an Economist Intelligence Unit business healthcare
Health England was established with a remit to take forward recommendations in the White Paper “Our health, our care, our say: a new direction for community services”. In order to do that, Health England wished to develop a methodological model for determining priorities for public health interventions, following on from the development of a similar methodology in the U.S. The idea of setting priorities for public health initiatives was in line with the White Paper, but how to go about it?
To devise and demonstrate a prioritisation methodology that was applicable to England by consulting with key stakeholders, including national and local decision-makers, and reviewing research findings of different interventions, Health England turned to a collaboration of Bazian, Matrix Knowledge Group, Imperial College London, and Kings College London. From the outset, it was agreed that the output of the project needed to be practical and useable, else it would fail to impact on current practice. One of the deliverables was an online tool that could provide information on the cost-effectiveness, impact on health inequalities, and reach of interventions to support the prioritisation.
Bazian had previously tested a methodological approach to reviewing the reviews of seventeen selected public health interventions. Our job this time was to provide the data that would allow a reference group to develop, apply and test out a prioritisation method for a range of interventions, including some of the seventeen we had previously examined. Our first activity was to look for the effectiveness and cost effectiveness evidence. If with a rapid review of the high-level evidence a high quality review or set of reviews (e.g. an HTA or reviews underpinning NICE guidance) was found for effectiveness and cost effectiveness then no more searching was undertaken for that intervention. If however the review level search identified effectiveness evidence but no cost effectiveness evidence for an intervention, supplemental, in-depth searches for primary cost effectiveness evidence were undertaken. Finally, if no review level evidence for effectiveness was forthcoming, a de novo review was done where literature sources were searched for primary studies for that intervention.
Bazian then provided expert advise and helped the group develop a quality assessment and scoring system, based on recognised standards in reporting systematic reviews, guidelines and RCTs (e.g. the PRISMA, AGREE, CONSORT and Drummond statements or guidelines). Four quality appraisal tools were used to score different study types:
Following the application of these quality appraisal tools to the best evidence that we found, and an assessment of the economic impact of each option, a reference group of experts used a multi-criteria decision analysis to rate and then rank the interventions.
The work of Health England was completed in 2009. The report is available here (http://help.matrixknowledge.com/file.axd?file=HE_final_report.pdf ) and the online tool is here (http://help.matrixknowledge.com/) The project demonstrates the feasibility of a relatively rapid yet systematic method to prioritise preventative health interventions, based on the evidence usually considered by decision makers. The method developed can make the decisionmaking process more explicit, formal and practical. This, or similar, approaches could be used more broadly and help improve the commissioning for public health interventions.
“The big achievement has been to make complex public health information readily accessible to the non expert who is not conversant with the evidence base or public health systems. It was great to have a chief executive making the case for public health interventions. It was great to present a lot of information in a way that others can use constructively and straight away.”
Member of Advisory Panel for Health England