In this episode, Medlock Holmes steps into the chamber of decision-making where evidence meets constraint. Public health operates under limited budgets, competing priorities, and ethical trade-offs. Economic appraisal provides the structured tools to guide those choices.

Holmes introduces the core approaches to economic evaluation:

* Cost-minimisation analysis

* Cost-effectiveness analysis (CEA)

* Cost-utility analysis (CUA)

* Cost-benefit analysis (CBA)

We explore how outcomes are measured - from cases prevented to life years gained to quality-adjusted life years (QALYs). Holmes explains incremental cost-effectiveness ratios (ICERs) and the concept of willingness-to-pay thresholds.

The episode also examines discounting, opportunity cost, sensitivity analysis, and uncertainty. A programme that appears effective may not represent good value if alternative investments generate greater population benefit.

Holmes highlights ethical tensions:Should all lives be valued equally?How do we compare interventions across age groups?Is cost-effectiveness the same as fairness?

Economic appraisal does not replace moral judgement - it informs it. It makes trade-offs explicit rather than hidden.

In public health, every allocation decision is both economic and ethical.

Key Takeaways

* Economic appraisal evaluates value relative to cost.

* Cost-effectiveness compares incremental gains and expenditures.

* QALYs integrate length and quality of life.

* ICERs support comparison between interventions.

* Sensitivity analysis assesses robustness under uncertainty.

* Opportunity cost reflects foregone alternatives.

* Economic evaluation informs - but does not dictate - policy decisions.

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