This short note sets out an approach for extracting tabular information from pdf documents such as published research. It utilises the the tabulizer package which in turn requires rJava. If you have trouble installing rJava try this link (for a Mac at least).
This example shows how to extract the data in tables 1 and 2 from Masters R, et al. J Epidemiol Community Health 2017;71:827–834. doi:10.1136/jech-2016-208141
We need to load the rJava, tabulizer and tabulizerjars libraries.
# install.packages("rJava")
library(rJava) # load and attach 'rJava' now
# install.packages("devtools")
# devtools::install_github("ropensci/tabulizer", args="--no-multiarch")
#
# devtools::install_github("ropensci/tabulizerjars", args="--no-multiarch")
library(tabulizer)
library(tabulizerjars)
library(tidyverse)We have downloaded the pdf from the JECH website. The first step is extract information from the pdf using the extract_tables function.
The result of this is shown below. It creates a list and we can see that table 1 is contained within 5th element.
tab <- extract_tables("~/Downloads/827.full.pdf")
tab## [[1]]
## [,1]
## [1,] "ounce of prevention is worth a pound of cure”."
## [2,] "Long-term pressures on public sector costs due to"
## [3,] "demographic and technological changes and cost"
## [4,] "inflation in the caring professions have intensified"
## [5,] "following the 2008 global financial crisis. Public"
## [6,] "health is often considered a politically soft target"
## [7,] "for budget cuts, as recently demonstrated by major"
## [8,] "budget reductions in the UK.1–3"
## [9,] "The benefits of population-level public health"
## [10,] "expenditure—unlike those of personal healthcare"
## [11,] "and social care expenditure—tend to be long term,"
## [12,] "mostly accruing after the current politicians and"
## [13,] "policymakers have moved on. Though large and"
## [14,] "certain at the population level, benefits are also"
## [15,] "seen as small and uncertain for individual voters. It"
## [,2]
## [1,] "authors felt that it would incorporate the various"
## [2,] "fields of public health. We searched the PubMed,"
## [3,] "MEDLINE, Scopus, CINAHL, Cochrane, PsycInfo"
## [4,] "and AMED databases using the following search"
## [5,] "terms: ‘public health’ (all fields) AND ‘return on"
## [6,] "investment’ OR ‘cost benefit analysis’ (title or"
## [7,] "abstract). We also hand searched the references of"
## [8,] "the included analyses to identify any further"
## [9,] "studies. A grey literature search was completed"
## [10,] "using Google, yielding three additional results."
## [11,] "Limits were set to publications in the English lan-"
## [12,] "guage, and to interventions targeted at humans"
## [13,] "(where applicable). Studies with poor generalisabil-"
## [14,] "ity to the UK were excluded, including a number"
## [15,] "from the USA that may poorly reflect UK health-"
##
## [[2]]
## [,1]
## [1,] "Table 1 ROI of public health programmes overall, and stratified by level and specialism"
## [2,] "Median ROI"
## [3,] "Overall 14.3"
## [4,] "Local level 4.1"
## [5,] "National level 27.2"
## [6,] "Specialism"
## [7,] "Health protection 34.2"
## [8,] "Legislation 46.5"
## [9,] "Health promotion 2.2"
## [10,] "Healthcare public health 5.1"
## [11,] "Wider determinants 5.6"
## [12,] "CBR, cost-benefit ratio; ROI, return on investment."
## [,2] [,3]
## [1,] "" ""
## [2,] "ROI range Number of ROI studies Median CBR" "CBR range"
## [3,] "–21.3 to 221 34 8.3" "0.7 to 29.4"
## [4,] "0.9 to 19.3 18 10.3" "0.9 to 23.6"
## [5,] "–21.3 to 221 17 17" "1.2 to 167."
## [6,] "" ""
## [7,] "0.7 to 221 8 41.8" "1.1 to 167"
## [8,] "38 to 55 2 5.8" "3 to 8.6"
## [9,] "0.7 to 6.2 12 14.4" "2 to 29.4"
## [10,] "1.1 to 19.3 6 None reported" "None reported"
## [11,] "1.1 to 10.8 6 7.1" "0.7 to 23.6"
## [12,] "" ""
## [,4]
## [1,] ""
## [2,] "Number of CBR studies"
## [3,] "23"
## [4,] "11"
## [5,] "10"
## [6,] ""
## [7,] "10"
## [8,] "2"
## [9,] "3"
## [10,] "None reported"
## [11,] "6"
## [12,] ""
##
## [[3]]
## [,1]
## [1,] "Andresen et al31"
## [2,] ""
## [3,] "Arrieta et al18"
## [4,] ""
## [5,] "Baker et al44"
## [6,] "Beard et al41"
## [7,] ""
## [8,] "Collins42"
## [9,] "Dopp et al57"
## [10,] ""
## [11,] "Goetzel et al45"
## [12,] ""
## [13,] "Guo et al59"
## [14,] "Kleitz et al21"
## [15,] ""
## [16,] "Kuehl et al46"
## [17,] ""
## [18,] "Long et al47"
## [19,] "Moore et al52"
## [20,] "Medivil et al60"
## [21,] ""
## [22,] "Nelson et al39"
## [23,] "Nyman et al22"
## [24,] ""
## [25,] "Ozminkowski et al51"
## [26,] "Peters et