ACE‐Prevention Media launch     8 September 2010            Prof Theo Vos           Prof Rob Carter  for ACE‐Prevention re...
 Australia ranks second world‐wide in life expectancy Large improvements in health in last 40 years due to:   ↓ tobacco‐...
 Health expenditure growing as % of GDP    ageing population    expensive new technologies    more demanding public N...
 Prevention better than cure?    often    …but not necessarily so ACE‐Prevention provides that information for:    12...
Results for 123 prevention measures:    23 net cost saving    20 very cost‐effective <$10,000 per healthy life year     ...
Very cost‐effective and large health impact:    Tax alcohol, tobacco and ‘unhealthy food’    Regulation of salt content ...
Very cost‐effective and moderate health impact:    Pedometers & mass media for physical activity    Smoking cessation dr...
Very cost‐effective and more modest health impact:    Fluoride drinking water    Hepatitis B vaccination    A range of ...
Other cost‐effective measures:    Increased Sunsmart effort    HPV vaccination and Pap smear testing cervix cancer    S...
Not recommended:   PSA testing for prostate cancer (more harm than good)   Weight watchers   Drugs for losing weight  ...
Insufficient evidence of effectiveness:    Screening for vision loss    Dental check‐ups
Combined impact 23 cost saving prevention measures
Combined impact 23 cost saving prevention measures                              Cost offsets - Dominant package           ...
Combined impact 43 very cost‐effective prevention measures
Combined impact 43 very cost‐effective prevention measures                           1 million healthy                    ...
Blue print for governments:    good investments in prevention that are affordable    opportunities for large health impr...
ACE‐Prevention for Indigenous Health Different costs      delivering services to remote areas      greater cost of Abor...
IHSD Template service delivery component values    Component category          Additional cost per patient                ...
Cost per healthy life year for selected interventions:         Indigenous versus non‐Indigenous               Value‐for‐mo...
Cost per healthy life year: blood pressure and cholesterol treatments                    mainstream GPs versus ACCHSs     ...
Healthy life years saved: blood pressure and cholesterol treatments                   mainstream GPs versus ACCHSs        ...
Conclusions on Indigenous health component The costs of ACCHSs are higher due to the comprehensive nature   of these serv...
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Assessing Cost-effectiveneess Prevention sept_2010

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Assessing Cost-effectiveneess Prevention sept_2010

  1. 1. ACE‐Prevention Media launch 8 September 2010 Prof Theo Vos Prof Rob Carter for ACE‐Prevention research team
  2. 2.  Australia ranks second world‐wide in life expectancy Large improvements in health in last 40 years due to: ↓ tobacco‐related disease ↓ cardiovascular disease ↓ injuries .. but large health gap for Indigenous Australians  remains
  3. 3.  Health expenditure growing as % of GDP  ageing population  expensive new technologies  more demanding public Need to spend health dollars wisely  more on services that give good value for money  avoid spending on services that are not
  4. 4.  Prevention better than cure?  often  …but not necessarily so ACE‐Prevention provides that information for:  123 preventive services and 27 treatments as comparison  largest study of its kind in the world  holding up Australia’s reputation as a leader in prevention  funded by National Health and Medical Research Council
  5. 5. Results for 123 prevention measures:  23 net cost saving  20 very cost‐effective <$10,000 per healthy life year  (DALY)  31 cost‐effective $10‐50,000 per DALY  38 not cost‐effective  2 more harm than good; 2 for which better alternatives  4 insufficient evidence of effectiveness 
  6. 6. Very cost‐effective and large health impact:  Tax alcohol, tobacco and ‘unhealthy food’  Regulation of salt content in bread, cereals and margarine  Treating blood pressure and cholesterol  …. but doing this  more efficiently than we currently do • using  cheaper drugs • better  targeting who needs to be treated  Gastric banding for the very obese (but expensive!)
  7. 7. Very cost‐effective and moderate health impact:  Pedometers & mass media for physical activity  Smoking cessation drugs  Screen elderly women for osteoporosis & alendronate  Screen diabetics for chronic kidney disease
  8. 8. Very cost‐effective and more modest health impact:  Fluoride drinking water  Hepatitis B vaccination  A range of 7 measures to prevent mental disorders or suicide
  9. 9. Other cost‐effective measures:  Increased Sunsmart effort  HPV vaccination and Pap smear testing cervix cancer  Screen for pre‐diabetes + drug or lifestyle intervention  Screen for chronic kidney disease + drug  Diet and exercise for overweight people (but limited  impact on weight loss)
  10. 10. Not recommended:  PSA testing for prostate cancer (more harm than good)  Weight watchers  Drugs for losing weight  Most fruit and veg interventions  Aspirin to prevent cardiovascular disease  School based drug interventions  Vaccination for shingles
  11. 11. Insufficient evidence of effectiveness:  Screening for vision loss  Dental check‐ups
  12. 12. Combined impact 23 cost saving prevention measures
  13. 13. Combined impact 23 cost saving prevention measures Cost offsets - Dominant package Intervention costs - Current practice Intervention costs - Dominant package Cost offsets - Current practice Health gain - Dominant package Health gain - Current practice $1,400 70 Thousands Millions $1,000 50 DALYs averted $600 30 Costs $200 10 -$200 -10 -$600 -30 2003 2010 2017 2024 2031 2038 2045 2052 2059 2066 2073 2080 Years
  14. 14. Combined impact 43 very cost‐effective prevention measures
  15. 15. Combined impact 43 very cost‐effective prevention measures 1 million healthy  life years$4 billion Immediate upfront cost savings in investment blood pressure  & cholesterol Treatment  cost saved
  16. 16. Blue print for governments:  good investments in prevention that are affordable  opportunities for large health improvement  potential to reduce wasteful spendingGovernments will need strong arguments to ignore the  compelling evidence
  17. 17. ACE‐Prevention for Indigenous Health Different costs  delivering services to remote areas  greater cost of Aboriginal Community Controlled Health Services (ACCHS)  compared to mainstream GPs  • average cost short consultation  $113  versus  $31 • average cost long consultation  $156  versus  $59  BUT better attendance (73% v 60%) and better adherence to treatments (96% v  78%) in ACCHS Different health outcomes  Indigenous health gap – improvements more important  many diseases start at a much younger age 
  18. 18. IHSD Template service delivery component values Component category Additional cost per patient encounter at an ACCHSBasic intervention components $16.67 per short consult $31.57 per long consult Population health activities $9.28Administrative & governance $3.87 structures Patient transport services $47.01 Remoteness adjustment $5.50 18 18
  19. 19. Cost per healthy life year for selected interventions: Indigenous versus non‐Indigenous Value‐for‐money      Not value‐ for‐money?
  20. 20. Cost per healthy life year: blood pressure and cholesterol treatments mainstream GPs versus ACCHSs Value‐for‐money       Not value‐for‐money? Cost saving
  21. 21. Healthy life years saved: blood pressure and cholesterol treatments mainstream GPs versus ACCHSs ACCHSs Mainstream GP practices
  22. 22. Conclusions on Indigenous health component The costs of ACCHSs are higher due to the comprehensive nature  of these services + patient transport services …. but utilisation of health services, adherence and health gain  are all higher for ACCHSs  than for mainstream GP services What weight should we give to social justice considerations  (‘closing the gap’): “should we be willing to pay 2, 3 …4 times  more for Indigenous health improvement”? Interesting work on equity weights and Indigenous concept of  ‘good health’ commenced in ACE‐Prevention

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