ROI Analysis: Art or Science?

  • Subhash Pokhrel
  • Lesley Owen
  • Kathryn Coyle
  • Doug Coyle


The post-2008 financial crisis led many governments worldwide to adopt austerity measures with profound impact on the public financing of services. This chapter argues that public health budgets should be a priority as whilst individuals may be less willing to pay for many public health interventions, consumption decisions (e.g. choosing not to breastfeed) often do not consider the full economic costs and benefits (externalities). Return on investment (ROI) analyses provide a single, simplified metric comparing the costs and benefits of an investment portfolio. ROI information can be useful in supporting resource allocation decisions; however, its use in decision making may be influenced by how this information is communicated to stakeholders.


Public financing Public health Return on investment ROI 


  1. 1.
    American Public Health Association (APHA). Public health is ROI: save lives, save money. National Public Health Week (1–7 April 2013). 2013.
  2. 2.
    The King’s Fund. Making the case for public health interventions. 2014.
  3. 3.
    National Institute for Health and Care Excellence (NICE). Return on investment tools. 2016.
  4. 4.
    EQUIPT. European-study on Quantifying Utility of Investment in Protection from Tobacco. 2016.
  5. 5.
    Local Government Association (LGA). Money well spent? Assessing the cost effectiveness and return on investment of public health interventions. London: Local Government Association; 2013.Google Scholar
  6. 6.
    Pokhrel S. Return on investment (ROI) modelling in public health: strengths and limitations. Eur J Public Health. 2015;25(6):908–9.CrossRefGoogle Scholar
  7. 7.
    National Institute for Health and Care Excellence (NICE). Supporting investment in public health: review of methods for assessing cost-effectiveness, cost impact and return on investment. Proof of concept report. London: National Institute for Health and Care Excellence; 2011.Google Scholar
  8. 8.
    Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017. Published Online First: 29 March 2017.
  9. 9.
    National Instititute for Health and Care Excellence (NICE). Methods for the development of NICE public health guidance. 3rd ed. London: National Instititute for Health and Care Excellence; 2012.Google Scholar
  10. 10.
    Edwards RT, Charles JM, Lloyd-Williams H. Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues. BMC Public Health. 2013;13:1001.CrossRefGoogle Scholar
  11. 11.
    Owen L, Morgan A, Fischer A, Ellis S, Hoy A, Kelly MP. The cost-effectiveness of public health interventions. J Public Health (Oxf). 2012;34(1):37–45.CrossRefGoogle Scholar
  12. 12.
    Olsen JA, Donaldson C. Helicopters, hearts and hips: using willingness to pay to set priorities for public sector health care programmes. Soc Sci Med. 1998;46(1):1–12.CrossRefGoogle Scholar
  13. 13.
    Drummond M, Jefferson T. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996;313(7052):275.CrossRefGoogle Scholar
  14. 14.
    Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Cost Eff Resour Alloc. 2013;11(1):6.CrossRefGoogle Scholar
  15. 15.
    Berg ML, Cheung KL, Hiligsmann M, Evers S, Kinderen RJ, Kulchaitanaroaj P, et al. Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review. Addiction. 2017.Google Scholar
  16. 16.
    Renfrew MJ, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, et al. Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. New York: UNICEF; 2012.Google Scholar
  17. 17.
    Pokhrel S, Quigley M, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child. 2015;100:334–40. Scholar
  18. 18.
    Rutter J. Evidence and evaluation in policy making. London: Institute for Government; 2012.Google Scholar
  19. 19.
    Cheung K, Evers S, de Vries H, Hiligsmann M. The most important barriers and facilitators to the use of HTA by policy makers. European Health Psychologist 2016;18(Suppl):477.Google Scholar
  20. 20.
    Cheung KL, Evers SM, Hiligsmann M, Voko Z, Pokhrel S, Jones T, et al. Understanding the stakeholders’ intention to use economic decision-support tools: a cross-sectional study with the tobacco return on investment tool. Health Policy. 2016;120(1):46–54.CrossRefGoogle Scholar
  21. 21.
    Vokó Z, Cheung KL, Józwiak-Hagymásy J, Wolfenstetter S, Jones T, Muñoz C, et al. Similarities and differences between stakeholders’ opinions on using Health Technology Assessment (HTA) information across five European countries: results from the EQUIPT survey. Health Research Policy and Systems. 2016;14(1):38.CrossRefGoogle Scholar
  22. 22.
    Public Health England (PHE). Making the case for investment in prevention and early intervention: tools and frameworks to help local authorities and the NHS. London: Public Health England; 2014.Google Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Subhash Pokhrel
    • 1
  • Lesley Owen
    • 2
  • Kathryn Coyle
    • 3
  • Doug Coyle
    • 4
  1. 1.Health Economics Research Group (HERG), Division of Health SciencesBrunel University LondonUxbridgeUK
  2. 2.Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
  3. 3.Health Economics Research Group (HERG)Brunel University LondonUxbridgeUK
  4. 4.School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada

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