al9"
## [27,] "Reynolds et al20"
## [28,] ""
## [29,] "Reynolds et al20"
## [30,] ""
## [31,] "Reynolds et al20"
## [32,] ""
## [33,] "Richard et al43"
## [34,] "Rundell et al53"
## [35,] "Schwartz et al48"
## [,2]
## [1,] "Supervised injection facilities"
## [2,] ""
## [3,] "Home blood pressure monitoring for hypertension diagnosis and"
## [4,] "treatment"
## [5,] "Workplace obesity management"
## [6,] "Community-based falls prevention"
## [7,] ""
## [8,] "Smoking cessation"
## [9,] "Multisystematic therapy with serious juvenile offenders and their"
## [10,] "siblings"
## [11,] "Workplace health risk management programme for small"
## [12,] "businesses"
## [13,] "Improved walking and cycling infrastructure"
## [14,] "Multisystematic therapy with serious juvenile offenders"
## [15,] ""
## [16,] "Workplace health promotion for fire fighters"
## [17,] ""
## [18,] "Health promotion programme for hospital staff"
## [19,] "Medication management for high-risk groups"
## [20,] "Speed cameras in urban settings"
## [21,] ""
## [22,] "Water fluoridation"
## [23,] "Workplace health promotion"
## [24,] ""
## [25,] "Workplace health management"
## [26,] "20 mph zones in London"
## [27,] "Intensive early education programme for socioeconomically"
## [28,] "deprived families (preschool programme)"
## [29,] "Intensive early education programme for socioeconomically"
## [30,] "deprived families (school age programme)"
## [31,] "Intensive early education programme for socioeconomically"
## [32,] "deprived families (extended intervention)"
## [33,] "Tobacco cessation"
## [34,] "Therapeutic services for alcoholism"
## [35,] "Wellness and disease prevention programme"
## [,3] [,4]
## [1,] "IDU population of Vancouver, Canada" "5.12"
## [2,] "" ""
## [3,] "16 375 participants, USA" ""
## [4,] "" ""
## [5,] "890 employees, USA" ""
## [6,] "2000 cases and 1600 matched controls, Australia" "20.6"
## [7,] "" ""
## [8,] "Population of Wirral, UK" ""
## [9,] "305 participants, USA" "5.04"
## [10,] "" ""
## [11,] "2458 employees, USA" ""
## [12,] "" ""
## [13,] "4674 participants, USA" "1.87"
## [14,] "176 participants, USA" "9.51–23.59"
## [15,] "" ""
## [16,] "1369 fire fighters, USA" ""
## [17,] "" ""
## [18,] "4402 hospital staff, USA" ""
## [19,] "4500 health plan participants, USA" ""
## [20,] "Barcelona, Spain" ""
## [21,] "" ""
## [22,] "Population of Houston, Texas" ""
## [23,] "1757 cases and 3619 matched controls," ""
## [24,] "employer, USA" ""
## [25,] "25 931 Citibank employees" ""
## [26,] "Population of London, UK" "0.66–2.19"
## [27,] "1539 participants, USA" ""
## [28,] "" ""
## [29,] "850 participants, USA" ""
## [30,] "" ""
## [31,] "553 participants, USA" ""
## [32,] "" ""
## [33,] "805 Medicaid insured tobacco users, USA" ""
## [34,] "3034 Oklahoma alcohol service users, USA" ""
## [35,] "57 940 health insurance clients, USA" ""
## [,5] [,6]
## [1,] "" "Medical and"
## [2,] "" "societal"
## [3,] "$7.50–$19.35" "Insurer"
## [4,] "" ""
## [5,] "$1–$1.17" "Medical"
## [6,] "" "Medical and"
## [7,] "" "societal"
## [8,] "£1.77" "Medical"
## [9,] "" "Medical and"
## [10,] "" "societal"
## [11,] "$2.03" "Medical and"
## [12,] "" "productivity"
## [13,] "" "Medical"
## [14,] "" "Medical and"
## [15,] "" "societal"
## [16,] "$4.61" "Medical and"
## [17,] "" "insurer"
## [18,] "$2.87" "Employer"
## [19,] "$2" "Insurer"
## [20,] "€6.80" "Medical and"
## [21,] "" "societal"
## [22,] "$1.51" "Societal"
## [23,] "$0.87" ""
## [24,] "" ""
## [25,] "$4.61" "Insurer"
## [26,] "" "Societal"
## [27,] "$10.83" "Medical and"
## [28,] "" "societal"
## [29,] "$3.97" "Medical and"
## [30,] "" "societal"
## [31,] "$8.24" "Medical and"
## [32,] "" "societal"
## [33,] "$2–$2.25" "Insurer"
## [34,] "$1.98" "Medical and l"
## [35,] "$2.02" "Insurer"
##
## [[4]]
## [,1]
## [1,] ""
## [2,] "Table 2 Return on investment of local public health programmes: specific studies"
## [3,] ""
## [4,] "Reference"
## [5,] "Andresen et al31"
## [6,] ""
## [7,] "Arrieta et al18"
## [8,] ""
## [9,] "Baker et al44"
## [10,] "Beard et al41"
## [11,] ""
## [12,] "Collins42"
## [13,] "Dopp et al57"
## [14,] ""
## [15,] "Goetzel et al45"
## [16,] ""
## [17,] "Guo et al59"
## [18,] "Kleitz et al21"
## [19,] ""
## [20,] "Kuehl et al46"
## [21,] ""
## [22,] "Long et al47"
## [23,] "Moore et al52"
## [24,] "Medivil et al60"
## [25,] ""
## [26,] "Nelson et al39"
## [27,] "Nyman et al22"
## [28,] ""
## [29,] "Ozminkowski et al51"
## [30,] "Peters et al9"
## [31,] "Reynolds et al20"
## [32,] ""
## [33,] "Reynolds et al20"
## [34,] ""
## [35,] "Reynolds