Investing in physical activity: The economic case

Transcription

1 Investing in physical activity: The economic case BHFHC/NCSEM-England Conference 22 nd September 2015

2 Three presentations Introduction to economic evaluation Professor Julia Fox-Rushby Long term economic modelling of physical activity interventions Dr Nana Anokye Wider benefits and cost-benefit analysis in physical activity Dr Sabina Sanghera Health Economics Research Group (HERG)

3 Introduction to economic evaluation with reference to. Health and Sport Engagement (HASE) project Julia BHFHC/NCSEM-England Conference 22 nd September 2015

4 Why economic evaluation? Resources are limited Choices Local or national decisions to fund sport, for health or other benefits, implies need for planning What is economic evaluation? compares at least two alternatives in terms of costs and consequences

5 How are economic evaluations used? Worse Effectiveness: Better Cost: Higher Lower Reject intervention Trade-off Trade-off Adopt intervention

6 HASE Project: Delivery Training 30 coaches/sports leaders in the RSPH Level 2 Award Understanding Public Health Improvement 15 health professionals understanding sport for health Community views cross-sector input e.g. Hounslow Community Network Focus groups with existing local community groups e.g. BME groups, people with disabilities, women s groups, older adults 12 providers contracted to deliver 15 health programmes that each achieve 20 previously inactive participants in at least 30 minutes of sports activity a week for 12 months (e.g. older adult swimming, multi-sports (deaf adults, disadvantaged youth)) 6

7 HASE Project : Evaluation Contribute to the very limited evidence base Formal recruitment to study.. repeated measures before & after intervention (with follow-up at 12 months) What is assessed? Effects: e.g. levels of activity, patterns of attendance, health status, well-being Inputs: resources used in targeting, training, design, and delivery with monitoring over 12 months

8 How are data being collected? Effects Standardised questions in repeated surveys of study participants Observation and use of attendance logs at activities Inputs Workshop and observation of activities..(to identify range money and non-money costs) Interviews, review of routine records and diaries..(to identify quantity of specific resources and value) Participant time and money from questionnaires 8

9 HASE Project: Economic evaluation Compare costs and effects of HASE programme versus no programme i.e. cost per. Attendance Number sessions of activity lasting 30mins Quality-adjusted life years (QALYs)

10 Some issues addressed in HASE to help improve evidence on cost-effectiveness Lack of comparative data Lack of measures that allow comparison with other interventions Lack of data on effectiveness over time

11 Acknowledgements Funders: Sport England s Get Healthy Get Active awards Investigators and researchers at BUL: Louise Mansfield (PI), N. Anokye, T. Kay, J. Ryan, S. Sanghera, XXXXX HASE is being designed, delivered and evaluated in the London Borough of Hounslow with key delivery partners. Brentford Football Club Community Sport Trust, CB Hounslow United, Cattaway Tennis, Cycle Experience, Centre for Workplace and Community Health at St Mary s University Twickenham, Fusion Lifestyle, England Netball, Hounslow Homes, LKFitness, Sport Impact, The Urban Youth Network and Westside Basketball Club Additional design and delivery support is from British Airways, British Army Welfare, Cranford Community School, Hounslow and Richmond Community Health, Integrated Neurological Services (Richmond), UK Dodgeball Association, Make Sport Fun, West Thames College, The Hub Youth Club HERG Short Course: 11

12 Long term economic modelling of physical activity interventions Nana Kwame Anokye Health Economics Research Group

13 Outline of presentation What is long term economic modelling? Why do we need it? How to do..? Exemplar : Economic model underpinning NICE Guidelines on Brief Advice in Primary Care, ERS, NICE ROI on Physical Activity What next? Long term economic modelling of physical activity interventions 13

14 What is long term economic modelling? Simplified representation of reality Brings together data and assumptions long term effects & costs Resource use GP visits, pedometers Unit costs per pedometer Treatment effects PA status MODEL Utilities QoL Epidemiology Baseline risks, sub-groups Cost Effectiveness /QALY Long term economic modelling of physical activity interventions 14

15 Why do we need modelling? Extrapolation Link intermediate to final outcomes Generalisability Long term economic modelling of physical activity interventions 15

16 How to do (Brief advice Model - NICE Guidelines on Brief advice & ERS; NICE ROI) To assess the cost effectiveness of brief advice versus usual care Gaps in previous evidence: Weak evidence base on effectiveness Inadequate exploration of uncertainty Constant physical activity levels Long term economic modelling of physical activity interventions 16

17 Key features of model (I) Follows a cohort of physically inactive but healthy adults over their remaining lifetime Offered an intervention (brief advice) or usual care in 1 st year Remained inactive or became active Long term economic modelling of physical activity interventions 17

