Category: economic evaluation

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economic evaluation Licensing Planning

Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial

Snooks H, Bailey-Jones K, Burge-Jones D, et alEffects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trialBMJ Qual Saf Published Online First: 05 November 2018. doi: 10.1136/bmjqs-2018-007976

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Aim We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.
Methods Randomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.
Results Across 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (while ΔL=0.030, 95% CI 0.028 to 0.032); outpatient visit rates by untransformed 5 % (while ΔL=0.055, 95% CI 0.051 to 0.058); the proportion of days with recorded GP activity by untransformed 1 % (while ΔL=0.011, 95% CI 0.007 to 0.014) and time in hospital by untransformed 3 % (while ΔL=0.029, 95% CI 0.026 to 0.031). Thus NHS costs per participant increased by £76 (95% CI £46 to £106).
Conclusions Introduction of PRISM resulted in a statistically significant increase in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS.

Categories
economic evaluation Green spaces Healthy Settings Licensing Planning Well-Being

Revaluing parks and green spaces: measuring their economic and wellbeing value to individuals

By Fields in Trust (2018)

This report demonstrates that parks and green spaces across the UK provide people with over £34 billion of health and wellbeing benefits and generates savings to the NHS of at least £111 million per year. It calculates that parks provide a total economic value to each person in the UK of just over £30 per year and that this is higher for individuals from lower socio-economic groups and also from black and minority ethnic backgrounds.

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Categories
cost-effective economic evaluation Nutrition Obesity

Economic evaluations of system‐based obesity interventions – the case for a new approach

Sonntag. D.  et al. Obesity Reviews, 2018; 19(5)

System‐based interventions are of increasing interest as they seek to modify environments (e.g. socio‐cultural system, transport system or policy system) that promote development of conditions such as obesity and its related risk factors. In our commentary, we draw attention to features of the system‐based approach that may explain the relative absence of economic evaluations of the cost‐effectiveness of these interventions, needed to guide decision‐making on which to deploy. We present and discuss potentially applicable methods and alternative approaches based on our experiences in two major system‐based interventions currently underway (in Melbourne, Australia and Gaggenau, Germany) that begin to fill this gap. We feel the issues and potential solutions outlined in this commentary are important for a broad range of stakeholders (e.g. clinicians, interventionalists, policy makers) to consider as they seek to address the issue of obesity.

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Categories
cost-effective economic evaluation Finance Licensing Planning

The Prioritisation Framework: making the most of your budget

By Public Health England (2018)

Local public health teams are facing increasingly complex and challenging decisions over what services to invest in and disinvest from. The Prioritisation Framework is designed to help local authorities conduct a systematic prioritisation exercise, by greatly reducing the burden and complexity of the task.

The approach is based on Multi Criteria Decision Analysis, a recognised decision support technique which has been successfully used in a variety of contexts.

Throughout the tool, users are provided with extensive guidance and links to other relevant resources. A supporting materials pack is available from the PHE Health Economics team at healtheconomics@phe.gov.uk.

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Categories
Alcohol cost-effective economic evaluation Nutrition Obesity Oral Health Physical Activity Smoking STPs Tobacco & Drugs

A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom

White, P. et al. Journal of Public Health, 2018, doi.org/10.1093/pubmed/fdy026

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Abstract
Background
Since 2013, local authorities in England have been responsible for commissioning preventative public health interventions. The aim of this systematic review was to support commissioning by collating published data on economic evaluations and modelling of local authority commissioned public health preventative interventions in the UK.

Methods
Following the PRISMA protocol, we searched for economic evaluations of preventative intervention studies in four different areas: overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation. The systematic review identified studies between January 1994 and February 2015, using five databases. We synthesized the studies to identify the key methods and examined results of the economic evaluations.

Results
The majority of the evaluations related to cost-effectiveness, rather than cost-benefit analyses or cost-utility analyses. These analyses found preventative interventions to be cost effective, though the context of the interventions differed between the studies.

Conclusions
Preventative public health interventions in general are cost-effective. There is a need for further studies to support justification of continued and/or increased funding for public health interventions. There is much variation between the types of economically evaluated preventative interventions in our review. Broader studies incorporating different contexts may help support funding for local authority-sponsored public health initiatives.