PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity

Adam D M Briggs,Jane Wolstenholme,Linda J Cobiac,Peter Scarborough

doi:10.1186/s12913-019-4237-4

Abstract

BackgroundNon-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes.MethodsThe multistate life table model, PRIMEtime Cost Effectiveness (PRIMEtime CE), is developed from the Preventable Risk Integrated ModEl (PRIME) and the PRIMEtime model. PRIMEtime CE uses routinely available data to estimate how changing diet and physical activity in England affects morbidity and mortality from heart disease, stroke, diabetes, liver disease, and cancers either directly or via raised blood pressure, cholesterol, and body weight.ResultsModel outcomes are change in quality adjusted life years, and change in English National Health Service and social care costs.ConclusionThis paper describes PRIMEtime CE and highlights its main strengths and limitations. The model can be used to compare any number of public policies affecting diet and physical activity, allowing decision makers to understand how they can maximise population health with limited financial resources.

Highlights

Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors
Estimating the effects and costs of the interventions and model validation Interventions affecting any of the risk factors included in PRIMEtime CE can be modelled based on the intervention
Cost-effectiveness is calculated as: (Cb – Ca) / (Eb – Ea); where Cb is the sum of intervention costs and expenditure on health and social care in the 10 years following the intervention; Ca is the 10 year costs of health and social care in the scenario where there is no intervention; Eb is the total number of Quality adjusted life year (QALY) experienced by the modelled population in the 10 years following the intervention; and Ea is the same but where no intervention is modelled

Summary

Introduction

Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. There have been increasing pressures on acute health services in England and as a consequence, health providers are arguing for there to be a greater emphasis placed on prevention. Both the 2019 NHS Long Term Plan and the UK Secretary of State for Health and Social Care’s 2018 vision for prevention explicitly state that prevention and population health improvement are policy priorities [5, 6]. In 2016 the UK Health Select Committee highlighted the challenges faced by public health professionals, citing evidence that real-terms funding of public health in England will be cut from £3.47bn to just over £3bn between 2015/ 16 and 2020/21 [9]

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Conclusion