HEALTH ECONOMICS Health Econ. 17: 441–448 (2008) Published online 3 September 2007 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hec.1277 HEALTH ECONOMICS LETTERS COST-EFFECTIVE PUBLIC HEALTH GUIDANCE: ASKING QUESTIONS FROM THE DECISION-MAKER’S VIEWPOINT KALIPSO CHALKIDOU a, * ,y , ANTHONY CULYER b,z,} , BHASH NAIDOO c,} and PETER LITTLEJOHNS d,k a Research and Development, National Institute for Health and Clinical Excellence, London, UK b University of York, York, UK c Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London, UK d National Institute for Health and Clinical Excellence, London, UK SUMMARY In February 2004, in his assessment of the long-term financial viability of the NHS, Derek Wanless recommended the use of ‘a consistent framework, such as the methodology developed by NICE, to evaluate the cost-effectiveness of interventions and initiatives across health care and public health’. One year later public health was added to NICE’s remit and the new National Institute for Health and Clinical Excellence (NICE) was established, with amended statutory instruments to permit consideration of broader public sector costs when developing cost- effective guidance for public health. With the principle of ‘a consistent framework’ put forward by Wanless as the starting point, this paper provides an insight into the most challenging aspects of applying the principles of cost-effectiveness analysis in the public health context from the policymaker’s perspective. It reflects on the long-term consequences of taking on responsibility for producing public health guidance on the Institute’s overall approach to guidance development and describes the tension between striving for consistency and cross-evaluation comparability while ensuring that the methodological tools used are fit for the purpose of developing public health guidance. Copyright # 2007 John Wiley & Sons, Ltd. Received 4 July 2006; Revised 27 February 2007; Accepted 5 July 2007 KEY WORDS: health policy; public health; cost-utility analysis; cost-consequence analysis BACKGROUND In 2004, Derek Wanless recommended using ‘a consistent framework, such as the methodology developed by NICE, to evaluate the cost-effectiveness of interventions and initiatives across health care and public health’ (Wanless, 2004). One year later public health was added to NICE’s remit and the new National Institute for Health and Clinical Excellence (NICE) was established, with amended statutory instruments (see: http://www.opsi.gov.uk/si/si2005/20050497.htm) to permit consideration of broader public sector costs when developing cost-effective guidance for public health. *Correspondence to: Research and Development, National Institute for Health and Clinical Excellence, 71 High Holborn, London WC1V 6NA, UK. E-mail: kalipso.chalkidou@nice.org.uk y Associate Director. z Professor of Economics, Senior Scientist. } Currently on sabbatical from Institute for Work & Health, 481 University Avenue, Toronto, Ont., Canada M5G 2E9. } Technical Advisor. k Clinical and Public Health Director. Copyright # 2007 John Wiley & Sons, Ltd.