In this episode, Medlock Holmes steps into the chamber of decision-making where evidence meets constraint. Public health operates under limited budgets, competing priorities, and ethical trade-offs. Economic appraisal provides the structured tools to guide those choices.
Holmes introduces the core approaches to economic evaluation:
Cost-minimisation analysis
Cost-effectiveness analysis (CEA)
Cost-utility analysis (CUA)
Cost-benefit analysis (CBA)
We explore how outcomes are measured - from cases prevented to life years gained to quality-adjusted life years (QALYs). Holmes explains incremental cost-effectiveness ratios (ICERs) and the concept of willingness-to-pay thresholds.
The episode also examines discounting, opportunity cost, sensitivity analysis, and uncertainty. A programme that appears effective may not represent good value if alternative investments generate greater population benefit.
Holmes highlights ethical tensions:
Should all lives be valued equally?
How do we compare interventions across age groups?
Is cost-effectiveness the same as fairness?
Economic appraisal does not replace moral judgement - it informs it. It makes trade-offs explicit rather than hidden.
In public health, every allocation decision is both economic and ethical.
Key Takeaways
Economic appraisal evaluates value relative to cost.
Cost-effectiveness compares incremental gains and expenditures.
QALYs integrate length and quality of life.
ICERs support comparison between interventions.
Sensitivity analysis assesses robustness under uncertainty.
Opportunity cost reflects foregone alternatives.
Economic evaluation informs - but does not dictate - policy decisions.
