable such as blood Objective To explore a risk factor approach for identifying preventive interventions that require more in-depth economic assessment, including cost-effectiveness analyses. Methods A three-step approach was employed to: (i) identify the risk factors that contribute most substantially to disability-adjusted life years (DALYs); (ii) re-rank these risk factors based on the availability of effective preventive interventions warranting further cost-effectiveness analysis (and in some instances on evidence from existing cost-effectiveness analyses); and (iii) re-rank these risk factors in accordance with their relative contribution to health inequalities. Health inequalities between the Māori and non-Māori populations in New Zealand were used by way of illustration. Findings Seven of the top 10 risk factors prioritized for research on preventive interventions in New Zealand were also among the 10 risk factors most highly ranked as contributing to DALYs in high-income countries of the World Health Organization's Western Pacific Region. The final list of priority risk factors included tobacco use; alcohol use; high blood pressure; high blood cholesterol; overweight/obesity, and physical inactivity. All of these factors contributed to health inequalities. Effective interventions for preventing all of them are available, and for each risk factor there is at least one documented cost-saving preventive intervention. Conclusion The straightforward approach to prioritizing risk factors described in this paper may be applicable in many countries, and even in those countries that lack the capacity to perform additional cost-effectiveness analyses, this approach will still make it possible to determine which cost-effective interventions should be implemented in the short run.
A conceptual framework for selecting appropriate populations for public health interventions
Frontiers in Public Health, 2023
This article suggests a conceptual framework for choice of target populations for public health interventions. In short, who should benefit? Taking the seminal work of Geoffrey Rose on "individuals at risk" versus the "whole population approach" as a point of departure, we explore later contributions. Frohlich and Potvin introduced the notion of "vulnerable populations" applying relevant social determinants as the defining selection criterion. Other interventions focus on a "physical space" (spatial demarcations) such as a neighborhood as a means to define intervention populations. As an addition to these criteria, we suggest that the life-course perspective entails an alternative means of selecting target populations based on a "temporal" perspective. A focus on the various age phases ranging from fetal life and infancy to old age may guide selection of population segments for targeted public health interventions. Each of the selection criteria has advantages and disadvantages when used for primary, secondary, or tertiary prevention. Thus, the conceptual framework may guide informed decisions in public health planning and research regarding precision prevention versus various approaches to complex community-based interventions.