Evaluations of population and system level health policies often focus on ex-post estimation of their causal effects on short-term surrogate outcomes. The value of such information is limited in informing decision-making as the failure to reflect policy-relevant outcomes and disregard for opportunity costs prohibits the assessment of value for money. Further, these evaluations do not always consider all relevant evidence, other alternative courses of action and the associated decision uncertainty.
In this seminar, we will explore how evaluation of population and system level policies could better meet the needs of decision-making and provide an assessment of ‘value for money’. We begin by defining the evidence required to inform decision-making in terms of the magnitude of impacts on the outcomes of interest, the costs and associated opportunity costs, and the consequences of uncertainty. Informed by a literature review, we consider the key challenges when evaluating population and system level policies. We group these into 8 categories: i) valuation space, ii) comparators, iii) time of evaluation, iv) mechanisms of action, v) effects, vi) resources, constraints and opportunity costs, vii) fidelity, adaptation and level of implementation, and viii) generalisability and external validity. We discuss the methods available to help tackle these different challenges and highlight their application through a series of examples. We identify a broad set of available methods from across multiple disciplines that can improve the evaluation of population and system level policies, including decision-analytic modelling, theory of change, realist evaluation, causal inference and structured expert elicitation.
Speaker: Simon Walker, Centre for Health Economics, University of York, Link bio