Daily Archives: 07/05/2016

Investing in prevention: is it cost-effective?

Investing in preventionThis was an interesting blog from Public Health England that looks at investing in prevention and its value as cost-effective.  As a public health nurse I would say yes unequivocally but around alcohol there is an argument that says why bother.  Here’s PHE’s view:

In the first blog of this series I explained why it is so important that we make the case for investment in preventive activity, as highlighted in the NHS Five Year Forward View.

If we are to ‘get serious’ about prevention, we need to look at the economic arguments that justify these types of initiatives and public health investments more broadly.

Two of the key questions that we need to address are: how cost-effective is prevention activity in general? And what are the most cost-effective public health interventions?

These questions are of course even more important in the context of tightening budgets in both the NHS and local government. Frequently quoted is the £30bn NHS funding gap, while the gap between local government income and expenditure is forecast to rise to around £14bn by 2019-20.

As well as focusing on the cost-effectiveness of new interventions, we have to be sure that we are using resources efficiently now.  Are we allocating resources to the right activities (the ones that achieve the best outcomes within the resource envelope) and are we delivering those outcomes in the most efficient ways?

This blog will explain why most public health investments are cost-effective, meaning they generate a better outcome than the next best alternative use of resources.

Owen et al (2011) summarised evidence relating to around 200 public health interventions, including smoking and alcohol prevention and physical activity. The research showed that the vast majority of these interventions are highly cost-effective, in most cases far below the typical NICE threshold of £20,000 per Quality-Adjusted Life Year (QALY).

More recently, the WHO report The Case for Investing in Public Health highlighted cost-effective interventions that provide returns on investment and/or cost savings in either the short or longer term.

In assessing the cost-effectiveness of preventive interventions, compared with treatment, it’s only fair to take into account the longer time horizons of most public health interventions.

The blog then goes on to look at discount rates and perverse incentives before concluding:

Economics students are rightly taught that economics is an aid to decision-making; it will not provide all the answers, but its value does lie in structuring problems. Pragmatically, faced with making the business case for investing in prevention, we must consider how we approach a number of key factors including:

  • Long-term return on investments in prevention;
  • Incentives for investing in prevention and early intervention activities; and
  • The evidence on the cost-effectiveness of public health interventions.

In the third and fourth blogs in this series I will look at the issue of public health and cost savings, and the benefits of prevention to the wider health and social care system.

This pragmatic and sensible approach would require some long term planning and investment though and as the election cycle is only 5 years long some inter-party agreement too if it is to be successful.  Short-termism doesn’t work for preventative strategies – they have to be given long enough to follow through longitudinally to assess success …….