title: A qualitative study on the views of experts regarding the incorporation of non-health outcomes into the economic evaluations of public health interventions.
abstract: BACKGROUND
  Public health interventions can impact a broad number of outcomes, including both health and non-health outcomes (NHOs). However, although it is often acknowledged that it's important to take NHOs into account in economic evaluation studies, in practice these are often neglected. To address this issue, our study investigated expert views regarding the incorporation of NHOs into the economic evaluations of public health interventions, by means of a qualitative study.
  
  
  METHODS
  A purposive sampling method was used to recruit the experts in the field of health economics and/or public health for this study. Twenty-two semi-structured interviews were held. After recording, the interviews were transcribed verbatim and entered in Nvivo. The data was analyzed using a thematic analysis to identify all important themes mentioned by the experts. Data collection and analysis was continued until saturation was reached. Multiple coding and validity checks were performed to further strengthen the rigour of our methodology.
  
  
  RESULTS
  Based on the expert interviews, the following overarching themes were identified; Theme 1: NHOs on the individual level, direct social level and societal level. Theme 2: Pros and Cons regarding the development of a new instrument to measure NHOs. Theme 3: The most important requirements for a new questionnaire to be developed for measuring broader outcomes. Theme 4: Alternative methods which could be used for measuring and valuating NHOs in economic evaluations for public health.
  
  
  CONCLUSIONS
  Our research findings indicate that the importance of NHOs and the need to measure them are universally accepted. Most of the experts acknowledge the importance of measuring broader outcomes and support the development of a new instrument to measure these. The experts, who do not support the development of a new instrument, question its usefulness and feasibility; i.e., they are not sure whether it is possible to valuate NHOs. Furthermore, experts have strong and sometimes conflicting views on the specific requirements of a new instrument to be developed for measuring NHOs. They did not identify a single preferred alternative method for measurement and valuation.
  
  
  CONCLUSIONS
  Most experts find a wide range of NHOs important and are in favor of developing a new instrument for identifying and measuring NHOs. Hence, an open discussion needs to be initiated with experts and other stakeholders about which steps need to be taken to move forward.
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. g.vanmastrigt@maastrichtuniversity.nl.
authors.forename: Ghislaine Apg
authors.initials: GA
authors.lastname: van Mastrigt
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. a.paulus@maastrichtuniversity.nl.
authors.forename: Aggie Tg
authors.initials: AT
authors.lastname: Paulus
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. m.aarts@vrln.nl.
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Aarts
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. s.evers@maastrichtuniversity.nl.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. s.evers@maastrichtuniversity.nl.
authors.forename: Silvia Maa
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. adrienne.alayli@uk-koeln.de.|Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Strasse 176-178, 50935, Cologne, Germany. adrienne.alayli@uk-koeln.de.
authors.forename: Adrienne Fg
authors.initials: AF
authors.lastname: Alayli-Goebbels
mesh_terms: D003362:Cost-Benefit Analysis; D005104:Expert Testimony; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011634:Public Health / Q000191:economics*; D011795:Surveys and Questionnaires