et al20"
## [36,] ""
## [37,] "Richard et al43"
## [38,] "Rundell et al53"
## [39,] "Schwartz et al48"
## [40,] "Schweinhart et al56"
## [41,] ""
## [42,] "Steinbach et al19"
## [43,] "Spence et al54"
## [44,] ""
## [45,] "Van Vonno et al17"
## [46,] "Wang et al61"
## [47,] ""
## [48,] "Windsor et al49"
## [,2]
## [1,] ""
## [2,] ""
## [3,] ""
## [4,] "Intervention Population"
## [5,] "Supervised injection facilities IDU population of Vancouver, Canada"
## [6,] ""
## [7,] "Home blood pressure monitoring for hypertension diagnosis and 16 375 participants, USA"
## [8,] "treatment"
## [9,] "Workplace obesity management 890 employees, USA"
## [10,] "Community-based falls prevention 2000 cases and 1600 matched controls, Australia"
## [11,] ""
## [12,] "Smoking cessation Population of Wirral, UK"
## [13,] "Multisystematic therapy with serious juvenile offenders and their 305 participants, USA"
## [14,] "siblings"
## [15,] "Workplace health risk management programme for small 2458 employees, USA"
## [16,] "businesses"
## [17,] "Improved walking and cycling infrastructure 4674 participants, USA"
## [18,] "Multisystematic therapy with serious juvenile offenders 176 participants, USA"
## [19,] ""
## [20,] "Workplace health promotion for fire fighters 1369 fire fighters, USA"
## [21,] ""
## [22,] "Health promotion programme for hospital staff 4402 hospital staff, USA"
## [23,] "Medication management for high-risk groups 4500 health plan participants, USA"
## [24,] "Speed cameras in urban settings Barcelona, Spain"
## [25,] ""
## [26,] "Water fluoridation Population of Houston, Texas"
## [27,] "Workplace health promotion 1757 cases and 3619 matched controls,"
## [28,] "employer, USA"
## [29,] "Workplace health management 25 931 Citibank employees"
## [30,] "20 mph zones in London Population of London, UK"
## [31,] "Intensive early education programme for socioeconomically 1539 participants, USA"
## [32,] "deprived families (preschool programme)"
## [33,] "Intensive early education programme for socioeconomically 850 participants, USA"
## [34,] "deprived families (school age programme)"
## [35,] "Intensive early education programme for socioeconomically 553 participants, USA"
## [36,] "deprived families (extended intervention)"
## [37,] "Tobacco cessation 805 Medicaid insured tobacco users, USA"
## [38,] "Therapeutic services for alcoholism 3034 Oklahoma alcohol service users, USA"
## [39,] "Wellness and disease prevention programme 57 940 health insurance clients, USA"
## [40,] "Preschool education programme for socioeconomically deprived 123 preschool children, USA"
## [41,] "children"
## [42,] "20 mph zones in London Population of London, UK"
## [43,] "Outpatient pharmacy services for medication adherence 2957 matched cases and controls, USA"
## [44,] ""
## [45,] "Heart failure disease management 1360 matched cases and controls, USA"
## [46,] "Bike and pedestrian trails 225 351 individual uses of bike and pedestrian"
## [47,] "trails over a 1 year period, USA"
## [48,] "Antinatal stop smoking services 994 pregnant smokers in Alabama, USA"
## [,3] [,4] [,5]
## [1,] "" "Review" ""
## [2,] "" "" ""
## [3,] "Benefit-cost" "Return on" ""
## [4,] "ratio" "investment" "Cost perspec"
## [5,] "5.12" "" "Medical and"
## [6,] "" "" "societal"
## [7,] "" "$7.50–$19.35" "Insurer"
## [8,] "" "" ""
## [9,] "" "$1–$1.17" "Medical"
## [10,] "20.6" "" "Medical and"
## [11,] "" "" "societal"
## [12,] "" "£1.77" "Medical"
## [13,] "5.04" "" "Medical and"
## [14,] "" "" "societal"
## [15,] "" "$2.03" "Medical and"
## [16,] "" "" "productivity"
## [17,] "1.87" "" "Medical"
## [18,] "9.51–23.59" "" "Medical and"
## [19,] "" "" "societal"
## [20,] "" "$4.61" "Medical and"
## [21,] "" "" "insurer"
## [22,] "" "$2.87" "Employer"
## [23,] "" "$2" "Insurer"
## [24,] "" "€6.80" "Medical and"
## [25,] "" "" "societal"
## [26,] "" "$1.51" "Societal"
## [27,] "" "$0.87" ""
## [28,] "" "" ""
## [29,] "" "$4.61" "Insurer"
## [30,] "0.66–2.19" "" "Societal"
## [31,] "" "$10.83" "Medical and"
## [32,] "" "" "societal"
## [33,] "" "$3.97" "Medical and"
## [34,] "" "" "societal"
## [35,] "" "$8.24" "Medical and"
## [36,] "" "" "societal"
## [37,] "" "$2–$2.25" "Insurer"
## [38,] "" "$1.98" "Medical and l"
## [39,] "" "$2.02" "Insurer"
## [40,] "7.16" "" "Medical and"
## [41,] "" "" "societal"
## [42,] "" "£1.12" "Medical"
## [43,] "" "$5.97" "Medical and"
## [44,] "" "" "productivity"
## [45,] "" "$1.15" "Insurer"
## [46,] "" "$2.94" "Public health"
## [47,] "" "" ""
## [48,] "6.72–17.18" "" "Medical"
##
## [[5]]
## [,1]
## [1,] "Table 