A paper by Frew and Breheny (2019), aimed to answer this question by conducting a Delphi Panel of English and Welsh decision makers who allocated funding for public health for local government. Unsurprisingly, cost, health outcomes and quality of life were the most important factors. Beyond these top 3 factors, interventions’ impact on productivity and political pressures also ranked highly.
What sources of data do they use? On a scale from 1 (most often) to 5 (least often):
The most common sources cited were the U.K. NICE (median 2) and Public Health England reports (median 2); followed in descending order by peer‐reviewed academic literature (median 3), a google/internet search (median 4); and last, contact with known health economics colleagues (median 5).
One key challenge when making centralized decision-making is whether to take into account bigger studies conducted at the national level or information more relevant to the local context. The panelists believed both were important. This could indicate either a divided group or a unified feeling that both are important. In fact, when these statements were combined to form the statement: “economic evidence should be generalizable but take account of local context,” only a moderate strength of agreement was obtained across the panel. In short, it is not clear how much weight English and Welsh decisionmakers are truly giving to the local context.
Overall, the authors summarize their findings as follows:
Overall, the Delphi panel achieved high levels and strength of agreement for costs, health and well‐being effects, and productivity impact to be important pieces of information when making resource allocation decisions; and for economic evaluation to be relevant to the local context, to be disseminated using local reports; for a time‐horizon that captures all costs and benefits or a lifetime horizon; and for analysis that transparently reports costs and effects for different population subgroups, and by different sectors; and for economic evaluation that formally weights outcomes by population subgroup.
- Frew E, Breheny K. Methods for public health economic evaluation: A Delphi survey of decision makers in English and Welsh local government. Health economics. 2019 Jun 7.