title: The cost-effectiveness of public health interventions.
abstract: BACKGROUND
  The need to make best use of limited resources in the English National Health Service is now greater than ever. This paper contributes to this endeavour by synthesizing data from cost-effectiveness evidence produced to support the development of public health guidance at the National Institute of Health and Clinical Excellence (NICE). No comprehensive list of cost-effectiveness estimates for public health interventions has previously been published in England.
  
  
  METHODS
  Cost-effectiveness estimates using English cost data were collected and analysed from 21 (of 26) economic analyses underpinning public health guidance published by NICE between 2006 and 2010.
  
  
  RESULTS
  Two hundred base-case cost-effectiveness estimates were analysed, 15% were cost saving (i.e. the intervention was more effective and cheaper than comparator). Eighty-five per cent were cost-effective at a threshold of £20,000 per quality-adjusted life year and 89% at the higher threshold of £30,000. A further 5.5% were above £30,000 and 5.5% of the interventions were dominated (i.e. the intervention was more costly and less effective than comparator).
  
  
  CONCLUSIONS
  The majority of public health interventions assessed are highly cost-effective. The next challenge is to provide commissioners with a framework that allows information from economic analyses to be combined with other criteria that supports making better investment decisions at a local level.
authors.affiliation: Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London WC1V 6NA, UK. lesley.owen@nice.org.uk
authors.forename: Lesley
authors.initials: L
authors.lastname: Owen
authors.forename: Antony
authors.initials: A
authors.lastname: Morgan
authors.forename: Alastair
authors.initials: A
authors.lastname: Fischer
authors.forename: Simon
authors.initials: S
authors.lastname: Ellis
authors.forename: Andrew
authors.initials: A
authors.lastname: Hoy
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
mesh_terms: D003362:Cost-Benefit Analysis; D004739:England; D015438:Health Behavior; D006801:Humans; D011314:Preventive Health Services / Q000191:economics* / Q000379:methods / Q000592:standards; D011634:Public Health / Q000191:economics* / Q000379:methods / Q000592:standards; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics* / Q000592:standards