Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.
Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.
Health Res Policy Syst. 2021 Dec 19;19(1):147. doi: 10.1186/s12961-021-00796-w.
Australian governments are increasingly mandating the use of cost-benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations.
We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers.
Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making.
This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes.
澳大利亚政府越来越多地要求使用成本效益分析（CBA）来为政府资源的有效配置提供信息。CBA 在评估通常具有跨部门性质且需要内阁批准才能实施的预防保健干预措施时可能会很有用。本研究为评估预防保健干预措施制定了 CBA 框架，该框架在平衡一致性需求与其他机构准则的同时，坚持健康经济评估的准则和惯例。
我们分析了澳大利亚联邦和新南威尔士州（新州）政府部门发布的 CBA 和其他评估指南文件。数据提取比较了不同机构的建议及其对预防保健干预措施分析的影响。该框架根据以下考虑因素指定了参考案例和敏感性分析：（1）应用经济评估理论；（2）不同政府部门之间 CBA 的一致性；（3）从 CBA 向通常用于健康干预措施的更传统的成本效益/成本效用分析框架转变的难易程度；（4）应用的实际情况；以及（5）内阁决策者和卫生政策制定者等最终用户的需求。
有 9 份文件提供了 CBA 或相关经济评估指南。指南之间在术语和一致性及分歧领域存在差异。指南之间的分歧涉及（1）社会视角中包含的社区；（2）应在事前分析中评估的选项数量；（3）具有较长经济寿命的干预措施的适当时间范围；（4）折现率的理论依据和价值；（5）变量（如生命统计价值）的参数值；以及（6）决策的汇总衡量标准。
本文通过概述一个符合财政部准则同时考虑预防政策独特特征的框架，解决了一些阻碍 CBA 在预防领域应用的方法学挑战。州和联邦政府卫生和财政部的大量时间和资源的投入可能有助于有效使用和实施预防保健 CBA 框架，但有可能改善与预防保健政策和方案相关的决策。
