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Combining Health and Outcomes Beyond Health in Complex Evaluations of Complex Interventions: Suggestions for Economic Evaluation

Lookup NU author(s): Professor John Wildman, Dr Josephine Wildman



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research In this journal there has been considerable discussion regarding the development of tools for valuing the multiple attributes that arise from complex interventions with benefits beyond health. Nevertheless, unlike the rigorous underpinnings of cost-utility analysis, much of this work has been taking place in fragmented research communities and without theoretical underpinnings, leading to a call for better and more comprehensive frameworks. We discuss the challenges faced by economic evaluation using as our example a “social prescribing” intervention, a novel health intervention based on the social model of health. We suggest a mixed-methods approach to uncover important attributes and then combine tools from health economics and economics to provide measures of benefit in a common money numeraire. This approach provides the theoretical underpinnings necessary for deliberate, transparent, and structured decision-making processes. It also enables the correct allocation of costs within complex payment systems. We suggest that, because of the complexities of randomized controlled trials, interventions should be introduced in a way that allows the application of causal analysis for evaluation. In the short term, such evaluations may be challenging and expensive. Nevertheless, as has happened with health economics evaluation and the quality-adjusted life-year, when a common set of attributes is agreed upon, the expense will fall and these methods can become embedded in interventions with diffuse outcomes.

Publication metadata

Author(s): Wildman J, Wildman JM

Publication type: Article

Publication status: Published

Journal: Value in Health

Year: 2019

Volume: 22

Issue: 5

Pages: 511-517

Print publication date: 01/05/2019

Online publication date: 17/05/2019

Acceptance date: 05/01/2019

Date deposited: 18/01/2019

ISSN (print): 1098-3015

ISSN (electronic): 1524-4733

Publisher: Elsevier


DOI: 10.1016/j.jval.2019.01.002


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Funder referenceFunder name
National Institute for HealthResearch, UK (grant no. 16/122/33)