18 Key features of model (II) Changes in physical activity overtime Health outcomes: CHD, stroke, type 2 diabetes Inclusion of short-term psychological benefits (feel good factor) Long term economic modelling of physical activity interventions 18

19 Data requirements Model inputs (main) Effectiveness & cost of intervention at Year 1 Impact of PA on risk of CHD, stroke, T2D Short-term psychological benefits Cost and utility estimates of disease conditions Mortality Data sources Meta-analysis, within- trial analysis Cohort studies via national/international science based guidelines on PA and health Regression model adjusting for disease conditions (HSE dataset) NICE guidelines on CVD and diabetes, HSE dataset National life tables, cohort studies Long term economic modelling of physical activity interventions 19

20 Results (cohort of 100k) Long term economic modelling of physical activity interventions 20

21 Incremental cost/qaly comparing brief advice with usual care (100,000 cohort) Long term economic modelling of physical activity interventions 21

22 What next? Brief advice promoting physical activity among adults in primary care is cost effective Economic case can be further strengthened via: comparing with other interventions individual based modelling wider benefits Long term economic modelling of physical activity interventions 22

23 Cross-sectoral decision-making: wider economic benefits of physical activity Sabina Sanghera HERG, Health Economics Research Group (HERG) 23

24 Background NICE provide guidance on public health Health and non-health benefits may be considered Cost consequence analysis balance sheet Cost benefit analysis monetary terms Economic evaluations can be broadened! PH interventions directly and indirectly affect health Social determinants impact health Commission across multiple sectors need for cross sectoral studies Could strengthen the case for funding Health Economics Research Group (HERG) 24

25 Background Physical activity improves, prevents and reduces risk: CVD Stroke Depression Dementia Cancer Physical activity also has wider benefits: Transport & environment (reduce congestion and pollution) Improve education Reduce crime Health Economics Research Group (HERG) 25

26 Aim(s) Cross-sectoral evaluations of physical activity interventions: 1. Assess current evidence in NICE guidelines 2. Explore current UK evidence in wider literature 3. Identify areas for improvement Health Economics Research Group (HERG) 26

27 Method Rapid review to identify cross-sectoral evaluations August 2014 we searched: Web of Knowledge Grey literature Specific institutional websites Contacted key stakeholders Inclusion criteria: NICE: Any evidence w/ benefits beyond health Wider literature: UK evidence & last 10 years Health Economics Research Group (HERG) 27

28 Results Studies identified from searches and screened n=2,400 Potentially relevant full text studies reviewed in full detail n=54 Studies included in the review n=9 n=4 studies by NICE n= 5 studies from the wider literature Health Economics Research Group (HERG) 28

29 Results Studies by NICE (n = 4) Workplace, local measures, environmental and primary care interventions 2/4 only absenteeism was considered (limited assessment) Remaining 2 studies: Pollution (1) Indirect tax (1) Absenteeism (1) 2/4 Studies by NICE Comfort & security (1) Accidents (1) Congestion (1) Health Economics Research Group (HERG) 29

30 Results Studies by NICE (n = 4) All 4 studies based on limited secondary data: Older than 10 years Outside the UK The use of these studies now relies on outdated evidence from a different country context Paucity of cross-sectoral evidence Health Economics Research Group (HERG) 30

31 Results Wider literature (n = 5) Encouraging active travel to work and school Large scale studies based on primary data Health captured as reduction in mortality/ NHS savings Wider benefits: Employment Accidents (5) Absenteeism (5) Pollution Wider Literature (5) Congestion (5) tourism Other Health Economics Research Group (HERG) 31

32 Results Wider literature (n = 5) Wider range of benefits captured Health benefits have highest percentage of benefits (65-73%) Range of BCR s 2:1 to 32.8:1 Route usage before and after intervention is observed: Assumptions of wider effects Values extrapolated overtime and across populations Little analysis of uncertainty Health Economics Research Group (HERG) 32

33 Overall; Main findings Variety of economic benefits claimed BCR s range from 2 to 32.8:1 where provided Most frequently assessed benefits Congestion, pollution, amenity and accidents Transport sector commonly assesses wider benefits Limited quality of evidence Function of budgets & not research focused Health Economics Research Group (HERG) 33

34 Discussion Carry out a comprehensive uncertainty analysis Increase the no. of evaluations of wider benefits Provide support to encourage collection of wider benefits Engage w/ providers of physical activity Work w/ researchers or evaluators who can provide advice for quality study design The collection of wider benefits is likely to strengthen the case for funding of interventions Health Economics Research Group (HERG) 34

35 Thank you Acknowledgements: Elaine McNish Mary Goad Charlie Foster Nick Cavill Justin Varney Health Economics Research Group (HERG) 35