3 Return on investment of national public health programmes: specific studies"
## [2,] ""
## [3,] "Reference Intervention"
## [4,] "Abelson et al10 Hib vaccination"
## [5,] "Abelson et al10 HIV/AIDS prevention"
## [6,] "Abelson et al10 Measles vaccination"
## [7,] "Abelson et al10 Programmes to reduce rates of coronary heart disease"
## [8,] "Abelson et al10 Programmes to reduce tobacco consumption"
## [9,] "Abelson et al10 Road safety campaigns"
## [10,] "Boccalini et al32 Universal hepatitis B vaccination"
## [11,] ""
## [12,] "Bonin et al58 Parenting programmes for the prevention of persistent conduct"
## [13,] "disorders"
## [14,] "Drummond11 Needle exchange"
## [15,] "Evans-Lacko et al12 Antistigma social marketing campaign"
## [16,] "Garpenholt et al38 Hib vaccination"
## [17,] "Gortmaker et al15 Sugar sweetened beverage tax"
## [18,] "Gortmaker et al15 Eliminating tax subsidy of nutritionally poor food advertising to"
## [19,] "children"
## [20,] "Gould8 Lead paint control"
## [21,] ""
## [22,] "Holtgrave et al34 HIV counselling, testing, referral and partner notification services"
## [23,] "Hutchinson et al35 Expanded HIV testing"
## [24,] "Kwon et al36 Needle exchange"
## [25,] "Lokkerbol et al55 Telemedicine for depression"
## [26,] ""
## [27,] "McGuire et al14 Family planning services"
## [28,] "Miller et al16 Booster seats for 4–7 years olds"
## [29,] "Nguyen et al37 Needle exchange"
## [30,] "Nichol et al7 Influenza vaccination of healthy workers"
## [31,] "Romano et al40 Folic acid fortification of grain"
## [32,] "Trust for America13 Primary and secondary prevention programmes"
## [33,] "Wang et al50 Universal school nursing services"
## [34,] "White et al28 MMR vaccination"
## [35,] "Ding et al30 Hospital-based postpartum influenza vaccination"
## [36,] ""
## [37,] "Zhou et al38 Hib vaccination"
## [38,] ""
## [39,] "Hib, haemophilus influenzae type b; MMR, measles, mumps and rubella."
## [,2] [,3] [,4]
## [1,] "" "" ""
## [2,] "" "Benefit-cost" "Return on"
## [3,] "Population" "ratio" "investment"
## [4,] "Australia" "1.06" ""
## [5,] "Australia" "4" ""
## [6,] "Australia" "167" ""
## [7,] "Australia" "11" ""
## [8,] "Australia" "2" ""
## [9,] "Australia" "3" ""
## [10,] "Italy" "" "€2.78"
## [11,] "" "" ""
## [12,] "England" "7.89" ""
## [13,] "" "" ""
## [14,] "Australia" "1.2" ""
## [15,] "England" "" "£0.7 to £1.90"
## [16,] "Sweden" "1.59" ""
## [17,] "USA" "" "$55"
## [18,] "USA" "" "$38"
## [19,] "" "" ""
## [20,] "USA" "" "$17 to $221"
## [21,] "" "" ""
## [22,] "USA" "20.09" ""
## [23,] "USA" "" "$1.46 to $2.01"
## [24,] "Australia" "" "$A1.3 to $A5.5"
## [25,] "The" "" "€1.45 to €1.76"
## [26,] "Netherlands" "" ""
## [27,] "UK" "11.09 to 29.39" ""
## [28,] "USA" "8.6" ""
## [29,] "USA" "" "$3.48"
## [30,] "USA" "" "−$21.27 to +$174.32"
## [31,] "USA" "4.3 to 6.1" ""
## [32,] "USA" "" "$6.2"
## [33,] "USA" "" "$2.20"
## [34,] "USA" "14" ""
## [35,] "USA" "" "$1.7"
## [36,] "" "" ""
## [37,] "USA" "5.4" ""
## [38,] "" "" ""
## [39,] "" "" ""
## [,5] [,6] [,7] [,8]
## [1,] "" "" "" ""
## [2,] "" "" "Time" "Study"
## [3,] "Cost perspective" "Discount rate" "horizon" "quality"
## [4,] "Medical" "5%" "15 years" "++"
## [5,] "Medical" "5%" "25 years" "++"
## [6,] "Medical" "5%" "33 years" "++"
## [7,] "Medical" "5%" "40 years" "++"
## [8,] "Medical" "5%" "40 years" "++"
## [9,] "Medical" "5%" "40 years" "++"
## [10,] "Medical and" "3%" "20 years" "++"
## [11,] "societal" "" "" ""
## [12,] "Medical and" "3.5%" "35 years" "++"
## [13,] "societal" "" "" ""
## [14,] "Public health" "5%" "Lifetime" "++"
## [15,] "Unclear" "None" "1 year" "-"
## [16,] "Societal" "5%" "20 years" "++"
## [17,] "Medical" "3%" "10 years" "++"
## [18,] "Medical" "3%" "10 years" "++"
## [19,] "" "" "" ""
## [20,] "Medical and" "None" "Unclear" "−"
## [21,] "societal" "" "" ""
## [22,] "Societal" "6%" "Lifetime" "++"
## [23,] "Health sector" "3%" "Lifetime" "++"
## [24,] "Health sector" "3%" "Lifetime" "++"
## [25,] "Medical" "1.5% costs, 4%" "5 years" "++"
## [26,] "" "effects" "" ""
## [27,] "Medical" "6%" "Lifetime" "++"
## [28,] "Medical" "3%" "3 years" "++"
## [29,] "Medical" "None" "1 year" "+"
## [30,] "Societal" "3%" "1 year" "+"
## [31,] "Human capital" "4%" "Lifetime" "++"
## [32,] "Medical" "0%" "10–20 years" "+"
## [33,] "Societal" "None" "1 year" "+"
## [34,] "Medical" "10%" "Lifetime" "++"
## [35,] "Medical and" "3%" "1 year" "++"
## [36,] "societal" "" "" ""
## [37,] "Medical and" "3%" "Lifetime" "++"
## [38,] "societal" "" "" ""
## [39,] "" "" "" ""
##
## [[6]]
## [,1]
## [1,] "was clear that most public health interventions are substantially"
## [2,] "cost saving. This confirms our theory that public health inter-"
## [3,] "ventions generally offer a considerable ROI. Median ROI was"
## [4,] "generally higher than median CBR in all of our key public"
## [5,] "health expenditure categories. This was because most studies"
## [6,] "only report one of these two measures, and studies that report"
## [7,] "ROI tend to have higher estimates. A direct comparison is pos-"
## [8,] "sible, by converting between ROI and CBR at the study level"
## [9,] "using the simple formula ROI=CBR−1."
