scholarly journals Estimating the potential impact of the UK government’s sugar reduction programme on child and adult health: modelling study

BMJ ◽  
2019 ◽  
pp. l1417 ◽  
Author(s):  
Ben Amies-Cull ◽  
Adam D M Briggs ◽  
Peter Scarborough
Keyword(s):  
Weight Change ◽  
Healthcare Costs ◽  
Disease Burden ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Sugar Reduction ◽  
The Uk ