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Eupha 4.obesityhealthandeconomicassessment by_michelececchini

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    Eupha 4.obesityhealthandeconomicassessment by_michelececchini Eupha 4.obesityhealthandeconomicassessment by_michelececchini Presentation Transcript

    • Improving Lifestyles, Tackling Obesity: Assessing the Health and Economic Impact of Prevention Strategies Michele Cecchini MD, MSc Health Policy Analyst, OECD
    • 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?
    • 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
    • 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
    • Are Prevention Interventions Justified? “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? • Market and rationality failure: – Externalities – Information failures – Supply-side market failures – Failures of rationality • Existing policies have undesired effects • Health inequalities
    • Education and Smoking Smoking risk knowledge and degree Smoking prevalence and degree From D. Kenkel’s presentation at OECD Expert Group meeting, 27 April 2007.
    • 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
    • Obesity: a Growing Problem 80% Proportion overweight (adult population) 70% 60% 50% Canada USA England Spain 40% Austria Italy Australia 30% France Korea 20% 1970 1980 1990 2000 2010 2020 Year
    • 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
    • What Policy-Makers Want to Know • Does prevention improve health? • Does it reduce health expenditure? • Does it improve health inequalities? • Is it cost-effective?
    • Expectations Must Be Realistic 36% Proportion of published cost-effectiveness ratios 32% 28% 24% 20% 16% 12% 8% 4% 0% Cost-saving < 10,000 10,000 to 50,000 to 100,000 to 250,000 to ≥ increases 50,000 100,000 250,000 1,000,000 1,000,000 cost and worsen Cost-effectiveness ratio ($ per QALY) health Preventive measures Treatments for existing conditions Adapted from Cohen JT, et al. NEJM 2008;358(7):661-3
    • Intermediate risk Distal risk factors factor Proximal risk factors Diseases Blood pressure Z0 normal Cancers Z1 hypertension Fibre Y0 adequate fibre intake Y1 low fibre intake Body mass Cholesterol Fat F0 low fat intake index A0 normal Stroke F1 medium fat intake N normal weight A1 hypercholesterolemia F2 high fat intake U pre-obesity V obesity Physical activity P0 adequate physical act P1 insuff .physical act Glycaemia Ischemic heart B0 normal B1 diabetes disease Socio-economic status I0 upper I1 lower
    • Interventions Health education and Regulation Primary-care based health promotion and fiscal measures interventions Fiscal measures Physician counselling Mass media campaigns (fruit and vegetables and foods high in fat) of individuals at risk Government regulation or Intensive physician and School-based industry self-regulation of dietician counselling of interventions food advertising to individuals at risk children Compulsory food Worksite interventions labelling
    • Scope of Modelling Work Regional analysis Country analyses
    • Does Prevention Improve Population Health?
    • Health Outcomes of Prevention mass media campaigns 1 LY/DALY every 115/121 people food adverting self-regulation school-based interventions food advertising regulation worksite interventions food labelling physician counselling fiscal measures 1 LY/DALY every 12/10 people physician-dietician counselling 0 100,000 200,000 300,000 400,000 500,000 Disability-adjusted life years Life years
    • Health Outcomes over Time England 10,000 school-based interventions 9,000 worksite interventions 8,000 mass media DALYs (per million population) 7,000 campaigns fiscal measures 6,000 5,000 physician counselling 4,000 physician- dietician 3,000 counselling food advertising 2,000 regulation food adverting 1,000 self-regulation food labelling 0 0 10 20 30 40 50 60 70 80 90 100 Time (years)
    • Intervention Effectiveness (coverage) Worksite interventions Population aged 18-65 [64%] Employed [64%] Working for large employer [63%] Participating employers [50%] Participating employees [45%] Coverage = 5.8% of the population
    • Intervention Effectiveness (Time to Steady State) age 1 2 3 4 5 6 7 8 9 10 11 12 13 14 98 99 100 1 period 2 3 90 91 fiscal measures food labelling mass media camp phys/diet couns years to physician couns steady worksite interv state food advert self-reg food advert reg school-based int 0 10 20 30 40 50 60 70 80 90 100
    • Does Prevention Reduce Expenditure on Health Care?
    • Financial Impacts 550 450 350 Cost (billion $ PPP) 250 150 50 -50 intervention costs health expenditure
    • -10000 -15000 10000 - Health Outcomes and Expenditure Physician-Dietician Counselling Health outcomes Impact on health expenditure 14,000 10,000 12,000 5,000 10,000 8,000 0 6,000 -5,000 4,000 -10,000 2,000 0 -15,000 life years (thousands) DALYs (thousands) costs (million $PPP)
    • Interventions vs. Age Change in risk of IHD 1.15 1.10 1.05 1.00 0.95 Intervention (50 yrs old) Age (51 vs 50) Note: risk equals to 1 for 50 year olds and no intervention
    • Does Prevention Improve Health Inequalities?
    • Impact on Inequalities Different social groups have: • Different risk profiles: – Larger benefits in those most at risk (~) • Different responses to interventions: – Larger benefits with a greater response
    • Impact on Inequalities Worksite interventions Fiscal measures 0.7% 0.7% 0.6% 0.6% 0.5% 0.5% 0.4% 0.4% 0.3% 0.3% 0.2% 0.2% 0.1% 0.1% 0.0% 0.0% high SES low SES high SES low SES
    • Is Prevention Cost-Effective?
    • Cost-Effectiveness of Prevention 300,000 250,000 Cost-effectiveness ratio ($PPP per DALY) 200,000 150,000 100,000 50,000 0 10 20 30 40 50 60 70 80 90 100 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
    • Cost-effectiveness of Prevention after 20 years 150 ‡ food adv reg * school-based int 120 Cost (annual average, billion $ PPP) 90 60 phys-diet couns phys couns 30 worksite interv * ‡ food labelling 0 mass media camp 0 fiscal measures 1 2 3 4 5 6 7 8 9 10 food adv self-reg -30 Effect (average annual DALY gain, millions)
    • Cost-effectiveness of Prevention after 100 years 250 200 Cost (annual average, billion $ PPP) school-based int 150 mass media camp 100 phys-diet couns phys couns 50 worksite interv food labelling 0 food adv reg 0 2.5 5 7.5 fiscal measures 10 12.5 15 17.5 20 food adv self-reg -50 Effect (average annual DALY gain, millions)
    • The role of prevention packages
    • Multiple interventions Health outcomes Impact on health expenditure (selected diseases) 80,000 70,000 0 60,000 50,000 -10,000 40,000 -20,000 30,000 -30,000 20,000 -40,000 10,000 0 -50,000 -60,000 -70,000 Life years (thousands) Disability-adjusted life years (thousands) Impact on health expenditure (million $PPP) Multiple int. 1 school-based intervention + mass media camp + physician-dietician counselling food labelling + food advert self-regulation + school-based interventions + mass media Multiple int. 2 campaigns + physician-dietician counselling
    • Multiple Interventions Cost-effectiveness of interventions after 10 years Cost-effectiveness of interventions after 100 years 50,000 $PPP/DALY Fiscal measures 50,000 $PPP/DALY Mass media camp Phys-diet couns. Food labelling Multiple int. 2 Multiple int. 1 more than 1,000,000 $PPP/DALY Physician couns. Worksite interv. Food adv self-reg. Food advert. School-based int. 400 350 300 250 200 150 100 50 0 0 25 50 75 100 Cost-effectiveness ratio (thousand $PPP per DALY) Cost-effectiveness ratio (thousand $PPP per DALY)
    • 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
    • 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