IDEAS home Printed from
   My bibliography  Save this article

Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations


  • Weatherly, Helen
  • Drummond, Michael
  • Claxton, Karl
  • Cookson, Richard
  • Ferguson, Brian
  • Godfrey, Christine
  • Rice, Nigel
  • Sculpher, Mark
  • Sowden, Amanda


Rationale Increasing attention is being given to the evaluation of public health interventions. Methods for the economic evaluation of clinical interventions are well established. In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them.Methods To identify the methodological challenges, five reviews that explored the economics of public health were consulted. From these, four main methodological challenges for the economic evaluation of public health interventions were identified. A review of empirical studies was conducted to explore how the methodological challenges had been approached in practice and an expert workshop convened to discuss how they could be tackled in the future.Results The empirical review confirmed that the four methodological challenges were important. In all, 154 empirical studies were identified, covering areas as diverse as alcohol, drug use, obesity and physical activity, and smoking. However, the four methodological challenges were handled badly, or ignored in most of the studies reviewed.Discussion The empirical review offered few insights into ways of addressing the methodological challenges. The expert workshop suggested a number of ways forward for overcoming the methodological challenges.Conclusion Although the existing empirical literature offers few insights on how to respond to these challenges, expert opinion suggests a number of ways forward. Much of what is suggested here has not yet been applied in practice, and there is an urgent need both for pilot studies and more methodological research.

Suggested Citation

  • Weatherly, Helen & Drummond, Michael & Claxton, Karl & Cookson, Richard & Ferguson, Brian & Godfrey, Christine & Rice, Nigel & Sculpher, Mark & Sowden, Amanda, 2009. "Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations," Health Policy, Elsevier, vol. 93(2-3), pages 85-92, December.
  • Handle: RePEc:eee:hepoli:v:93:y:2009:i:2-3:p:85-92

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Werner B. F. Brouwer & Marc A. Koopmanschap & Frans F. H. Rutten, 1997. "Productivity Costs Measurement Through Quality of Life? A Response to the Recommendation of the Washington Panel," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 253-259.
    3. Richard Blundell & Monica Costa Dias, 2000. "Evaluation methods for non-experimental data," Fiscal Studies, Institute for Fiscal Studies, vol. 21(4), pages 427-468, January.
    4. Smith, Richard D. & Yago, Milton & Millar, Michael & Coast, Jo, 2005. "Assessing the macroeconomic impact of a healthcare problem: The application of computable general equilibrium analysis to antimicrobial resistance," Journal of Health Economics, Elsevier, vol. 24(6), pages 1055-1075, November.
    5. Ryan, Mandy & Netten, Ann & Skatun, Diane & Smith, Paul, 2006. "Using discrete choice experiments to estimate a preference-based measure of outcome--An application to social care for older people," Journal of Health Economics, Elsevier, vol. 25(5), pages 927-944, September.
    6. Milton C. Weinstein & Joanna E. Siegel & Alan M. Garber & Joseph Lipscomb & Bryan R. Luce & Willard G. Manning & George W. Torrance, 1997. "Productivity costs, time costs and health-related quality of life: a response to the Erasmus Group," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 505-510.
    7. Werner B.F. Brouwer & Marc A. Koopmanschap & Frans F.H. Rutten, 1997. "Productivity costs in cost-effectiveness analysis: numerator or denominator: a further discussion," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 511-514.
    8. Hugh Gravelle & Werner Brouwer & Louis Niessen & Maarten Postma & Frans Rutten, 2007. "Discounting in economic evaluations: stepping forward towards optimal decision rules," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 307-317.
    9. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    10. Phil Shackley & Simon Dixon, 2000. "Using contingent valuation to elicit public preferences for water fluoridation," Applied Economics, Taylor & Francis Journals, vol. 32(6), pages 777-787.
    11. Cookson, Richard & Drummond, Mike & Weatherly, Helen, 2009. "Explicit incorporation of equity considerations into economic evaluation of public health interventions," Health Economics, Policy and Law, Cambridge University Press, vol. 4(2), pages 231-245, April.
    12. Karl Claxton & Mark Sculpher & Anthony Culyer & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier, 2006. "Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-4.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Sam Watson’s journal round-up for 4th April 2016
      by Sam Watson in The Academic Health Economists' Blog on 2016-04-04 16:00:24


