Cost-effectiveness of prevention: Opportunities for public health policy in the Netherlands Kosteneffectiviteit van preventie: Kansen voor het Nederlandse volksgezondheidsbeleid

Objective: To gain insight into the cost-effectiveness of new preventive interventions. Design: Systematic review and interviews. Method: Based on literature search, a search of the project database of ZonMw and interviews with experts, the National Institute for Public Health and the Environment drew up a long list of preventive interventions that are potentially cost-effective but are not yet systematically carried out in the Netherlands. From this long list, 21 interventions were selected for each of which, at least 3 economic evaluations were available that indicate favourable cost-effectiveness (< e 20,000,- per QALY gained). Results: The majority of the interventions concerned vaccination and screening programmes (7 and 5 respectively). Only a small minority concerned health promotion or health protection (1 respectively 3). There was strong evidence that 5 interventions were both cost-effective and feasible. These were: screening for Chlamydia, screening for diabetic retinopathy in type 2 diabetes, screening for neonatal group bèta streptococcal infections through a combination strategy, prevention of recurrent myocardial infarction through heart habilitation, and prevention of head injuries by wearing of bicycle helmets by children. Conclusion: Before implementation of preventive interventions, it is necessary to investigate whether these interventions are also cost-effective in the Dutch context.