## [10,] "Second, we demonstrated a public health ‘effectiveness hier-"
## [11,] "archy’. Public health interventions at a local level averaged an"
## [12,] "impressive ROI of 4, meaning that every pound invested yields"
## [13,] "a return of £4 plus the original investment back. However,"
## [14,] "‘upstream’ interventions delivered on a national scale generally"
## [15,] "achieve even greater returns on investment, particularly legisla-"
## [,2]
## [1,] "mated that investing an additional £13 000 in the English"
## [2,] "National Health Service (NHS) can achieve health benefits of"
## [3,] "one additional quality-adjusted life year (QALY).23 When this"
## [4,] "health benefit is valued in monetary terms at the UK"
## [5,] "Department of Health’s current rate of £60 000 per QALY,24"
## [6,] "this represents a ROI of 3.16 (£60 000−£13 000/£13 000)."
## [7,] "Fourth, this systematic review was partly prompted by recent"
## [8,] "government cuts to public health budgets in England. We there-"
## [9,] "fore focused on public health interventions delivered in other"
## [10,] "high-income countries in order to maximise UK relevance. We"
## [11,] "can therefore now better estimate the likely opportunity costs of"
## [12,] "the proposed cuts in local and national public health budgets."
## [13,] "The median ROI for all public health interventions was 14.3, and"
## [14,] "the median CBR was 8.3. An ROI of 14.3 implying a cash return"
## [15,] "of 1430% would sound too good to be true in the financial"
##
## [[7]]
## [,1]
## [1,] "Review"
## [2,] "making is governed by politics rather than markets. Our systematic"
## [3,] "review clearly demonstrates that there are big public health invest-"
## [4,] "ment opportunities out there—they just need some political will"
## [5,] "to implement them. If we take the lower, conservative CBR figure"
## [6,] "of 8.3, this would suggest that the opportunity cost of the recent"
## [7,] "£200 million cuts to public health funding in England is likely to"
## [8,] "be eightfold higher, in the region of £1.6 billion. The UK govern-"
## [9,] "ment’s ‘efficiency savings’ thus represent a false economy which"
## [10,] "will generate many billions of additional future costs to the ailing"
## [11,] "NHS and wider UK economy. The recent UK increases in (avoid-"
## [12,] "able) teen pregnancies, sexually transmitted infections, homeless-"
## [13,] "ness and suicides are thus predictable and worrying. Do they"
## [14,] "represent harbingers of worse to come? Although this study draws"
## [15,] "on the experience of the UK public health system, there are impli-"
## [16,] "cations for public health systems outside of the UK, which may be"
## [17,] "guided towards areas of potential underinvestment, and avoid"
## [18,] "harmful cuts in public health budgets."
## [19,] "Previous reviews"
## [20,] "Ours may be the first comprehensive systematic review of"
## [21,] "ROI and CBR to include the broad spectrum of public health"
## [22,] "interventions. Furthermore, it extends and strengthens earlier,"
## [23,] "narrower reviews which consistently highlighted the cost-"
## [,2]
## [1,] ""
## [2,] "Health promotion interventions"
## [3,] "The 15 studies analysing health promotion"
## [4,] "reported an overall twofold ROI with a more impressive median"
## [5,] "CBR of 14.4.10 13 14 22 41–51 Interventions aimed at reducing"
## [6,] "rates of falls are able to show one of the swiftest returns on"
## [7,] "investment of any of the public health interventions identified"
## [8,] "within this study, with a CBR of 20.6 returned within 18"
## [9,] "months.41 Falls prevention interventions by their nature are rela-"
## [10,] "tively low cost (structured exercise programmes for those at risk"
## [11,] "of falls), and yet their potential impact on demand management"
## [12,] "for hospital services is clearly demonstrated. Shifting investment"
## [13,] "from secondary care for the treatment of falls to primary pre-"
## [14,] "vention would show significant and swift returns on investment."
