evaluang))the)costs)of) ncds;)the)nutri&onal) component · results: module 2 prevalence cases...
TRANSCRIPT
Evalua&ng the costs of
NCDs; The Nutri&onal
Component
Foresight and Beyond
Klim McPherson
University of Oxford
Chair UKHF
WPHNA Oxford Sept 8th 2014
With Mar)n Brown Laura Webber & team
£4.2 billion NHS spending, NHS Butland, 07 £15.8billion indirect costs, Butland, 07
Costs
The costs of obesity have been es&mated at up to 8% of overall health
budgets and represent an enormous burden both in individual illness, disability and early mortality as well as in terms of the costs to employers, tax payers and society IASO, 02
The Future?
Foresight Tackling Obesities 2007
Our response
health_simula)ons.exe C++ development 2006-‐2013
risk_distribu)on.exe C++ development 2006-‐2013 1
.
2.
Adult Males predicted to 2050
BMI >30
25< BMI <30
BMI <25
Health Survey for England survey data -‐ 1993 -‐2008 data
Risk distribu)on – con)nuous in simula)on
Age 16-‐39 M
1993 1996 1999 2002 2005 2008 2011 2014 2017 2020 2023 2026 2029
0
10
20
30
40
50
60
70
80
90
100
Year
Pro
po
rtio
n o
f p
op
ula
tion
(%
)
BMI<25BMI 25−30BMI>30BMI 30−40BMI>40
●● ●
●
●
●
●●
● ● ● ●
●
●
●
●
● ● ●● ●
● ●●
●● ●
●
●
●
●●
● ● ● ●
●
●
●
●
● ● ●● ●
● ●●
1993 1996 1999 2002 2005 2008 2011 2014 2017 2020 2023 2026 2029
0
10
20
30
40
50
60
70
80
90
100
Year
Pro
po
rtio
n o
f p
op
ula
tion
(%
)
BMI<25BMI 25−30BMI>30BMI 30−40BMI>40
●● ●
●
● ●
●
●
● ● ● ●
●● ●
●
● ● ●●
● ●
●
●
●● ●
●
● ●
●
●
● ● ● ●
●● ●
●
● ● ●●
● ●
●
●
1995-‐2002 data 2003-‐2010 data
Module 2: Micro-Simulation
• Computer model of any specified population
• Population accurately reflects age profiles, birth, death and health statistics to make future projections
• Model specifically targets the relationship between individuals’ evolving risk factors and disease incidence (several million individuals)
• Risk factor distributions are determined by predictions & specified health interventions
• The model can simulate and compare the impact and cost of various public health interventions
• Simulations for over 80 countries and 50 US States at present
Microsimulation models
+ve Micro models simulate en&re popula&ons and offer flexibility to test a range of “what if” policy scenarios related to preven&on, treatment and the organisa&on and financing of care; to examine forecasted results by different characteris&cs included in the model, such as by diseases, age-‐groups, providers or treatments. They are more capable of answering a greater variety of challenging policy ques&ons.
-‐ve Very data intensive
Micro-Simulation
Adapted from Willett, Dietz & Colditz, NEJM, 1999; 341, 426-434
Body Mass Index
Rel
ativ
e R
isk
Women
1
2
3
4
5
6
0<21 22 23 24 25 26 27 28 29 30
Type 2 diabetes
Coronary Heart Disease
Hypertension
Aged 30-55 at start
"Normal" BMIs
Risks markedly increase within "normal" BMI range
Prevalence cases projected (UK)
0
1000
2000
3000
4000
5000
6000
7000
8000
2010 2020 2030 2040 2050
Num
ber o
f cas
es p
er 1
00,0
00
Hypertension
Type 2 Diabetes
CHD & Stroke
7 Cancers
Knee Osteoarthritis
Results: Module 2 Prevalence cases per 100,000 in 2030
0 5000 10000 15000 20000 25000
Armenia Austria
Azerbaijan Belgium Bulgaria
Czech Republic Denmark Estonia Finland France
Germany Greece Iceland Ireland Israel Italy
Kazakhstan Kyrgyzstan
Latvia Lithuania
Luxembourg Malta
Netherlands Norway Poland
Portugal Republic of Moldova
Romania Russian Federa&on
Slovakia Spain
Sweden Switzerland
Turkey UK
Ukraine
Cancers CHD & Stroke Diabetes Webber et al, 2014, BMJ Open
Interventions
• The micro-‐simula&on enables us to test various policy interven&ons
• For example, the impact of a 1% and 5% decrease of the mean BMI across the popula&on
• Outputs are for disease prevalence and healthcare costs
Disease incidence. NHS costs Social Cost
QoL Life expectancy
Epidemiology decides risk of individuals. >60 million
say
Popula)on demography. Changing risk
factor exposure
