Towards a Multi‑sectoral Approach to Population Health: A Scoping Review of Cross‑sectoral Evaluations of Health Interventions

Background
Health interventions, particularly those targeted at health promotion and disease prevention, often have a range of impacts that span beyond the healthcare sector. Making the case for investment in these interventions may require an inventory of costs and outcomes across multiple sectors beyond the health sector.

Objectives
To perform a scoping review of economic evaluations that used existing approaches for cross-sectoral evaluation of healthcare interventions and provide an understanding of how these approaches have been applied in empirical studies.

Methods
Scoping reviews, a type of evidence synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. We used the PRISMA extension for scoping reviews and a pearl-growing search approach. A forward citation searching in Google Scholar and Web of Science of an initial set of selected papers that recommend cross-sectoral evaluations of health interventions was performed, complemented by free-word search in Google and Google Scholar. Cross-sectoral evaluations of health interventions that consider costs and outcomes beyond healthcare were included.

Results
From the 204 identified cross-sectoral evaluation studies of health interventions, the vast majority (85%) were cost-effectiveness and cost-utility analyses taking the societal costing perspective. Other approaches included social return on investment (6%), cost-benefit analysis (4%), cost study (3%), and combined approaches (2%). Two-thirds of the studies evaluated a treatment-based intervention while the remainder evaluated preventive interventions. In addition to healthcare, studies evaluated mostly costs related to productivity and non-direct medical costs, e.g., transport costs. Outcomes were focused on clinical results and patient-reported health and well-being.

Conclusions
There is a limited number of published cross-sectoral evaluations of health interventions despite the need of public and private investors for global value assessment. Issuing guidance on performing cross-sectoral evaluations and highlighting their need by health technology assessment agencies may improve existing evidence and therefore novel forms of investment in population health interventions.