## [15,] "Tobacco control interventions10 42 43 overall"
## [16,] "twofold ROIs, which increased when targeted"
## [17,] "clients such as pregnant women.42 Such contrasting results"
## [18,] "perhaps highlight the complexity of public health interventions."
## [19,] "Healthcare public health interventions"
## [20,] "Six studies17 18 52–55 reported healthcare public health results,"
## [21,] "offering a substantial median ROI of 5.14."
## [22,] "focused on disease management or medication adherence for"
## [23,] "high-risk patients, such as home blood pressure monitoring for"
## [,3]
## [1,] ""
## [2,] ""
## [3,] "interventions"
## [4,] ""
## [5,] ""
## [6,] ""
## [7,] ""
## [8,] ""
## [9,] ""
## [10,] ""
## [11,] ""
## [12,] ""
## [13,] ""
## [14,] ""
## [15,] "reported a"
## [16,] "at high-risk"
## [17,] ""
## [18,] ""
## [19,] ""
## [20,] ""
## [21,] "The majority"
## [22,] ""
## [23,] ""
##
## [[8]]
## [,1]
## [1,] "Fifth, the quality of the economic evaluations varied consider-"
## [2,] ""
## [3,] "ably. Practice has clearly improved substantially since the 1970s,"
## [4,] "with recent evaluations employing more sophisticated modelling"
## [5,] "techniques. Designing such studies can be challenging as public"
## [6,] "health interventions are often complex and multifactorial, and it"
## [7,] "can be difficult to isolate an effect size even within a randomised"
## [8,] "controlled trial. Some of the published literature may therefore"
## [9,] ""
## [10,] "systematically overestimate or underestimate the ROI of inter-"
## [11,] "ventions, and hence the need for more research."
## [12,] ""
## [13,] ""
## [14,] "Unanswered questions and future research"
## [15,] "There is a clear need for further high-quality economic evalua-"
## [16,] ""
## [17,] "tions of public health interventions, which include a range of"
## [18,] "discount rates and robust sensitivity analyses."
## [19,] ""
## [20,] ""
## [21,] "Implications for clinicians and policymakers"
## [22,] "Overall, the results of our systematic review clearly demonstrate"
## [23,] "that public health interventions are cost-saving, both to health ser-"
## [24,] "vices as well as the wider economy. Furthermore, some are very"
## [25,] "rapid: falls prevention interventions reported substantial returns"
## [26,] "within 6–12 months.41 One might reasonably expect equally rapid"
## [27,] "returns for preventive interventions such as immunisation, health-"
## [28,] "care, smoking cessation and nutrition.63 Although attempting to"
## [29,] ""
## [30,] "quantify returns within a short timescale can be challenging, even"
## [31,] "larger returns on investment were seen over a 10–20 years time"
## [32,] "horizon.10 15 17 32 58 This has significant implications for policy-"
## [33,] "makers, who often work to a much shorter time horizon (typically"
## [34,] ""
## [35,] "3–5 years). We suggest that Public Health England, NICE and"
## [36,] "other advisory bodies therefore need to routinely emphasise that"
## [37,] "public health interventions can offer surprisingly rapid returns,"
## [38,] "which may increase further over the longer term."
## [39,] ""
## [40,] ""
## [41,] "CONCLUSIONS"
## [42,] "This systematic review suggests that local public health interven-"
## [43,] "tions are cost-saving, and offer substantial returns on invest-"
## [44,] ""
## [45,] "ment, nationwide programmes even more so."
## [46,] "The cuts to public health budgets therefore represent a false"
## [47,] "economy. They are likely to generate billions of pounds of add-"
## [,2]
## [1,] ""
## [2,] "Acknowledgements The authors would like to thank Knowsley Metropolitan"
## [3,] "Borough Council Public Health Team, and Tracy Owen from the North West"
## [4,] "Commissioning Support Unit FADE Evidence Knowledge Centre, for their support in"
## [5,] "the development of this review."
## [6,] "Contributors RM drafted the paper, conducted the literature search, assessed the"
## [7,] "methodological quality of included studies and conducted the analysis. EA"
## [8,] "independently conducted the systematic review and assessed the methodological"
## [9,] "quality of the included studies. BC adjudicated in any disagreements in the"
## [10,] "methodological quality assessments, provided health economics advice and assisted"
## [11,] "with the data analysis. RC provided expert health economics advice and support"
## [12,] "throughout, and made significant contributions to the analysis and manuscript. SC"
## [13,] "devised the concept, supervised the project, provided expert public health advice"
## [14,] "and support throughout, and made significant contributions to the analysis and"
## [15,] "manuscript. All authors made substantial contributions to the analysis and"
## [16,] "manuscript, including final approval."