Micro Simula&on, 2014-‐2030 say England & Wales popula)on, Or Oxford County Council
Or any LA Plus survey data
PH Policy changes risk factor exposure
Steady state
New Policy
Delta
3405
7385
3060
3437
7778
3408
3450
7927
3542
0 1000 2000 3000 4000 5000 6000 7000 8000 9000
CANCERS
CHD & STROKE
DIABETES
CANCERS
CHD & STROKE
DIABETES
CANCERS
CHD & STROKE
DIABETES
5%
1%
NO CHA
NGE
Results: Prevalence cases per 100,000 by scenario for the Netherlands in 2030
Webber et al, 2014, BMJ Open
Cumula)ve incidence case avoided – 53 Euro region countries
Interven&on 1 (1%)
Interven&on 2 (5%)
Interven&on 1 (1%)
Interven&on 2 (5%)
Interven&on 1 (1%)
Interven&on 2 (5%)
Cancers CHD & Stroke Diabetes Cases 55 185 365 1317 408 1312
0
200
400
600
800
1000
1200
1400
Incide
nce avoide
d pe
r 100,000
Webber et al, 2014, BMJ Open
Diabetes Prevalence Men by age
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
2010 2015 2020 2025 2030 2035 2040 2045 2050
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75+
Economic module
• The micro-‐simula&on contains an economic module to es&mate:
1) The cost of increasing trends in obesity 2) The costs avoided given an effec&ve
interven&on 3) Cost-‐effec&veness of interven&ons
-‐5
0
5
10
15
20
25
2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055
£ Billion
£ Billion
savings
CURRENT TRENDS
NO FURTHER OBESITY GROWTH
ANNUAL SAVINGS
NHS Annual Costs for Diabetes £ Billion
CHD Costs
Diabetes Costs
What-if Scenarios – Health Care Costs
Scenario 1: 1% Reduc)on in BMI for
Every Adult at Baseline: Cases
Scenario 2: Reducing Percent Obese to 5%
in Youths and 15% in Adults by 2020
UK US
£15.5 Billion
$686 Billion
£61.8 Billion
$1.93 Trillion
Number in red represents medical costs avoided
UK US 2000 1800
1400 1200 1000 800 600 400 200
0
In m
illions
1600
Health and economic burden of the projected obesity trends in the USA and the UK; YC Wang, K McPherson , T Marsh, SL Gortmaker, M Brown. The Lancet 2011: 378, 9793, 815-‐825 )
Projected disease costs in 20 years (2034) (HSE 2000-‐2011)
2014 2024 2034 CHD 1598 1731 1857 Diabetes 1382 1912 2298 Hypertension 906 1007 1097 Stroke 819 1059 1225
0
500
1000
1500
2000
2500
£Millions
EConDA Economics of Chronic Diseases
EConDA Economics of Chronic Diseases
www.econdaproject.eu
Funding from the European Union in the framework of the Health Programme
} 2012-2015 } Test the cost-effectiveness of interventions
to prevent, screen and treat CHD, COPD, T2DM, CKD
} Focus on combined risks of smoking and obesity
} Upstream interventions – SSB tax, plain & picture packaging,
Publications
1. Rtveladze K, Marsh T, Conde W, Levy D, Webber L, Kilpi F, McPherson K, Brown M. Obesity Prevalence in Brazil; Impact on Health and Economic Burden. PLos One h+p://www.plosone.org/ar4cle/info%3Adoi%2F10.1371%2Fjournal.pone.0068785
2. Bierl M, Marsh T, Webber L, Brown M , McPherson K, Rtveladze K Apples and Oranges: A comparison of cos)ng methods for obesity. Obesity Reviews 10.1111/obr.12044
3. Kilpi F, Webber L, Musaigner A, Aitsi Selma A, Marsh t, Rtveladze K, McPherson K, Brown M Alarming predic)ons for obesity and non communicable disease in the Middle East Public Health Nutri)on hkp://dx.doi.org/10.1017/S1368980013000840
4. A Healthier America 2013: Strategies To Move From Sick Care To Health Care In The Next Four Years 2013. Trust for America’s Health hop://healthyamericans.org/assets/files/TFAH2013HealthierAmerica07.pdf
5. Rtveladze K, Marsh T, Barquera S, Sanchez Romero LM, Levy D, Melendez G, Webber L, Kilpi F, McPherson K, Brown M. Obesity Prevalence in Mexico; Impact on Health and Economic Burden. Public Health Nutri4on, FirstView Ar)cle, pp 1-‐7. hkp://journals.cambridge.org/ac)on/displayAbstract?fromPage=online&aid=8828009
6. Rtveladze K, Marsh T, Webber L, Kilpi K, Goryakin Ye, Kontsevaya A, Starodubova A, McPherson K, Brown M. Obesity trends in Russia; The impact on health and healthcare costs. Health 2012, Vol.4, No.12A, 1471-‐1484.