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Dyfrig Hughes & Joanna Charles & Dalia Dawoud & Rhiannon Tudor Edwards & Emily Holmes & Carys Jones & Paul Parham & Catrin Plumpton & Colin Ridyard & Huw Lloyd-Williams & Eifiona Wood & Seow Tien Yeo, 2016. "Conducting Economic Evaluations Alongside Randomised Trials: Current Methodological Issues and Novel Approaches," PharmacoEconomics, Springer, vol. 34(5), pages 447-461, May.
    2. Matthew Calver, 2016. "Measuring the Appropriate Outcomes for Better Decision-Making: A Framework to Guide the Analysis of Health Policy," CSLS Research Reports 2016-03, Centre for the Study of Living Standards.
    3. Giovanni Di Bartolomeo & Stefano Papa, 2019. "The Effects of Physical Activity on Social Interactions: The Case of Trust and Trustworthiness," Journal of Sports Economics, , vol. 20(1), pages 50-71, January.
    4. Giulia Greco & Paula Lorgelly & Inthira Yamabhai, 2016. "Outcomes in Economic Evaluations of Public Health Interventions in Low†and Middle†Income Countries: Health, Capabilities and Subjective Wellbeing," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 83-94, February.
    5. Goebbels, Adrienne F.G. & Lakerveld, Jeroen & Ament, André J.H.A. & Bot, Sandra D.M. & Severens, Johan L., 2012. "Exploring non-health outcomes of health promotion: The perspective of participants in a lifestyle behaviour change intervention," Health Policy, Elsevier, vol. 106(2), pages 177-186.
    6. Mac Giolla Phadraig, Caoimhin & Nunn, June & Guerin, Suzanne & Normand, Charles, 2016. "Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis," Evaluation and Program Planning, Elsevier, vol. 55(C), pages 46-54.
    7. Cochrane, M. & Watson, P.M. & Timpson, H. & Haycox, A. & Collins, B. & Jones, L. & Martin, A. & Graves, L.E.F., 2019. "Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions," Social Science & Medicine, Elsevier, vol. 232(C), pages 156-167.
    8. Den Daas, C. & Van Aar, F. & Van Benthem, B.H.B., 2019. "Evaluating the impact of health reforms in the Netherlands: Assessing the impact of an alcohol ban on sexually transmitted infections in national surveillance data," Health Policy, Elsevier, vol. 123(10), pages 992-997.
    9. Deidda, Manuela & Geue, Claudia & Kreif, Noemi & Dundas, Ruth & McIntosh, Emma, 2019. "A framework for conducting economic evaluations alongside natural experiments," Social Science & Medicine, Elsevier, vol. 220(C), pages 353-361.
    10. Emma Frew, 2016. "Economic Evaluation of Childhood Obesity Interventions: Reflections and Suggestions," PharmacoEconomics, Springer, vol. 34(8), pages 733-740, August.
    11. Anna Månsdotter & Björn Ekman & Inna Feldman & Lars Hagberg & Anna-Karin Hurtig & Lars Lindholm, 2017. "We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs," Applied Health Economics and Health Policy, Springer, vol. 15(4), pages 437-440, August.
    12. Emma Frew, 2017. "Aligning Health Economics Methods to Fit with the Changing World of Public Health," Applied Health Economics and Health Policy, Springer, vol. 15(3), pages 287-289, June.
    13. Susanne Mayer & Aggie T. G. Paulus & Agata Łaszewska & Judit Simon & Ruben M. W. A. Drost & Dirk Ruwaard & Silvia M. A. A. Evers, 2017. "Health-Related Resource-Use Measurement Instruments for Intersectoral Costs and Benefits in the Education and Criminal Justice Sectors," PharmacoEconomics, Springer, vol. 35(9), pages 895-908, September.
    14. Hill, Sarah R. & Vale, Luke & Hunter, David & Henderson, Emily & Oluboyede, Yemi, 2017. "Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges," Health Policy, Elsevier, vol. 121(12), pages 1249-1262.
    15. Tom L. Drake & Yoel Lubell, 2017. "Malaria and Economic Evaluation Methods: Challenges and Opportunities," Applied Health Economics and Health Policy, Springer, vol. 15(3), pages 291-297, June.

    More about this item


    Economic evaluation Public health;


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:93:y:2009:i:2-3:p:85-92. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Haili He) or (). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.