Evaluating childhood public health interventions: An exploration of the evidence and methods

Background: Decisions to fund public health interventions in early childhood may include reducing health inequalities, improving life chances and setting health trajectories throughout the child’s life. However, it is unclear whether these aspects of potential value are captured in the health economics evidence base and whether their inclusion would impact the value for money of the intervention.
Aims: To identify the evidence available of how childhood public health interventions have been evaluated in the past. Then, to explore methods available to introduce additional aspects of value.
Methods: The evidence was identified through a systematic review. The E-SEE Steps trial was then introduced as a case study to explore methods. This was done first by introducing health equity though the means of a distributional cost-effectiveness analysis (DCEA); longer term time horizons through the use of the LifeSim microsimulation model; and non-health costs and outcomes which were estimated using LifeSim and incorporated using an adapted framework proposed in the literature.
Findings: The systematic literature review identified inconsistencies across methodological approaches used. The DCEA revealed that although E-SEE Steps was not cost-effective for the children in the trial, it could be considered equity-improving but is sensitive to the measure of socioeconomic position. The results of the LifeSim extrapolation revealed little difference in cost-effectiveness compared to the within-trial results. Finally, incorporation of the non-health costs and outcomes has an impact on the results and the incorporation of equity alongside the non-health costs and outcomes has a considerable impact on the determination of value for money for some groups.
Conclusions: The reason for implementing public health interventions for children go beyond simply maximising health for the population and may consider reducing health inequalities and improving non-health outcomes. This research demonstrates the impact of including wider aspects of value.