7. F as in Fat: How obesity threatens Americas future 2012, Trust for Americas Health hDp://www.healthyamericans.org/report/100/ 8. Webber L, Kilpi F, Marsh T, Rtveladze K, Brown M, McPherson K. High Rates of Obesity and Non-‐Communicable Diseases Predicted across La)n America.
PLoS ONE 2012, Vol.7, No.8, 1-‐6. 9. Webber L, Kilpi F, Marsh T, Rtveladze K, McPherson K, Brown M. Modelling obesity trends and related diseases in Eastern Europe. Obesity Reviews 2012,
Vol.13, No.8, 744-‐51. 10. Hollingworth W, Hawkins J, Lawlor DA, Brown M, Marsh T, Kipping RR. Economic evalua)on of lifestyle interven)ons to treat overweight or obesity in
children. Interna4onal Journal of Obesity 2012, Vol.36, No.4, 559-‐66. 11. Levy DT, Mabry PL, Wang YC, Gortmaker S, Huang T, Marsh T, Moodie M, Swinburn B. Simula)on models of obesity: a review of the literature and
implica)ons for research and policy. Obesity Reviews 2011, Vol.12, No.5, 378-‐94. 12. Gortmaker SL, Swinburn B, Levy D, Carter R, Mabry PL, Finegood D, Huang T, Marsh T, Moodie M Changing the Future of Obesity: Science, Policy and
Ac)on. The Lancet 2011, Vol. 378, No. 9793, 838 – 47. 13. Swinburn B, Sacks G, Hall K, McPherson K, Finegood D, Moodie M, Gortmaker SL. The Global obesity pandemic: shaped by global drivers and local
environments. The Lancet 2011. Vol. 378. No. 9793, 804 -‐14. 14. Wang CY, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and Economic Burden of the Projected Obesity Trends in the US and the UK. The Lancet
2011. Vol. 378. No. 9793,815 -‐ 825 15. Brown M, Byao T, Marsh T, McPherson K. Obesity Trends for Adults. Analysis from the Health Survey for England 1993-‐2007. NaLonal Heart Forum 2010.
hop://nhfshare.hearqorum.org.uk/RMAssets/NHFreports/NHF_adultobese_long_170210.pdf 16. Brown M, Byao T, Marsh T, McPherson K. February 2010. A predic&on of obesity trends for adults and their associated diseases. Analysis from the Health
Survey for England 1993-‐2007. NaLonal Heart Forum 2010. hop://nhfshare.hearqorum.org.uk/RMAssets/NHFreports/NHF_adultobese_short_170210.pdf 17. McPherson K, Brown M, Marsh T, Byao T. Obesity: Recent Trends in Children -‐ Aged 2-‐11y and 12-‐19y. Analysis from the Health Survey for England
1993-‐2007. NaLonal Heart Forum 2009. hop://nhfshare.hearqorum.org.uk/RMAssets/NHFreports/Child_Obesity_short_Oct_09.pdf 18. McPherson K, Marsh T, Brown M. Foresight. Tackling Obesi&es: Future Choices -‐ Modelling Future Trends in Obesity and the Impact on Health. Government
Office for Science 2007. London, 2nd Edi&on, 1-‐76. hop://www.bis.gov.uk/assets/foresight/docs/obesity/14.pdf 19. Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V. Foresight Tackling Obesi&es: Future Choices -‐ Project Report, Government Office
for Science 2007. London, 2nd Edi&on, 1-‐161. hop://www.bis.gov.uk/assets/foresight/docs/obesity/17.pdf
The OECD overview on modelling
“The NHF (UKHF) microsimulation model projects public health expenditures associated with leading diseases where obesity is a significant risk factor. The model simulates and evaluates how future trends may change in response to policies to reduce the prevalence of obesity...
…New work has extended the model to focus on smoking and smoking-related diseases and the model is extensible to a broader range of risk factors and diseases.”
The future
• OECD Mul&-‐country Health Policy Microsimula&on Model with Stat Canada, SMI, USC, Stanford, Rome Uni and Precision Health Economics
• Local level modelling of alcohol and ac&ve travel • World Bank Tobacco in Sub Saharan Africa • World Bank /PAHO Obesity in La&n America and Caribbean • Double burden of disease with Uni Washington/GAIN • Alcohol and Health in Russia with IPH Moscow • DH/PHE/NHSE/NICE • Predict and plan PH interven&ons for local authori&es:
Given their data
END
Klim.McPherson @ new.ox.ac.uk