Relative contributions of treatments and risk factors to CHD mortality changes in various countries.

Relative contributions of treatments and risk factors to CHD mortality changes in various countries.</p

Estimated numbers of deaths from coronary heart disease prevented or postponed by medical and surgical treatments in Barbados in 2012.

Estimated numbers of deaths from coronary heart disease prevented or postponed by medical and surgical treatments in Barbados in 2012.</p

CHD mortality rates 1990 and 2012 by sex.

CHD mortality rates 1990 and 2012 by sex.</p

Percentage deaths prevented or postponed for several treatment groups and major cardiovascular risk factors in Barbados from 1990 to 2012.

Percentage deaths prevented or postponed for several treatment groups and major cardiovascular risk factors in Barbados from 1990 to 2012.</p

Estimated absolute and relative age-adjusted changes in risk factor prevalence/mean levels occurring in Barbados from 1990 to 2012 comparing models 1 and 2.

Estimated absolute and relative age-adjusted changes in risk factor prevalence/mean levels occurring in Barbados from 1990 to 2012 comparing models 1 and 2.</p

IMPACT: a generic tool for modelling and simulating public health policy

Background: Populations are under-served by local health policies and management ofresources. This partly reflects a lack of realistically complex models to enable appraisal of awide range of potential options. Rising computing power coupled with advances in machinelearning and healthcare information now enables such models to be constructed andexecuted. However, such models are not generally accessible to public health practitionerswho often lack the requisite technical knowledge or skills.Objectives: To design and develop a system for creating, executing and analysing the resultsof simulated public health and healthcare policy interventions, in ways that are accessibleand usable by modellers and policy-makers.Methods: The system requirements were captured and analysed in parallel with thestatistical method development for the simulation engine. From the resulting softwarerequirement specification the system architecture was designed, implemented and tested. Amodel for Coronary Heart Disease (CHD) was created and validated against empirical data.Results: The system was successfully used to create and validate the CHD model. The initialvalidation results show concordance between the simulation results and the empirical data.Conclusions: We have demonstrated the ability to connect health policy-modellers andpolicy-makers in a unified system, thereby making population health models easier to share,maintain, reuse and deploy.</p

IMPACT: a generic tool for modelling and simulating public health policy

Background: Populations are under-served by local health policies and management ofresources. This partly reflects a lack of realistically complex models to enable appraisal of awide range of potential options. Rising computing power coupled with advances in machinelearning and healthcare information now enables such models to be constructed andexecuted. However, such models are not generally accessible to public health practitionerswho often lack the requisite technical knowledge or skills.Objectives: To design and develop a system for creating, executing and analysing the resultsof simulated public health and healthcare policy interventions, in ways that are accessibleand usable by modellers and policy-makers.Methods: The system requirements were captured and analysed in parallel with thestatistical method development for the simulation engine. From the resulting softwarerequirement specification the system architecture was designed, implemented and tested. Amodel for Coronary Heart Disease (CHD) was created and validated against empirical data.Results: The system was successfully used to create and validate the CHD model. The initialvalidation results show concordance between the simulation results and the empirical data.Conclusions: We have demonstrated the ability to connect health policy-modellers andpolicy-makers in a unified system, thereby making population health models easier to share,maintain, reuse and deploy.</p

Cost effectiveness of chest pain unit care in the NHS.

Background Acute chest pain is responsible for approximately 700,000 patient attendances per year at emergency departments in England and Wales. A single centre study of selected patients suggested that chest pain unit (CPU) care could be less costly and more effective than routine care for these patients, although a more recent multi-centre study cast doubt on the generalisability of these findings. Methods Our economic evaluation involved modelling data from the ESCAPE multi-centre trial along with data from other sources to estimate the comparative costs and effects of CPU versus routine care. Cost effectiveness ratios (cost per QALY) were generated from our model. Results We found that CPU compared to routine care resulted in a non-significant increase in effectiveness of 0.0075 QALYs per patient and a non-significant cost decrease of £32 per patient and thus a negative incremental cost effectiveness ratio. If we are willing to pay £20,000 for an additional QALY then there is a 70% probability that CPU care will be considered cost-effective. Conclusion Our analysis shows that CPU care is likely to be slightly more effective and less expensive than routine care, however, these estimates are surrounded by a substantial amount of uncertainty. We cannot reliably conclude that establishing CPU care will represent a cost-effective use of health service resources given the substantial amount of investment it would require

Cost effectiveness of chest pain unit care in the NHS.

Background Acute chest pain is responsible for approximately 700,000 patient attendances per year at emergency departments in England and Wales. A single centre study of selected patients suggested that chest pain unit (CPU) care could be less costly and more effective than routine care for these patients, although a more recent multi-centre study cast doubt on the generalisability of these findings. Methods Our economic evaluation involved modelling data from the ESCAPE multi-centre trial along with data from other sources to estimate the comparative costs and effects of CPU versus routine care. Cost effectiveness ratios (cost per QALY) were generated from our model. Results We found that CPU compared to routine care resulted in a non-significant increase in effectiveness of 0.0075 QALYs per patient and a non-significant cost decrease of £32 per patient and thus a negative incremental cost effectiveness ratio. If we are willing to pay £20,000 for an additional QALY then there is a 70% probability that CPU care will be considered cost-effective. Conclusion Our analysis shows that CPU care is likely to be slightly more effective and less expensive than routine care, however, these estimates are surrounded by a substantial amount of uncertainty. We cannot reliably conclude that establishing CPU care will represent a cost-effective use of health service resources given the substantial amount of investment it would require

Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. METHODS: We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. FINDINGS: Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). INTERPRETATION: Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. FUNDING: Bill & Melinda Gates Foundation and Public Health England