The cost-effectiveness of public health interventions examined by the National Institute for Health and Care Excellence from 2005 to 2018

Public Health. 2019 Apr;169:151-162. doi: 10.1016/j.puhe.2019.02.011. Epub 2019 Mar 16.

Abstract

Background: Reviews of economic evaluations of public health (PH) interventions assessed by the National Institute for Health and Care Excellence (NICE) in the periods 2005-2010 and 2011-2016 have been undertaken. This study combines these analyses, adds six further guidelines published since then, and thus provides a summary of cost-effectiveness of NICE's PH interventions to the present.

Methods: As in previous studies, economic evaluations carried out between 2005 and 2018 were categorised by the type of economic analysis used to extract and summarise base-case ICERs. A number of 'sensitivity analyses' were carried out to test the validity of the approach.

Results: Of 71 guidelines examined, 27 used cost utility analysis (CUA) for specific interventions, yielding 380 individual base-case ICER estimates (or 221 taking into account clustering of interventions). The median cost per quality-adjusted life-year (QALY) ICER for the 380 estimates was £1,986. Of these, 21% were cost saving, and 54% ranged from £1 to £20,000, 3% were between £20,001 and £30,000, 16% were above £30,000 and 5% were dominated. Taking clustering into account made relatively little difference to these results. Reducing the threshold from £20,000/QALY to £15,000/QALY would result in 2% of ICERs moving across the threshold.

Conclusions: Seventy-five percent of PH interventions assessed were cost-effective at a threshold of £20,000 per QALY when disregarding clustering, and 68% were cost-effective when clusters were represented by a single ICER. Other analyses gave similar results for the distribution of ICERs. Limitations of the analysis are discussed.

Keywords: Cost Effectiveness; Cost utility analysis; Health Economics; Public Health.

MeSH terms

  • Cost-Benefit Analysis
  • England
  • Government Agencies
  • Health Promotion / economics*
  • Humans
  • Program Evaluation
  • Public Health Practice / economics*
  • Quality-Adjusted Life Years