Improving Lifestyles, Tackling
Obesity: Assessing the Health
and Economic Impact of
Prevention Strategies
Michele Cecchini...
Chronic Diseases and Prevention
• Increasing prevalence of chronic diseases
in the OECD area
– Incidence is increasing (ag...
Are Prevention Interventions Justified?
It is better to be healthy than ill or dead.
That is the beginning and the end of ...
The Goals of Prevention
Prevention may offer opportunities to:
• Increase social welfare
• Enhance health equity
Relative ...
“Maintaining good health is an important goal for
most individuals, but health is by no means the
only outcome that indivi...
• Market and rationality failure:
– Externalities
– Information failures
– Supply-side market failures
– Failures of ratio...
Education and Smoking
From D. Kenkel’s presentation at OECD Expert Group meeting, 27 April 2007.
Smoking risk knowledge an...
Concerns About Rising Obesity
• Evidence consistently shows rising overweight
and obesity rates in OECD area
• No sign of ...
Obesity: a Growing Problem
20%
30%
40%
50%
60%
70%
80%
1970 1980 1990 2000 2010 2020
Proportionoverweight(adultpopulation)...
What Policy Options?
Interventions assessed on the basis of interference
with individual choice:
1. Actions that widen the...
What Policy-Makers Want to Know
• Does prevention improve health?
• Does it reduce health expenditure?
• Does it improve h...
Expectations Must Be Realistic
0%
4%
8%
12%
16%
20%
24%
28%
32%
36%
Cost-saving < 10,000 10,000 to
50,000
50,000 to
100,00...
Physical activity
P0 adequate physical act
P1 insuff .physical act
Body mass
index
N normal weight
U pre-obesity
V obesity...
Interventions
Health education and
health promotion
Regulation
and fiscal measures
Primary-care based
interventions
Mass m...
Scope of Modelling Work
Regional analysis Country analyses
Does Prevention Improve
Population Health?
Health Outcomes of Prevention
0 100,000 200,000 300,000 400,000 500,000
physician-dietician counselling
fiscal measures
ph...
Health Outcomes over Time
England
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
0 10 20 30 40 50 60 70 80...
Intervention Effectiveness
(coverage)
Working for large employer [63%]
Employed [64%]
Population aged 18-65 [64%]
Particip...
Intervention Effectiveness
(Time to Steady State)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 98 99 100
1
2
3
90
91
age
period
0 10 2...
Does Prevention Reduce
Expenditure on Health Care?
Financial Impacts
-50
50
150
250
350
450
550
Cost(billion$PPP)
intervention costs health expenditure
Health Outcomes and Expenditure
Physician-Dietician Counselling
-15000-10000-10000
Health outcomes Impact on health expend...
Interventions vs. Age
0.95
1.00
1.05
1.10
1.15
Intervention (50 yrs old) Age (51 vs 50)
Change in risk of IHD
Note: risk e...
Does Prevention Improve
Health Inequalities?
Impact on Inequalities
Different social groups have:
• Different risk profiles:
– Larger benefits in those most at risk (~...
Impact on Inequalities
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
high SES low SES
Worksite interventions Fiscal measures
0.0...
Is Prevention Cost-Effective?
Cost-Effectiveness of Prevention
0
50,000
100,000
150,000
200,000
250,000
300,000
10 20 30 40 50 60 70 80 90 100
Cost-effe...
Cost-effectiveness of Prevention
after 20 years
-30
0
30
60
90
120
150
0 1 2 3 4 5 6 7 8 9 10
Cost(annualaverage,billion$P...
-50
0
50
100
150
200
250
0 2.5 5 7.5 10 12.5 15 17.5 20
Cost(annualaverage,billion$PPP)
Effect (average annual DALY gain, ...
The role of prevention packages
Multiple interventions
Health outcomes Impact on health expenditure
(selected diseases)
Multiple int. 1 school-based inter...
Multiple Interventions
050100150200250300350400
Cost-effectiveness ratio (thousand $PPP per DALY)
50,000$PPP/DALY
morethan...
Policy Implications
• Prevention is an effective and cost-effective way to
improve population health
• Prevention can decr...
OECD work on prevention
• Obesity and the economics
of prevention: fit not fat
• OECD health working papers
HWP 32, 45, 46...
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Eupha 4.obesityhealthandeconomicassessment by_michelececchini

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Eupha 4.obesityhealthandeconomicassessment by_michelececchini

  1. 1. Improving Lifestyles, Tackling Obesity: Assessing the Health and Economic Impact of Prevention Strategies Michele Cecchini MD, MSc Health Policy Analyst, OECD
  2. 2. Chronic Diseases and Prevention • Increasing prevalence of chronic diseases in the OECD area – Incidence is increasing (ageing, lifestyles) – Mortality is decreasing (better healthcare) • Some risk factors are declining (e.g. smoking)… • … but others are rising (e.g. unhealthy diet and physical inactivity) • Prevention or treatment?
