Public health research: Embracing economics to achieve greater population health gains
My blog aims to provide some insight into the application of health economics to the population health evaluation arena. I hope this insight will aid research teams when deciding if and how to include an economic evaluation within a public health focused bid to the NIHR. My guidance is based on my involvement with the NIHR Public Health Research (PHR) Programme as both a Funding Committee Member and as an applicant.
Embedding economists within multi-disciplinary research teams
With a growing recognition of the value of interdisciplinarity in complex public health intervention development and evaluation, there has been an associated growth in the understanding of the valuable role of economics in this research. Economics can make an important contribution to all stages of development, feasibility testing, evaluation and implementation, and embedding economic thinking at the outset of complex public health research is becoming commonplace.
This is evidenced by a substantial increase in the number of economic evaluations reported alongside complex public health interventions and, with the help of updated methods guidance from bodies such as NICE, an increasing use of more pragmatic frameworks such as cost-consequences analysis (CCA) and cost-benefit analysis (CBA). CCA and CBA approaches facilitate the broader perspectives often required for evaluating the full multi-sectoral impact of public health interventions. Developments in the theoretical literature such as ‘Nudge’ have also led to an increasing recognition of the important role of behavioural economics in the design and evaluation of complex interventions.
The role of economics within innovative research designs
Professor Frank Kee’s earlier blog entitled ‘Public Health Research: You can’t ignore the latest trends’ highlighted the ever-growing recognition that the “gold standard” randomised controlled trial (RCT) design is often ill-suited to the evaluation of complex public health interventions. There has been a timely rise in the number of economic evaluations being conducted using innovative systems modelling approaches, agent-based models and economic evaluations alongside natural experiments. A recent publication with colleagues from Glasgow and York entitled ‘A framework for conducting economic evaluations alongside natural experiments’ aims to provide long overdue practical guidance on incorporating economics into natural experiments.
If you are planning to apply to the NIHR PHR Programme please do consider incorporating economics into your application. There is readily accessible guidance* on how to do this and please remember that even the most basic information on resource use categories, cost and quality of life impacts can provide highly useful economic evidence.
An example of an ongoing NIHR PHR project which incorporates a strong health economics component is The Best Services Trial (BeST?): Effectiveness and cost-effectiveness of the New Orleans Intervention Model for Infant Mental Health. The health economics assessment plan is available in this BMJ article.
Many health economics and Health Technology Assessment units would be happy to be involved developing the economic perspective of your proposal for a NIHR public health research application. Health economists will relish the opportunity to develop a novel health economics design within a public health research evaluation. This might include suggestions for a within-trial or ‘within-natural experiment’ analysis but they are also likely to recommend the inclusion of a model to estimate the all-important long term cost and outcome impacts. Recent experience has also shown that the inclusion, where appropriate, of a behavioural economics component within a public health research proposal, such as discrete choice experiments, can also add valuable insights to the development and evaluation of complex public health interventions.
*For example: the forthcoming (2019) Oxford University Press handbook in Health Economics entitled ‘Applied Health Economics for Public Health Practice and Research’, the forthcoming updated economic evaluation sections of the MRC Complex Intervention Guidance and McDaid et al: Promoting Health, Preventing Disease: The Economic Case
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.