Framework for cross-sectoral economic evaluation of public health interventions : a case study on a brief alcohol intervention

Public health interventions are often characterised by costs and outcomes across multiple sectors, with benefits that might only be realised far in the future. Further, such interventions frequently aim to address health equity concerns. For these reasons, the economic evaluation of public health interventions raises methodological and technical challenges. The lack of a consistent framework to evaluate their cost-effectiveness has been emphasised in the literature. This thesis has two main objectives. First, to develop an analytical framework for the economic evaluation of public health interventions. The second aim is to show how to operationalise the proposed framework, using a brief alcohol intervention to reduce alcohol consumption among criminal offenders as a case study. The proposed framework extends cost-effectiveness analysis (CEA) methods which are widely used for the evaluation of health care interventions, and consists of a cross-sectoral analysis, with the potential incorporation of health equity concerns and cross-temporal impacts. The case study intervention impacts Health Care (HC) and Criminal Justice System (CJS). Conclusions and recommendations differ according to the perspective adopted for the evaluation. Analyses provide different results when conducted from the following perspectives: naïve HC (i.e. considering exclusively health-related costs and health effects on offenders); CJS; full HC (i.e. including also spill-over effects from criminal justice on victims' health and additional costs falling on the HC budget to treat victims); and joint HC and CJS. Alternative value judgments and equity considerations incorporated in the economic evaluation also affect the results of the analysis. The proposed framework can provide support to decision making for local authorities, and could be potentially employed for the economic evaluation of all public health interventions. Results of the case study demonstrate the important implications of this work for future evaluations.