  3. 3. Are Prevention Interventions Justified? It is better to be healthy than ill or dead. That is the beginning and the end of the only real argument for preventive medicine. It is sufficient. Geoffrey Rose
  4. 4. The Goals of Prevention Prevention may offer opportunities to: • Increase social welfare • Enhance health equity Relative to a situation in which chronic diseases are treated when they emerge
  5. 5. “Maintaining good health is an important goal for most individuals, but health is by no means the only outcome that individuals value when they choose how to lead their own lives. Individuals wish to engage in activities from which they expect to derive pleasure, satisfaction, or fulfilment, some of which may be conducive to good health, others less or not at all. […] An assessment of the role of prevention must not ignore those competing goals” (Sassi and Hurst, 2008) Are Prevention Interventions Justified?
  6. 6. • Market and rationality failure: – Externalities – Information failures – Supply-side market failures – Failures of rationality • Existing policies have undesired effects • Health inequalities Are Prevention Interventions Justified?
  7. 7. Education and Smoking From D. Kenkel’s presentation at OECD Expert Group meeting, 27 April 2007. Smoking risk knowledge and degree Smoking prevalence and degree
  8. 8. Concerns About Rising Obesity • Evidence consistently shows rising overweight and obesity rates in OECD area • No sign of decline or slowdown • BMI distributions are shifting following similar patterns across countries and over time • Countries with the lowest overweight prevalence today will have caught up with high prevalence rates within 10 years
  9. 9. Obesity: a Growing Problem 20% 30% 40% 50% 60% 70% 80% 1970 1980 1990 2000 2010 2020 Proportionoverweight(adultpopulation) Year USA England Spain Austria France Australia Canada Korea Italy
  10. 10. What Policy Options? Interventions assessed on the basis of interference with individual choice: 1. Actions that widen the choice set or decrease the price (opportunity cost) of selected choice options; 2. Actions that influence choices through means other than prices, such as persuasion, provision of information, or other suitable means; 3. Actions that increase the price (opportunity cost) of selected choice options; 4. Actions that restrict the choice set by banning selected choice options
  11. 11. What Policy-Makers Want to Know • Does prevention improve health? • Does it reduce health expenditure? • Does it improve health inequalities? • Is it cost-effective?
  12. 12. Expectations Must Be Realistic 0% 4% 8% 12% 16% 20% 24% 28% 32% 36% Cost-saving < 10,000 10,000 to 50,000 50,000 to 100,000 100,000 to 250,000 250,000 to 1,000,000 ≥ 1,000,000 increases cost and worsen health Proportionofpublishedcost-effectivenessratios Cost-effectiveness ratio ($ per QALY) Preventive measures Treatments for existing conditions Adapted from Cohen JT, et al. NEJM 2008;358(7):661-3
  13. 13. Physical activity P0 adequate physical act P1 insuff .physical act Body mass index N normal weight U pre-obesity V obesity Blood pressure Z0 normal Z1 hypertension Cholesterol A0 normal A1 hypercholesterolemia Glycaemia B0 normal B1 diabetes Cancers Stroke Ischemic heart disease Distal risk factors Intermediate risk factor Proximal risk factors Diseases Fat F0 low fat intake F1 medium fat intake F2 high fat intake Fibre Y0 adequate fibre intake Y1 low fibre intake Socio-economic status I0 upper I1 lower
  14. 14. Interventions Health education and health promotion Regulation and fiscal measures Primary-care based interventions Mass media campaigns Fiscal measures (fruit and vegetables and foods high in fat) Physician counselling of individuals at risk School-based interventions Government regulation or industry self-regulation of food advertising to children Intensive physician and dietician counselling of individuals at risk Worksite interventions Compulsory food labelling
  15. 15. Scope of Modelling Work Regional analysis Country analyses
  16. 16. Does Prevention Improve Population Health?
