Public health interventions represent ‘good value for money’
MedWire News: The majority of public health interventions considered by the UK National Institute for Health and Clinical Excellence (NICE) are highly cost-effective, say researchers.
"Given that the cost per QALY [quality-adjusted life year] for most interventions is extremely low, it seems likely that as a nation we are not investing sufficiently in public health interventions," write Lesley Owen (National Institute for Health and Clinical Excellence, London, UK) and colleagues in The Journal of Public Health.
"The need to make best use of limited resources in the English National Health Service (NHS) is now greater than ever," they add.
The researchers explain that the current level of tobacco use is estimated to cost the NHS around £ 2.7 billion (US$ 4.2 billion; € 3.2 billion) every year, while treating people with health problems related to being overweight or obese costs around £4.2 billion annually (US$ 6.6 billion; € 5.1 billion). Physical inactivity is estimated to cost the NHS £1.1 billion (US$ 1.7 billion; € 1.3 billion) per year and the costs of treating the chronic and acute effects of alcohol misuse up to £1.7 billion (US$ 2.7 billion; € 2.0 billion) per year.
Despite this, only 4% of NHS funding is spent on prevention. It has been suggested that this may be because the economic evidence in favor of disease prevention is largely missing or of poor quality.
To address this, Owen and team examined the cost-effectiveness estimates from 21 economic analyses underpinning public health guidance published by NICE between 2006 and 2010.
The 21 publications studied yielded 200 base-case cost-effectiveness estimates given in terms of QALYs gained. Of these, 15% were cost-saving (ie, the intervention was more effective and cheaper than the control), 85% were cost-effective at a threshold of £ 20,000 (US$ 31,406; € 24,056) per QALY and 89% at the higher threshold of £ 30,000 (US$ 47,114; € 36,076) per QALY.
A further 5.5% were only effective above accepted levels of spending (>£ 30,000 per QALY), while 5.5% of the interventions were dominated, meaning that the intervention was both more costly and less effective than control.
The researchers note that, in general, interventions costing less than £ 20,000 per QALY are considered by NICE to be cost-effective. Interventions costing between £ 20,000 and £ 30,000 per QALY may be considered cost-effective if certain conditions are satisfied.
Interventions targeting smoking accounted for the majority of the estimates (63.5%), followed by physical activity (10.5%), alcohol prevention (7.5%), prevention of sexually transmitted diseases (7.0%), social and emotional wellbeing (5.5%), substance misuse (3.0%), long-term sickness and incapacity (1.5%), behavior change (0.5%), and population strategies to prevent cardiovascular disease (0.5%).
Cost-effective interventions ranged from those targeted at individuals using face-to-face interventions to those targeted at whole populations, such as mass-media campaigns and legislative measures. However, the researchers found that interventions targeted at the general population tended to have a lower cost than those aimed at disadvantaged groups.
"The analysis in this paper provides a single, comprehensive source of evidence on the cost-effectiveness of public health interventions. It is a first step in compiling the evidence that would allow informed decisions about the allocation of resources between different public health interventions," Owen et al remark.
"Clearly, the analysis does not cover all public health interventions and we need to continue in this endeavour," they conclude.
By Laura Cowen