Applying economic evaluation to public health interventions: The case of interventions to promote physical activity

Copyright @ 2012 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: This paper explores the application of alternative approaches to economic evaluation of public health interventions, using a worked example of exercise referral schemes (ERSs). METHODS: Cost-utility (CUA) and cost-consequence analyses (CCA) were used to assess the cost-effectiveness of ERSs. For the CUA, evidence was synthesized using a decision analytic model that adopts a lifetime horizon and NHS/Personal Social Services perspective. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). CCA was conducted from a partial-societal perspective, including health and non-healthcare costs and benefits. Outcomes were reported in natural units, such as cases of strokes or CHD avoided. RESULTS: Compared with usual care, the incremental cost per QALY of ERS is £20 876. Based on a cohort of 100 000 individuals, CCA estimates cost of ERS at £22 million to the healthcare provider and £12 million to participants. The benefits of ERS include additional 3900 people becoming physically active, 51 cases of CHD avoided, 16 cases of stroke avoided, 86 cases of diabetes avoided and a gain of ∼800 QALYs. CONCLUSIONS: CCA might provide greater transparency than CUA in reporting the outcomes of public health interventions and have greater resonance with stakeholders involved in commissioning these interventions.This work was supported by the NIHR Health Technology Assessment programme (project number 08/72/01). This article is made available through the Brunel Open Access Publishing Fund

Determinants of Physical Activity and Dietary Habits among Adults in Ghana: A Cross-Sectional Study

Acknowledgments: We acknowledge support from the Ghana Statistical Service, Brunel Global Health Academy, and the Office of the President of Ghana. Data availability statement: The data presented in this study are available upon request from the corresponding author.Copyright: © 2022 by the authors. A critical understanding of the interrelationship between two behavioral decisions—participating in physical activity, and eating healthily—is lacking in Ghana. This study aimed to determine which factors affect each of the two behavioral decisions, jointly and separately, among adults aged 18 years or older in three metropolises (Kumasi, Accra, and Tamale) of Ghana. The data from the Ghana Obesity Survey 2021 were used. A bivariate probit model was fitted to estimate nonlinear models that indicate an individual’s joint decision to participate in physical activity and consume a healthy diet. A positive correlation (r = 0.085; p < 0.05) was found between these two decisions, indicating a relationship between these two behavioral decisions. The common correlates between these decisions were self-reported good health status, high income, and attitudes toward being overweight. Men were more likely to be physically active but less likely to eat well. Both religion and culture determined participation in physical activity, but not the consumption of a healthy diet. Marital status determined diet, but not physical activity. The new knowledge gained from this analysis around the nature and the extent of the interconnectedness between physical activity and diet is critical to devising targeted interventions for obesity prevention in Ghana.This research received no external funding

Cost-effectiveness of offering an area-level financial incentive on breast feeding: a within-cluster randomised controlled trial analysis

Objective To provide the first estimate of the cost-effectiveness of financial incentive for breastfeeding intervention compared with usual care. Design Within-cluster (‘ward’-level) randomised controlled trial cost-effectiveness analysis (trial registration number ISRCTN44898617). Setting Five local authority districts in the North of England. Participants 5398 mother-infant dyads (intervention arm), 4612 mother-infant dyads (control arm). Interventions Offering a financial incentive (over a 6-month period) on breast feeding to women living in areas with low breastfeeding prevalence (<40% at 6–8 weeks). Main outcome measures Babies breast fed (receiving breastmilk) at 6–8 weeks, and cost per additional baby breast fed. Methods Costs were compared with differences in area-level data on babies’ breast fed in order to estimate a cost per additional baby breast fed and the quality-adjusted life year (QALY) gains required over the lifetime of babies to justify intervention cost. Results In the trial, the total cost of providing the intervention in 46 wards was £462 600, with an average cost per ward of £9989 and per baby of £91. At follow-up, area-level breastfeeding prevalence at 6–8 weeks was 31.7% (95% CI 29.4 to 34.0) in control areas and 37.9% (95% CI 35.0 to 40.8) in intervention areas. The adjusted difference between intervention and control was 5.7 percentage points (95% CI 2.7 to 8.6; p<0.001), resulting in 10 (95% CI 6 to 14) more additional babies breast fed in the intervention wards (39 vs 29). The cost per additional baby breast fed at 6–8 weeks was £974. At a cost per QALY threshold of £20 000 (recommended in England), an additional breastfed baby would need to show a QALY gain of 0.05 over their lifetime to justify the intervention cost. If decision makers are willing to pay £974 (or more) per additional baby breast fed at a QALY gain of 0.05, then this intervention could be cost-effective. Results were robust to sensitivity analyses. Conclusion This study provides information to help inform public health guidance on breast feeding. To make the economic case unequivocal, evidence on the varied and long-term health benefits of breast feeding to both the baby and mother and the effectiveness of financial incentives for breastfeeding beyond 6–8 weeks is require

Mortality due to cardiovascular disease, respiratory disease and cancer in adults with cerebral palsy

Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population. Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care dataset (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorised according to ICD codes. Standardised mortality ratios were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar-year. Results: 958 adults with CP were identified (median age at start of follow-up 31 yr; 52.5% males) and followed for a total of 7693 person-years. 142 patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% CI 2.20 to 4.62) and respiratory disease (SMR: 13.59, 95% CI to 18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83 to 2.45). Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the US and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide. </p

Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial.

