Public health schemes face cost-effectiveness test

NICE is set to advise GP commissioners on the relative cost effectiveness of local public health initiatives.

The DoH has instructed NICE to pilot a return on investment (ROI) analysis of the various ways to deliver advice on smoking cessation and tobacco use.

If successful, NICE will be asked to produce similar advice on a range of measures such as cutting alcohol abuse and preventing obesity. It was described as the 'business case' for public health.

The scheme mirrors NICE's quality-adjusted life years (QALY) criteria used to judge the cost effectiveness of drugs to be funded by the NHS.

It aims to examine exactly how an intervention such as smoking cessation advice should be delivered in order to represent best value for money.

NICE claims it will help commissioners in local authorities and clinical commissioning groups (CCGs) spend limited budgets more effectively and improve clinical outcomes.

Professor Mike Kelly, director of the centre of public health excellence at NICE, unveiled the plans at a King’s Fund event on the public health reforms on Wednesday.

He said work began in 2008 to find a local equivalent of the QALY system, which, although useful for national resource allocation, was ‘a blunt instrument’ at local level.

Professor Kelly said: ‘If NICE guidance says that a brief intervention in primary care for smoking cessation is good value for money, which we do, you have to deconstruct that a bit further to say which type of brief intervention, how brief, who should do it and what should they say.’

The ROI and cost structure of efforts to reduce smoking vary depending on which methods were used, he added.

The information could assist priority setting by GP commissioners and local authorities - in charge of most public health services from 2013 - in their attempts to improve the health of their population, he said.

The pilot will be followed next year by a consultation on whether NICE should continue the work on other public health interventions.

Professor Kelly told GP the institute was ‘committed’ to seeing the work through and appeared confident that the work would become part of NICE’s future role.

He added that the advice would give CCGs a greater insight into the likely effects of public health interventions in their local area.

‘We’re not saying they must do this. But if they choose to do this [intervention], then this is the ROI and cost that could occur,’ he said.

It is not a national, objective assessment of a health intervention, and so ‘has to be well defined’ to be applicable to specific areas, he said.

Professor Kelly added that the consultation on wider roll-out will begin around June next year.

Speaking at a media briefing this week, NICE chief executive Sir Andrew Dillon said the plans were the ‘business case’ for public health.

'The ROI thing matters because for many interventions in public health, the impact isn’t actually visible for many years, sometimes decades downstream,’ he said.

He added it was a continued problem for the health system working on fiscal planning over a short term basis.

Sir Andrew said the work would show commissioners when the ROI would occur and how this return relates to money that has to be invested now.

Ministers have also handed NICE several new pieces of work.

The institute will examine the effectiveness of BMI and weight circumference measurements of obese patients. Proposals to add weight circumference to an existing QOF indicator on measuring BMI were rejected by NICE advisors in June.

NICE will also look at the effectiveness of community and commercial weight management programmes for child and adults.

It has been asked to scrutinise smoking cessation advice in secondary care, an opportunity being missed by hospitals, according to Professor Kelly.

NICE will also probe whether more powerful NRT methods that deliver nicotine more quickly into the bloodstream are cost effective.

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