title: Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations.
abstract: BACKGROUND
  Increasing attention is being given to the evaluation of public health interventions. Methods for the economic evaluation of clinical interventions are well established. In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them.
  
  
  METHODS
  To identify the methodological challenges, five reviews that explored the economics of public health were consulted. From these, four main methodological challenges for the economic evaluation of public health interventions were identified. A review of empirical studies was conducted to explore how the methodological challenges had been approached in practice and an expert workshop convened to discuss how they could be tackled in the future.
  
  
  RESULTS
  The empirical review confirmed that the four methodological challenges were important. In all, 154 empirical studies were identified, covering areas as diverse as alcohol, drug use, obesity and physical activity, and smoking. However, the four methodological challenges were handled badly, or ignored in most of the studies reviewed.
  
  
  CONCLUSIONS
  The empirical review offered few insights into ways of addressing the methodological challenges. The expert workshop suggested a number of ways forward for overcoming the methodological challenges.
  
  
  CONCLUSIONS
  Although the existing empirical literature offers few insights on how to respond to these challenges, expert opinion suggests a number of ways forward. Much of what is suggested here has not yet been applied in practice, and there is an urgent need both for pilot studies and more methodological research.
authors.affiliation: Centre for Health Economics, University of York, United Kingdom. hlw4@york.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Weatherly
authors.forename: Michael
authors.initials: M
authors.lastname: Drummond
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
authors.forename: Brian
authors.initials: B
authors.lastname: Ferguson
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
authors.forename: Nigel
authors.initials: N
authors.lastname: Rice
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.forename: Amanda
authors.initials: A
authors.lastname: Sowden
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D011634:Public Health / Q000191:economics*