Economic Evaluation of Environmental Interventions: Reflections on Methodological Challenges and Developments

Abstract

Evaluation of the costs and outcomes associated with environmental policies and interventions is often required to inform public policy and allocate scarce resources. Methods to conduct assessments of cost-effectiveness have been developed in the context of pharmaceuticals, but have more recently been applied in public health, diagnostics, and other more complex interventions. The suitability of existing economic evaluation methodology has been explored in many contexts, however, this is yet to be undertaken for interventions and policies pertaining to the natural environment, such as urban green spaces and strategies to reduce indoor and outdoor air pollution. To make significant inroads into the evaluation of interventions and policies relating to the natural environment requires an understanding of the challenges faced in this context. Many of these challenges may be practical (data-related), however, a number are also methodological, and thus have implications for the appropriate framework for economic evaluation. This paper considers some of the challenges faced when conducting cost-effectiveness analyses in this context and explores what solutions have been proposed thus far. The intention is to help pave the way for consideration of which existing framework is most appropriate for the evaluation of natural environment (NE) interventions, or if a distinct framework is required. Environmental policies and interventions relating to the built environment, for example, housing, are not explicitly included here.

Conducting Value for Money Analyses for Non-randomised Interventional Studies Including Service Evaluations: An Educational Review with Recommendations

“…NICE's processes and guidelines have influenced reimbursement agencies internationally specific to their HTA processes [4,5]. However, such guidelines have been described to not always be practical nor relevant in every decision-making context [33,[35][36][37][38][39][40][41][42][43][44]. Such guidelines may also align more with research practices than service evaluations, whereby the former could include conducting expensive RCTs whereas the latter may be a more 'budget and time' conscious approach.…”

“…This is partly because it is NICE's 'gold standard' reference case, with NICE's guidelines [3] informing HTA processes internationally [4]. There are several papers debating the extent that economic evaluations of different forms of interventions fit a typical HTA [33,34], such that current guidelines may not be fully applicable, including: public health [35][36][37], antimicrobials [38], diagnostics [39], medical devices [40], genetics [41], digital [42], environmental [43], and service and delivery interventions [33,44]. Whatever the intervention of interest, Drummond et al [26] suggest that an economic evaluation would "explicitly consider the relative consequences of the alternatives and compare them with the relative costs" (p. 5).…”

Quantitatively Evaluating the Cross-Sectoral and One Health Impact of Interventions: A Scoping Review and Application to Antibiotic Resistance

“…However, the possibility to include egalitarian motives or Amartya Sen's capability approaches was also noted [38]. Uncertainty was also highlighted in previous reviews as something that should be explicitly considered and quantified, as also valued by decision makers [36,[39][40][41].…”

“…Previous reviews highlighted the importance of outcomes such as equity, capability, sustainability, uncertainty and animal welfare [39][40][41][42]61]. A social cost-benefit analysis included various social discount rates alongside a survey on what the appropriate discount rate would be [62].…”

“…However, in order to rank policies based on criteria such as "reduction on incidence of human cases" and "impact on cost to public sector" [66], the outputs of epidemiological and health economic models are needed. Such methods can also incorporate other important outcome measures such as equity [40].…”