Health economics: a guide for public health teams
Resources to help local commissioners achieve value for money by estimating the return on investment (ROI) and cost-effectiveness of public health programmes.
Public Health England (PHE) looks to support local public health decision making by producing accessible health economics resources.
In this guide you will find links to tools and reports that can help you:
- assess which interventions provide the best value for money, by calculating their costs, benefits and ROI
- make the most of your budget by deciding how to split resources across different public health programmes
- compare costs, savings and clinical outcomes
- assess the available economic evidence in different public health topic areas
These evidence resources are relevant for local decision-makers as well as national policymakers.
The cost-effectiveness of specific topic areas
PHE’s Health Economics and Modelling team (HEMT) has produced a number of resources which can be used to estimate the value of investing in prevention and early diagnosis in your area. They pull together the best available evidence on costs, savings, and health benefits for specific topic areas in a single place, simplifying the process of commissioning cost-effective services.
This includes ROI tools in a number of areas, which allow you to estimate what impact implementing an intervention in a local authority and or a CCG would have on costs and health outcomes:
- Best Start in Life
- cardiovascular disease
- contraceptive services (and an extension to the contraception ROI tool)
- falls prevention
- mental health services
- musculoskeletal conditions
- oral health in pre-school children
- older adults
- sexual and reproductive health in young people
- weight management
The Health Economics team have also developed a number of tools to understand the impacts on costs and health outcomes of interventions specifically implemented in CCGs:
- colorectal cancer ROI tool
- end of life care economic tool
- NHS Diabetes Prevention Programme ROI tool
The Dementia in older age report discusses the difficulty in estimating ROI results for primary prevention of dementia. This difficulty is because of the long time periods between people undertaking behaviours that increases risk and the onset of the condition.
The burden of public health issues
The Air Pollution Tool allows local authorities to estimate the burden of air pollution on the health care system. It does this by estimating the potential costs to the NHS and social care due to the health impacts of particulate matter (PM2.5) and nitrogen dioxide (NO2), as well as the attributable disease cases. It also allows users to estimate the benefits of reducing local air pollution levels in terms of costs and health outcomes.
The Movement into Employment ROI tool helps local decision-makers assess the health and financial benefits for individuals, the exchequer and wider society of helping people in their area back into work. Local authorities, clinical commissioning groups (CCGs), Jobcentre Plus and national policymakers can use the results to make the case for greater investment in health and work interventions.
Modelling work
The report on Health and social care costs of health conditions and multi-morbidities sets out the estimated health and social care cost per case figures of a selection of common health conditions and multimorbidities.
The report on Alcohol Attributable Fractions (AAFs) sets out the national burden of disease associated with alcohol consumption.
The report on the wider impacts of COVID-19 on people aged 65 and over sets out changes to physical activity levels and provides an estimate for the impact on the number of falls.
Support making prioritisation decisions
To help local decision-makers think about how to split their budget across multiple public health programmes, PHE has developed the Prioritisation Framework. The Framework offers a transparent and evidence-based approach to making the most of the available resources in a local authority.
Collective summaries of economic evidence
The Health Economics Evidence Resources (HEER) collects and summarises the economic evidence on a wide selection of public health interventions. Each piece of evidence is categorised against over 20 criteria allowing you to filter and select only what you are interested in. The HEER replaces the previously published menu of preventative interventions.
The fiscal and pricing policies to improve public health report identifies and assesses potential fiscal or pricing policies that could be implemented in England to improve the population’s health. The framework accompanying the report allows policies in different policy areas to be comparable in terms of their impacts on health and other outcomes.
The Chartered Institute of Public Finance and Accountancy (CIPFA) have worked with PHE to produce a report on evaluating preventative investments in public health in England. This brings together tools, resources and ideas which aim to start conversations about improving the evaluation of preventative health. The report considers new ways of working across both systems and communities in order to help make the case for prevention as demand pressures on public services grow.
Comparing spend and outcomes
The Spend and Outcome Tool (SPOT) is designed to compare local authority spend and outcome measures against other local authorities including CIPFA statistical neighbours. The tool can be used to identify programmes with outcomes that are significantly different from similar local authorities, that may need more analysis. This can be done to support planning and prioritisation across programmes, support a needs assessment on an issue, and support thinking about the interface between public health and other areas.
Diabetes and cardiovascular disease tools look at the relationship between spending on treatment and care and local clinical outcomes for patients:
- Diabetes Outcomes Versus Expenditure (DOVE) tool
- Cardiovascular Disease Outcomes Versus Expenditure tool
Both the diabetes and cardiovascular disease tools are designed for use by CCGs, while the diabetes tool can also be used by GP practices.
Further supporting materials
To help you use health economic resources and ideas, PHE has developed 2 e-learning modules, which provide an introduction to basic health economics. These modules were developed alongside Health Education England and are hosted on e-Learning for Healthcare. Registration is required to access the material, however, it is completely free.
Getting in touch
The Health Economics team is keen to hear feedback on any of the tools and resources that you may have used. If you have any comments, suggestions or questions email healtheconomics@phe.gov.uk.
Last updated 12 August 2021 + show all updates
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Added a link to the wider impacts of COVID-19 on people aged 65 and over, listed under Modelling work.
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Added a link to PHE women’s reproductive health programme 2020 to 2021.
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Added link to 'Health and social care costs of health conditions and multi-morbidities'.
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Updated guidance.
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Added link to 'Sexual and reproductive health: return on investment tool'.
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Added interactive tool on older adults.
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Removed links to NICE ROI tools.
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Updated page with cardiovascular disease resources.
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Added 'Contraceptive services: estimating the return on investment' resources.
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Added air pollution resources.
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Added Prioritisation Framework, plus general editing and restructuring.
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Added link to 'Best start in life: cost effective commissioning'.
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Added link to fall prevention resources.
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Added new links to the musculoskeletal conditions, movement into employment tools and the health economics evidence resource.
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Added links to 'Mental health services: cost-effective commissioning' and 'dementia in older age report'.
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First published.