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Public Health. 2019 Apr;169:151-162. doi: 10.1016/j.puhe.2019.02.011. Epub 2019 Mar 16.

The cost-effectiveness of public health interventions examined by the National Institute for Health and Care Excellence from 2005 to 2018.

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Centre for Guidelines, National Institute for Health and Care Excellence, London, WC1V 6NA, UK. Electronic address:
Office of Health Economics, Southside, 105 Victoria Street, London, SW1E 6QT, UK.



Reviews of economic evaluations of public health (PH) interventions assessed by the National Institute for Health and Care Excellence (NICE) in the periods 2005-2010 and 2011-2016 have been undertaken. This study combines these analyses, adds six further guidelines published since then, and thus provides a summary of cost-effectiveness of NICE's PH interventions to the present.


As in previous studies, economic evaluations carried out between 2005 and 2018 were categorised by the type of economic analysis used to extract and summarise base-case ICERs. A number of 'sensitivity analyses' were carried out to test the validity of the approach.


Of 71 guidelines examined, 27 used cost utility analysis (CUA) for specific interventions, yielding 380 individual base-case ICER estimates (or 221 taking into account clustering of interventions). The median cost per quality-adjusted life-year (QALY) ICER for the 380 estimates was £1,986. Of these, 21% were cost saving, and 54% ranged from £1 to £20,000, 3% were between £20,001 and £30,000, 16% were above £30,000 and 5% were dominated. Taking clustering into account made relatively little difference to these results. Reducing the threshold from £20,000/QALY to £15,000/QALY would result in 2% of ICERs moving across the threshold.


Seventy-five percent of PH interventions assessed were cost-effective at a threshold of £20,000 per QALY when disregarding clustering, and 68% were cost-effective when clusters were represented by a single ICER. Other analyses gave similar results for the distribution of ICERs. Limitations of the analysis are discussed.


Cost Effectiveness; Cost utility analysis; Health Economics; Public Health


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