OBJECTIVE: To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA). DESIGN: Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention). SETTING: Primary care and ERS in three UK sites from 2015 to 2018. PARTICIPANTS: 450 inactive ERS referees with chronic health conditions. INTERVENTIONS: Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options. MAIN OUTCOME MEASURES: Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up. RESULTS: There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: -2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: -26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months. CONCLUSION: Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA. TRIAL REGISTRATION NUMBER: ISRCTN15644451

Physical activity and health related quality of life

Copyright @ 2012 Anokye et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: Research on the relationship between Health Related Quality of Life (HRQoL) and physical activity (PA), to date, have rarely investigated how this relationship differ across objective and subjective measures of PA. The aim of this paper is to explore the relationship between HRQoL and PA, and examine how this relationship differs across objective and subjective measures of PA, within the context of a large representative national survey from England. METHODS: Using a sample of 5,537 adults (40–60 years) from a representative national survey in England (Health Survey for England 2008), Tobit regressions with upper censoring was employed to model the association between HRQoL and objective, and subjective measures of PA controlling for potential confounders. We tested the robustness of this relationship across specific types of PA. HRQoL was assessed using the summary measure of health state utility value derived from the EuroQol-5 Dimensions (EQ-5D) whilst PA was assessed via subjective measure (questionnaire) and objective measure (accelerometer- actigraph model GT1M). The actigraph was worn (at the waist) for 7 days (during waking hours) by a randomly selected sub-sample of the HSE 2008 respondents (4,507 adults – 16 plus years), with a valid day constituting 10 hours. Analysis was conducted in 2010. RESULTS: Findings suggest that higher levels of PA are associated with better HRQoL (regression coefficient: 0.026 to 0.072). This relationship is consistent across different measures and types of PA although differences in the magnitude of HRQoL benefit associated with objective and subjective (regression coefficient: 0.047) measures of PA are noticeable, with the former measure being associated with a relatively better HRQoL (regression coefficient: 0.072). CONCLUSION: Higher levels of PA are associated with better HRQoL. Using an objective measure of PA compared with subjective shows a relatively better HRQoL.This project was funded by the NIHR Health Technology Assessment programme (project number 08/72/01)

CALMS: Modelling the long-term health and economic impact of Covid-19 using agent-based simulation

Data Availability Statement: All data files are available from https://doi.org/10.17633/rd.brunel.19350518 The software is available on https://gitlab.com/anabrunel/calms.Copyright: © 2022 Mintram et al. We present our agent-based CoronAvirus Lifelong Modelling and Simulation (CALMS) model that aspires to predict the lifelong impacts of Covid-19 on the health and economy of a population. CALMS considers individual characteristics as well as comorbidities in calculating the risk of infection and severe disease. We conduct two sets of experiments aiming at demonstrating the validity and capabilities of CALMS. We run simulations retrospectively and validate the model outputs against hospitalisations, ICU admissions and fatalities in a UK population for the period between March and September 2020. We then run simulations for the lifetime of the cohort applying a variety of targeted intervention strategies and compare their effectiveness against the baseline scenario where no intervention is applied. Four scenarios are simulated with targeted vaccination programmes and periodic lockdowns. Vaccinations are targeted first at individuals based on their age and second at vulnerable individuals based on their health status. Periodic lockdowns, triggered by hospitalisations, are tested with and without vaccination programme in place. Our results demonstrate that periodic lockdowns achieve reductions in hospitalisations, ICU admissions and fatalities of 6-8% compared to the baseline scenario, with an associated intervention cost of £173 million per 1,000 people and targeted vaccination programmes achieve reductions in hospitalisations, ICU admissions and fatalities of 89-90%, compared to the baseline scenario, with an associated intervention cost of £51,924 per 1,000 people. We conclude that periodic lockdowns alone are ineffective at reducing health-related outputs over the long-term and that vaccination programmes which target only the clinically vulnerable are sufficient in providing healthcare protection for the population as a whole.EU Horizon 2020 STAMINA project No. 883441 (https://cordis.europa.eu/project/id/883441)

The effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study

Copyright © Author(s) (or their employer(s)) 2020. Introduction: There is consistent evidence that people with cerebral (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently, to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility. Methods and analysis: Twenty-five young people (age 5-21 yr) with CP or acquired brain injury affecting co-ordination will be included in this single arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning. Ethics and dissemination: Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, NHS trusts, and organisations for people with disabilities. Trial registration number: ClinicalTrials.gov Identifier: NCT04034342. Protocol version 1.0; pre-results.Action Medical Research and Chartered Society of Physiotherapy Charitable Trust.Joint award from Action Medical Research and Chartered Society of Physiotherapy Charitable Trust

FACS-CHARM: A Hybrid Agent-Based and Discrete-Event Simulation Approach for Covid-19 Management at Regional Level

10.13039/100010661-EU H2020 STAMINA (Grant Number: 883441