- Title
- Economic evaluation of the implementation of preventive health interventions
- Creator
- Reeves, Penny
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background and aims: Fiscal sustainability of health systems is an ongoing concern of most western economies, including Australia, where universal health coverage is a key design feature of the health system. Drivers of escalating costs include aging populations and the treatment and management of increasingly complex, yet preventable conditions, such as non-communicable chronic diseases. Preventive health has a role in mitigating escalating health care costs. Hence government attention has turned to investment in policies to promote prevention on the basis that they have been demonstrated to have meaningful impact on reducing known risk factors for chronic conditions and some cancers. However, the investment may be wasted if it is not evidence based and optimised for efficiency and/or equity. Understanding the value from preventive health investment is difficult because, compared to clinical interventions, there is comparatively little economic evidence. Further, value assessments of investment in implementation science-based strategies, designed to realise disease prevention policy objectives, are also lacking. The evidence-base supporting the feasibility and effectiveness of implementation-interventions has burgeoned in recent years, driven by increasing interest in research on how to translate knowledge into practice, yet the generation of corresponding economic evidence has not kept pace. Improving both the quantity and quality of research into the cost and value for money delivered by implementation-science informed interventions is essential to ensure the efficient and equitable allocation of expenditure on health care. The aims of this thesis included: 1. To map, via systematic review, the existing evidence pertaining to the application of economic evaluation to preventive health implantation interventions. Chapter 2 presents the results of the systematic review and outlines a guideline for the conduct of future health economic evaluations of such interventions. 2. To trial alternate economic evaluation methods applied to preventive health implementation-interventions. Chapters 3, 4 and 5 present a series of case studies. In the first study (Chapter 3), a trial-based cost-utility analysis is applied to an intervention aimed at increasing adherence with screening guidelines in a population of first-degree relatives of people with a diagnosis of colorectal cancer. In study two (Chapter 4), cost-effectiveness analysis is employed to examine the technical efficiency of implementation-interventions conducted in a school setting with varying intensity (high, medium and low). In study three (Chapter 5), cost-consequence analysis is conducted alongside a cost-effectiveness analysis to provide decision makers with pragmatic information given complex study outcomes. 3. Based upon the evidence presented in Chapters 2-5, Chapter 6 provides recommendations for policy, future research and practice regarding the application of economic evaluation to preventive health implementation-interventions. Results: The systematic review highlighted the paucity of economic evidence applied to chronic disease prevention implementation-interventions and shows variation in the rigour applied to the small number of evaluations that have been conducted since 1990. The applied trial-based cost-utility analysis showed the challenges of trying to represent the value of an implementation-intervention using quality of life and life years as outcome measures in the confines of an implementation trial. Cost-utility analysis, applied in the context of implementation, was found to have limitations for informing decision making unless conducted as part of a larger, modelled evaluation. The trial-based cost-effectiveness summary metrics, calculated in the second applied analyses, were shown to have advantages over cost utility analysis for aiding decision making. However, this benefit only existed because multiple comparisons were made. Further, the analysis was limited by answering a question of productive not allocative efficiency. The third applied study, combining cost-consequence analysis and cost-effectiveness analysis provided the most useful economic evidence to inform decision making. Conclusion: Investing in evidence-based, cost-effective and or equity improving chronic disease prevention interventions is suggested to be critical to sustaining universal health coverage and for mitigating escalating health expenditure. While implementation science plays an important role informing the design of interventions to influence intervention uptake and to optimise effectiveness, there is a need to also be cognisant of the value and affordability of implementation-interventions. This thesis provides new evidence on the paucity of economic evaluations applied to implementation-interventions in preventive health. The thesis further describes the development of practical guidance to promulgate further applied work.
- Subject
- health economics; implementation; preventive health; economic evaluation
- Identifier
- http://hdl.handle.net/1959.13/1428685
- Identifier
- uon:38649
- Rights
- Copyright 2021 Penny Reeves
- Language
- eng
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