## [17,] ""
## [18,] "Funding RC is supported by the National Institute for Health Research (Senior"
## [19,] "Research Fellowship, SRF-2013-06-015)."
## [20,] "Disclaimer The views expressed in this publication are those of the authors and"
## [21,] "not necessarily those of the NHS, the National Institute for Health Research or the"
## [22,] "Department of Health."
## [23,] "Competing interests None declared."
## [24,] "Provenance and peer review Not commissioned; externally peer reviewed."
## [25,] "Open Access This is an Open Access article distributed in accordance with the"
## [26,] "terms of the Creative Commons Attribution (CC BY 4.0) license, which permits"
## [27,] "others to distribute, remix, adapt and build upon this work, for commercial use,"
## [28,] "provided the original work is properly cited. See: http://creativecommons.org/licenses/"
## [29,] "by/4.0/"
## [30,] ""
## [31,] ""
## [32,] ""
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## [65,] "Health Care 1993;9:26–36."With a bit of wrangling we can extract the tables. So for table 1 which contains summary information on ranges of cost-benefit or ROI for different categories of intervention. We’ll go step by step:
The first step extracts the 3rd to 11 rows of the 1st to 4th columns of the second element and binds the columns to form a data frame
x <- cbind(tab[[2]][3:11,1:4]) %>% data.frame()
x## X1 X2 X3
## 1 Overall 14.3 –21.3 to 221 34 8.3 0.7 to 29.4
## 2 Local level 4.1 0.9 to 19.3 18 10.3 0.9 to 23.6
## 3 National level 27.2 –21.3 to 221 17 17 1.2 to 167.
## 4 Specialism
## 5 Health protection 34.2 0.7 to 221 8 41.8 1.1 to 167
## 6 Legislation 46.5 38 to 55 2 5.8 3 to 8.6
## 7 Health promotion 2.2 0.7 to 6.2 12 14.4 2 to 29.4
## 8 Healthcare public health 5.1 1.1 to 19.3 6 None reported None reported
## 9 Wider determinants 5.6 1.1 to 10.8 6 7.1 0.7 to 23.6
## X4
## 1 23
## 2 11
## 3 10
## 4
## 5 10
## 6 2
## 7 3
## 8 None reported
## 9 6To reconstruct the original table we need to split out the values from columns X1 and X2. Lets start with X1…
We will split the first column into the text and numeric values, using a regular expression “\s(\d)” which identifies a space followed by a digit. The results are shown below.
x <- x %>% separate(X1, c("category", "median roi"), sep = "\\s(\\d)")
x## category median roi X2
## 1 Overall 4.3 –21.3 to 221 34 8.3
## 2 Local level .1 0.9 to 19.3 18 10.3
## 3 National level 7.2 –21.3 to 221 17 17
## 4 Specialism <NA>
## 5 Health protection 4.2 0.7 to 221 8 41.8
## 6 Legislation 6.5 38 to 55 2 5.8
## 7 Health promotion .2 0.7 to 6.2 12 14.4
## 8 Healthcare public health .1 1.1 to 19.3 6 None reported
## 9 Wider determinants .6 1.1 to 10.8 6 7.1
## X3 X4
## 1 0.7 to 29.4 23
## 2 0.9 to 23.6 11
## 3 1.2 to 167. 10
## 4
## 5 1.1 to 167 10
## 6 3 to 8.6 2
## 7 2 to 29.4 3
## 8 None reported None reported
## 9 0.7 to 23.6 6We can then repeat the action for column X2, this time separating on space. This gives us a set of new columns; roi min, to, roi max, no roi studies, median cbr.
x<- x %>% separate(X2, remove = FALSE, c("roi min", "to", "roi max", "no roi studies", "median cbr"), sep = " ")
x## category median roi X2 roi min
## 1 Overall 4.3 –21.3 to 221 34 8.3 –21.3
## 2 Local level .1 0.9 to 19.3 18 10.3 0.9
## 3 National level 7.2 –21.3 to 221 17 17 –21.3
## 4 Specialism <NA>
## 5 Health protection 4.2 0.7 to 221 8 41.8 0.7
## 6 Legislation 6.5 38 to 55 2 5.8 38
## 7 Health promotion .2 0.7 to 6.2 12 14.4 0.7
## 8 Healthcare public health .1 1.1 to 19.3 6 None reported 1.1
## 9 Wider determinants .6 1.1 to 10.8 6 7.1 1.1
## to roi max no roi studies median cbr X3 X4
## 1 to 221 34 8.3 0.7 to 29.4 23
## 2 to 19.3 18 10.3 0.9 to 23.6 11
## 3 to 221 17 17 1.2 to 167. 10
## 4 <NA> <NA> <NA> <NA>
## 5 to 221 8 41.8 1.1 to 167 10
## 6 to 55 2 5.8 3 to 8.6 2
## 7 to 6.2 12 14.4 2 to 29.4 3
## 8 to 19.3 6 None None reported None reported
## 9 to 10.8 6 7.1 0.7 to 23.6 6We can apply some further tidying - removing X2 and “to”, filtering out the row corresponding to “Specialism”, and renaming columns X3 and X4. Combining all this into a single “pipe” gives a passing reproduction of the published table. Because this is now a data frame in R we can reuse these data.
