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The cost-effectiveness of public health interventions examined by NICE from 2011 to 2016
Lesley Owen1, Becky Pennington2,3, Alastair Fischer4
1Centre for Guidelines, National Institute for Health and Clinical Excellence, London, UK.
Background:
A review of economic evaluations of public health interventions assessed by NICE between 2005 and 2010 found 85% were cost-effective. Owen et al. (The cost-effectiveness of public health interventions. J Public Health 2012;34(1):37-45). With significant pressure on budgets the role of economics in securing funding remains important. This study updates the earlier analysis.
Methods:
Economic evaluations carried out between 2011 and 2016 were categorized: cost-utility analysis (CUA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA) and cost-consequences analysis (CCA). Cost-effectiveness estimates were analysed and compared with Owen et al. (The cost-effectiveness of public health interventions. J Public Health 2012;34(1):37-45).
Results:
Of 43 guidelines examined, 23 used CUA for specific interventions yielding 138 base-case incremental cost-effectiveness ratio (ICER) estimates, 11 used CUA for a threshold or 'what if' analysis, 1 used CEA, 3 used CCA, 1 used CBA and CUA and 1 used CEA and CUA, 5 did not require economic modelling. Compared with the earlier period, the median ICER for the 138 estimates was substantially higher (£7843 versus £1053) and there was greater variability (a higher proportion in the later period was cost-saving, but a higher proportion was also over £20 000 per quality adjusted life year).
Conclusions:
Nearly two-thirds (63%) of public health interventions assessed were cost-effective. However, increased variability in estimates highlights the importance of assessing cost-effectiveness to ensure good use of scarce resources.
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