Identifying and capturing intersectoral costs and benefits relating to sexual health

Schnitzler, Lena ORCID: 0000-0003-4624-6252 (2024). Identifying and capturing intersectoral costs and benefits relating to sexual health. University of Birmingham. Ph.D.

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Abstract

Sexual health is a complex but comprehensive concept and is defined by the World Health Organization (WHO) as ‘a state of physical, emotional, mental and social well-being in relation to sexuality’. Sexual health problems and interventions can generate wide-ranging health, social and economic implications (i.e. in form of costs and benefits), both within and beyond the health sector. Those costs and benefits that spill over to other sectors outside health are referred to as intersectoral costs and benefits (ICBs). There has been increasing recognition of the importance of capturing ICBs relating to public health interventions (including those in sexual health) in economic studies, and the importance of adopting a societal perspective to capture all relevant costs and benefits including ICBs. Despite international literature highlighting the need to assess economic studies from a broader perspective, most studies around sexual health still adopt a healthcare perspective for analysis, and hence ICBs have remained relatively unexplored. The primary aim of this thesis was to identify and capture relevant ICBs relating to sexual health and to develop a sector-specific (cost) classification scheme that would categorise these ICBs into different (policy) sectors. An additional aim was to develop a consensus-based checklist for the critical appraisal of cost-of-illness (COI) studies to review and assess these studies (including the assessment of the choice of study perspective and the costs included in the analysis). Two systematic literature reviews, one of COI studies and one of economic evaluations, assessed the intersectoral costs relating to sexually transmitted infections (STIs) and HIV considered in these studies. The reviews revealed that the intersectoral costs captured are mostly limited to a few cost sectors, predominantly to patient/family costs and paid productivity losses. Interviews with experts in sexual health, however, revealed there are relevant ICBs for other areas of health (including reproductive health and mental health) and other sectors of society (including education and criminal justice). A sector-specific (cost) classification scheme was developed based on these findings that can assist in guiding future comprehensive research and policy/decision-making. The review of COI studies revealed there was lack of and important need for a standard critical appraisal tool to review and assess COI studies. Hence, a consensus-based checklist for the critical appraisal of COI studies was developed, using a six-step approach that involved a scoping review and key expert interviews. The checklist can be used as a minimum standard to appraise COI studies in terms of their comprehensiveness, transparency and consistency (i.e. as part of a systematic review).

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):