Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges

Abstract

Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions. Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006-2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers. 619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.

Keywords: Alcohol interventions; Economic evaluation; Health economics; Methodological challenges; Priority-setting; Public health.

Fig. 1

Prisma flow diagram.

Fig. 2

Frequency of intervention types evaluated. ^a The frequency of interventions is greater than the total number of included studies due to several studies considering multiple interventions. *These interventions do not fit our inclusion criteria, however they were included in studies which evaluated a mix of interventions, the rest of which did fit our inclusion criteria, therefore have been included in this figure for reference.