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Mark versus Luke? Appropriate Methods for the Evaluation of Public Health Interventions

Author

Listed:
  • Karl Claxton

    (Centre for Health Economics, University of York)

  • Mark Sculpher

    (Centre for Health Economics, University of York)

  • Tony Culyer

    (Institute for Work and Health, Toronto, Ontario, Canada)

Abstract

The purpose of this paper is to demonstrate that a social decision making approach to evaluation can be generalised to interventions such as public health and national policies which have multiple objectives and impact on multiple constraints within and beyond the health sector. We demonstrate that a mathematical programming solution to this problem is possible, but the information requirements make it impractical. Instead we propose a simple compensation test for interventions with multiple and cross-sectoral effects. However, rather than compensation based on individual preferences, it can be based on the net benefits falling on different sectors. The valuation of outcomes is based on the shadow prices of the existing budget constraints, which are implicit in existing public expenditure and its allocation across different sectors. A ‘welfarist’ societal perspective is not sufficient; rather, a multiple perspective evaluation which accounts for costs and effects falling on each sector is required.

Suggested Citation

  • Karl Claxton & Mark Sculpher & Tony Culyer, 2007. "Mark versus Luke? Appropriate Methods for the Evaluation of Public Health Interventions," Working Papers 031cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:31cherp
    as

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    File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/rp31_evaluation_of_public_health_interventions.pdf
    File Function: First version, 2007
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    References listed on IDEAS

    as
    1. Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial-based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687.
    2. 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.
    3. Machina, Mark J, 1987. "Choice under Uncertainty: Problems Solved and Unsolved," Journal of Economic Perspectives, American Economic Association, vol. 1(1), pages 121-154, Summer.
    4. Karl Claxton & John Posnett, "undated". "An Economic Approach to Clinical Trial Design and Research Priority Setting," Discussion Papers 96/19, Department of Economics, University of York.
    5. Elizabeth Fenwick & Karl Claxton & Mark Sculpher & Andrew Briggs, 2000. "Improving the efficiency and relevance of health technology assessent: the role of iterative decision analytic modelling," Working Papers 179chedp, Centre for Health Economics, University of York.
    6. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 34-58, Spring.
    7. Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118 Elsevier.
    8. Boadway, Robin W, 1974. "The Welfare Foundations of Cost-Benefit Analysis," Economic Journal, Royal Economic Society, vol. 84(336), pages 926-939, December.
    9. Weinstein, Milton & Zeckhauser, Richard, 1973. "Critical ratios and efficient allocation," Journal of Public Economics, Elsevier, vol. 2(2), pages 147-157, April.
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. David Epstein & Dolores Jiménez-Rubio & Peter C. Smith & Marc Suhrcke, 2009. "Social determinants of health: an economic perspective," Health Economics, John Wiley & Sons, Ltd., vol. 18(5), pages 495-502.
    2. Coast, Joanna, 2009. "Maximisation in extra-welfarism: A critique of the current position in health economics," Social Science & Medicine, Elsevier, vol. 69(5), pages 786-792, September.
    3. Karl Claxton & Simon Walker & Steven Palmer & Mark Sculpher, 2010. "Appropriate Perspectives for Health Care Decisions," Working Papers 054cherp, Centre for Health Economics, University of York.
    4. Mike Paulden & Karl Claxton, 2009. "Budget allocation and the revealed social rate of time preference for health," Working Papers 053cherp, Centre for Health Economics, University of York.

    More about this item

    Keywords

    cost-effectiveness analysis; decision rules; public health;

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