  17. 17. Health Outcomes of Prevention 0 100,000 200,000 300,000 400,000 500,000 physician-dietician counselling fiscal measures physician counselling food labelling worksite interventions food advertising regulation school-based interventions food adverting self-regulation mass media campaigns Disability-adjusted life years Life years 1 LY/DALY every 115/121 people 1 LY/DALY every 12/10 people
  18. 18. Health Outcomes over Time England 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 0 10 20 30 40 50 60 70 80 90 100 DALYs(permillionpopulation) Time (years) school-based interventions worksite interventions mass media campaigns fiscal measures physician counselling physician- dietician counselling food advertising regulation food adverting self-regulation food labelling
  19. 19. Intervention Effectiveness (coverage) Working for large employer [63%] Employed [64%] Population aged 18-65 [64%] Participating employers [50%] Participating employees [45%] Coverage = 5.8% of the population Worksite interventions
  20. 20. Intervention Effectiveness (Time to Steady State) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 98 99 100 1 2 3 90 91 age period 0 10 20 30 40 50 60 70 80 90 100 school-based int food advert reg food advert self-reg worksite interv physician couns phys/diet couns mass media camp food labelling fiscal measures years to steady state
  21. 21. Does Prevention Reduce Expenditure on Health Care?
  22. 22. Financial Impacts -50 50 150 250 350 450 550 Cost(billion$PPP) intervention costs health expenditure
  23. 23. Health Outcomes and Expenditure Physician-Dietician Counselling -15000-10000-10000 Health outcomes Impact on health expenditure 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 life years (thousands) DALYs (thousands) -15,000 -10,000 -5,000 0 5,000 10,000 costs (million $PPP)
  24. 24. Interventions vs. Age 0.95 1.00 1.05 1.10 1.15 Intervention (50 yrs old) Age (51 vs 50) Change in risk of IHD Note: risk equals to 1 for 50 year olds and no intervention
  25. 25. Does Prevention Improve Health Inequalities?
  26. 26. Impact on Inequalities Different social groups have: • Different risk profiles: – Larger benefits in those most at risk (~) • Different responses to interventions: – Larger benefits with a greater response
  27. 27. Impact on Inequalities 0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% high SES low SES Worksite interventions Fiscal measures 0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% high SES low SES
  28. 28. Is Prevention Cost-Effective?
  29. 29. Cost-Effectiveness of Prevention 0 50,000 100,000 150,000 200,000 250,000 300,000 10 20 30 40 50 60 70 80 90 100 Cost-effectivenessratio($PPPperDALY) Years after initial implementation school-based interventions worksite interventions mass media campaigns fiscal measures physician counselling physician-dietician counselling food advertising regulation food adverting self-regulation food labelling
  30. 30. Cost-effectiveness of Prevention after 20 years -30 0 30 60 90 120 150 0 1 2 3 4 5 6 7 8 9 10 Cost(annualaverage,billion$PPP) Effect (average annual DALY gain, millions) phys-diet couns phys couns fiscal measures food labelling worksite interv food adv self-reg ‡ food adv reg mass media camp * school-based int ‡ *
  31. 31. -50 0 50 100 150 200 250 0 2.5 5 7.5 10 12.5 15 17.5 20 Cost(annualaverage,billion$PPP) Effect (average annual DALY gain, millions) phys-diet couns phys couns worksite interv food labelling fiscal measures food adv self-reg food adv reg school-based int mass media camp Cost-effectiveness of Prevention after 100 years
  32. 32. The role of prevention packages
  33. 33. Multiple interventions Health outcomes Impact on health expenditure (selected diseases) Multiple int. 1 school-based intervention + mass media camp + physician-dietician counselling Multiple int. 2 food labelling + food advert self-regulation + school-based interventions + mass media campaigns + physician-dietician counselling 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 Life years (thousands) Disability-adjusted life years (thousands) -70,000 -60,000 -50,000 -40,000 -30,000 -20,000 -10,000 0 Impact on health expenditure (million $PPP)
  34. 34. Multiple Interventions 050100150200250300350400 Cost-effectiveness ratio (thousand $PPP per DALY) 50,000$PPP/DALY morethan1,000,000$PPP/DALY 0 25 50 75 100 Cost-effectiveness ratio (thousand $PPP per DALY) 50,000$PPP/DALY Fiscal measures Mass media camp Phys-diet couns. Food labelling Multiple int. 2 Multiple int. 1 Physician couns. Worksite interv. Food adv self-reg. Food advert. School-based int. Cost-effectiveness of interventions after 10 years Cost-effectiveness of interventions after 100 years
  35. 35. Policy Implications • Prevention is an effective and cost-effective way to improve population health • Prevention can decrease health expenditure and improve inequalities, but not to a major degree • Comprehensive strategies combining population and individual approaches provide best results • Involvement of relevant stakeholders is key to the success of prevention
  36. 36. OECD work on prevention • Obesity and the economics of prevention: fit not fat • OECD health working papers HWP 32, 45, 46, 48 • Paper in Lancet series on chronic diseases (forthcoming) www.oecd.org/health/prevention www.oecd.org/health/fitnotfat michele.cecchini@oecd.org
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