The appraisal of public health interventions: an overview

A. J. Fischer, A. Threlfall, S. Meah, R. Cookson, H. Rutter, M. P. Kelly

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: The approach currently used to appraise public health interventions is close to that of health technology appraisal for drugs. This approach is not appropriate for many public health interventions, however, when extremely small individual level benefits are delivered to extremely large populations. In many such situations, randomized controlled trials with sufficient size and power to determine individual level effects are impractical. Such interventions may be cost-effective, even in the absence of traditional evidence to demonstrate this. METHODS: We outline an alternative approach based on decision theory. We apply it to cases where prior beliefs are sufficiently strong and well grounded to allow decision-makers to assume the direction of change of the intervention's outcome, within the context of a transparent and deliberative decision-making process. Decision theory also assumes that decision-makers are risk neutral, implying that they should make decisions based on an intervention's mean cost-effectiveness, and should therefore disregard variance except when deciding to wait for more information. However, they must allow for biases. RESULTS: A framework is presented which has the potential to achieve large health gains at no additional cost. CONCLUSIONS: This analysis provides a rigorous theoretical framework for decision-makers in public health. The implied paradigm shift also applies to some clinically based areas.
LanguageEnglish
Pages488-494
Number of pages7
JournalJournal of Public Health
Volume35
Issue number4
DOIs
StatusPublished - 29 Aug 2013

Keywords

  • Cost-Benefit Analysis Decision Theory Humans Hypertension/etiology Program Evaluation Public Health/*methods/standards Public Health Administration/methods Sodium, Dietary/adverse effects economics methods public health

Cite this

Fischer, A. J., Threlfall, A., Meah, S., Cookson, R., Rutter, H., & Kelly, M. P. (2013). The appraisal of public health interventions: an overview. Journal of Public Health, 35(4), 488-494. https://doi.org/10.1093/pubmed/fdt076

The appraisal of public health interventions: an overview. / Fischer, A. J.; Threlfall, A.; Meah, S.; Cookson, R.; Rutter, H.; Kelly, M. P.

In: Journal of Public Health, Vol. 35, No. 4, 29.08.2013, p. 488-494.

Research output: Contribution to journalArticle

Fischer, AJ, Threlfall, A, Meah, S, Cookson, R, Rutter, H & Kelly, MP 2013, 'The appraisal of public health interventions: an overview' Journal of Public Health, vol. 35, no. 4, pp. 488-494. https://doi.org/10.1093/pubmed/fdt076
Fischer, A. J. ; Threlfall, A. ; Meah, S. ; Cookson, R. ; Rutter, H. ; Kelly, M. P. / The appraisal of public health interventions: an overview. In: Journal of Public Health. 2013 ; Vol. 35, No. 4. pp. 488-494.
@article{21f4eae7618d4f608178ce8fecc99dc7,
title = "The appraisal of public health interventions: an overview",
abstract = "BACKGROUND: The approach currently used to appraise public health interventions is close to that of health technology appraisal for drugs. This approach is not appropriate for many public health interventions, however, when extremely small individual level benefits are delivered to extremely large populations. In many such situations, randomized controlled trials with sufficient size and power to determine individual level effects are impractical. Such interventions may be cost-effective, even in the absence of traditional evidence to demonstrate this. METHODS: We outline an alternative approach based on decision theory. We apply it to cases where prior beliefs are sufficiently strong and well grounded to allow decision-makers to assume the direction of change of the intervention's outcome, within the context of a transparent and deliberative decision-making process. Decision theory also assumes that decision-makers are risk neutral, implying that they should make decisions based on an intervention's mean cost-effectiveness, and should therefore disregard variance except when deciding to wait for more information. However, they must allow for biases. RESULTS: A framework is presented which has the potential to achieve large health gains at no additional cost. CONCLUSIONS: This analysis provides a rigorous theoretical framework for decision-makers in public health. The implied paradigm shift also applies to some clinically based areas.",
keywords = "Cost-Benefit Analysis Decision Theory Humans Hypertension/etiology Program Evaluation Public Health/*methods/standards Public Health Administration/methods Sodium, Dietary/adverse effects economics methods public health",
author = "Fischer, {A. J.} and A. Threlfall and S. Meah and R. Cookson and H. Rutter and Kelly, {M. P.}",
note = "Fischer, A J Threlfall, A Meah, S Cookson, R Rutter, H Kelly, M P eng Review England 2013/09/03 06:00 J Public Health (Oxf). 2013 Dec;35(4):488-94. doi: 10.1093/pubmed/fdt076. Epub 2013 Aug 29.",
year = "2013",
month = "8",
day = "29",
doi = "10.1093/pubmed/fdt076",
language = "English",
volume = "35",
pages = "488--494",
journal = "Journal of Public Health",
issn = "1741-3842",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - The appraisal of public health interventions: an overview