data.frame(cbind(tab[[2]][3:11,1:4])) %>%
separate(X1, c("category", "median roi"), sep = "\\s(\\d)") %>%
separate(X2, remove = FALSE, c("roi min", "to", "roi max", "no roi studies", "median cbr"), sep = " ") %>%
select(-c(to, X2)) %>%
filter(category != "Specialism") %>%
rename(cbr_range = X3,
No_CBR_studies = X4 ) %>%
knitr::kable(caption = "Table 1, Masters R, et al. J Epidemiol Community Health 2017;71:827–834. doi:10.1136/jech-2016-208141 ")| category | median roi | roi min | roi max | no roi studies | median cbr | cbr_range | No_CBR_studies |
|---|---|---|---|---|---|---|---|
| Overall | 4.3 | –21.3 | 221 | 34 | 8.3 | 0.7 to 29.4 | 23 |
| Local level | .1 | 0.9 | 19.3 | 18 | 10.3 | 0.9 to 23.6 | 11 |
| National level | 7.2 | –21.3 | 221 | 17 | 17 | 1.2 to 167. | 10 |
| Health protection | 4.2 | 0.7 | 221 | 8 | 41.8 | 1.1 to 167 | 10 |
| Legislation | 6.5 | 38 | 55 | 2 | 5.8 | 3 to 8.6 | 2 |
| Health promotion | .2 | 0.7 | 6.2 | 12 | 14.4 | 2 to 29.4 | 3 |
| Healthcare public health | .1 | 1.1 | 19.3 | 6 | None | None reported | None reported |
| Wider determinants | .6 | 1.1 | 10.8 | 6 | 7.1 | 0.7 to 23.6 | 6 |
We can go through a similar process to extract table 3.
table <- data.frame(cbind(tab[[5]][-1,1:7]))
colnames(table) <- tab[[5]][1,1:7]
table %>%
knitr::kable(caption = "Table 3, Masters R, et al. J Epidemiol Community Health 2017;71:827–834. doi:10.1136/jech-2016-208141 ")| Table 3 Return on investment of national public health programmes: specific studies | ||||||
|---|---|---|---|---|---|---|
| Benefit-cost | Return on | Time | ||||
| Reference Intervention | Population | ratio | investment | Cost perspective | Discount rate | horizon |
| Abelson et al10 Hib vaccination | Australia | 1.06 | Medical | 5% | 15 years | |
| Abelson et al10 HIV/AIDS prevention | Australia | 4 | Medical | 5% | 25 years | |
| Abelson et al10 Measles vaccination | Australia | 167 | Medical | 5% | 33 years | |
| Abelson et al10 Programmes to reduce rates of coronary heart disease | Australia | 11 | Medical | 5% | 40 years | |
| Abelson et al10 Programmes to reduce tobacco consumption | Australia | 2 | Medical | 5% | 40 years | |
| Abelson et al10 Road safety campaigns | Australia | 3 | Medical | 5% | 40 years | |
| Boccalini et al32 Universal hepatitis B vaccination | Italy | €2.78 | Medical and | 3% | 20 years | |
| societal | ||||||
| Bonin et al58 Parenting programmes for the prevention of persistent conduct | England | 7.89 | Medical and | 3.5% | 35 years | |
| disorders | societal | |||||
| Drummond11 Needle exchange | Australia | 1.2 | Public health | 5% | Lifetime | |
| Evans-Lacko et al12 Antistigma social marketing campaign | England | £0.7 to £1.90 | Unclear | None | 1 year | |
| Garpenholt et al38 Hib vaccination | Sweden | 1.59 | Societal | 5% | 20 years | |
| Gortmaker et al15 Sugar sweetened beverage tax | USA | $55 | Medical | 3% | 10 years | |
| Gortmaker et al15 Eliminating tax subsidy of nutritionally poor food advertising to | USA | $38 | Medical | 3% | 10 years | |
| children | ||||||
| Gould8 Lead paint control | USA | $17 to $221 | Medical and | None | Unclear | |
| societal | ||||||
| Holtgrave et al34 HIV counselling, testing, referral and partner notification services | USA | 20.09 | Societal | 6% | Lifetime | |
| Hutchinson et al35 Expanded HIV testing | USA | $1.46 to $2.01 | Health sector | 3% | Lifetime | |
| Kwon et al36 Needle exchange | Australia | $A1.3 to $A5.5 | Health sector | 3% | Lifetime | |
| Lokkerbol et al55 Telemedicine for depression | The | €1.45 to €1.76 | Medical | 1.5% costs, 4% | 5 years | |
| Netherlands | effects | |||||
| McGuire et al14 Family planning services | UK | 11.09 to 29.39 | Medical | 6% | Lifetime | |
| Miller et al16 Booster seats for 4–7 years olds | USA | 8.6 | Medical | 3% | 3 years | |
| Nguyen et al37 Needle exchange | USA | $3.48 | Medical | None | 1 year | |
| Nichol et al7 Influenza vaccination of healthy workers | USA | −$21.27 to +$174.32 | Societal | 3% | 1 year | |
| Romano et al40 Folic acid fortification of grain | USA | 4.3 to 6.1 | Human capital | 4% | Lifetime | |
| Trust for America13 Primary and secondary prevention programmes | USA | $6.2 | Medical | 0% | 10–20 years | |
| Wang et al50 Universal school nursing services | USA | $2.20 | Societal | None | 1 year | |
| White et al28 MMR vaccination | USA | 14 | Medical | 10% | Lifetime | |
| Ding et al30 Hospital-based postpartum influenza vaccination | USA | $1.7 | Medical and | 3% | 1 year | |
| societal | ||||||
| Zhou et al38 Hib vaccination | USA | 5.4 | Medical and | 3% | Lifetime | |
| societal | ||||||
| Hib, haemophilus influenzae type b; MMR, measles, mumps and rubella. |