AU - Fischer, A. J.

AU - Threlfall, A.

AU - Meah, S.

AU - Cookson, R.

AU - Rutter, H.

AU - Kelly, M. P.

N1 - Fischer, A J Threlfall, A Meah, S Cookson, R Rutter, H Kelly, M P eng Review England 2013/09/03 06:00 J Public Health (Oxf). 2013 Dec;35(4):488-94. doi: 10.1093/pubmed/fdt076. Epub 2013 Aug 29.

PY - 2013/8/29

Y1 - 2013/8/29

N2 - BACKGROUND: The approach currently used to appraise public health interventions is close to that of health technology appraisal for drugs. This approach is not appropriate for many public health interventions, however, when extremely small individual level benefits are delivered to extremely large populations. In many such situations, randomized controlled trials with sufficient size and power to determine individual level effects are impractical. Such interventions may be cost-effective, even in the absence of traditional evidence to demonstrate this. METHODS: We outline an alternative approach based on decision theory. We apply it to cases where prior beliefs are sufficiently strong and well grounded to allow decision-makers to assume the direction of change of the intervention's outcome, within the context of a transparent and deliberative decision-making process. Decision theory also assumes that decision-makers are risk neutral, implying that they should make decisions based on an intervention's mean cost-effectiveness, and should therefore disregard variance except when deciding to wait for more information. However, they must allow for biases. RESULTS: A framework is presented which has the potential to achieve large health gains at no additional cost. CONCLUSIONS: This analysis provides a rigorous theoretical framework for decision-makers in public health. The implied paradigm shift also applies to some clinically based areas.

AB - BACKGROUND: The approach currently used to appraise public health interventions is close to that of health technology appraisal for drugs. This approach is not appropriate for many public health interventions, however, when extremely small individual level benefits are delivered to extremely large populations. In many such situations, randomized controlled trials with sufficient size and power to determine individual level effects are impractical. Such interventions may be cost-effective, even in the absence of traditional evidence to demonstrate this. METHODS: We outline an alternative approach based on decision theory. We apply it to cases where prior beliefs are sufficiently strong and well grounded to allow decision-makers to assume the direction of change of the intervention's outcome, within the context of a transparent and deliberative decision-making process. Decision theory also assumes that decision-makers are risk neutral, implying that they should make decisions based on an intervention's mean cost-effectiveness, and should therefore disregard variance except when deciding to wait for more information. However, they must allow for biases. RESULTS: A framework is presented which has the potential to achieve large health gains at no additional cost. CONCLUSIONS: This analysis provides a rigorous theoretical framework for decision-makers in public health. The implied paradigm shift also applies to some clinically based areas.

KW - Cost-Benefit Analysis Decision Theory Humans Hypertension/etiology Program Evaluation Public Health/methods/standards Public Health Administration/methods Sodium, Dietary/adverse effects economics methods public health

U2 - 10.1093/pubmed/fdt076

DO - 10.1093/pubmed/fdt076

M3 - Article

VL - 35

SP - 488

EP - 494

JO - Journal of Public Health

T2 - Journal of Public Health

JF - Journal of Public Health

SN - 1741-3842

IS - 4

ER -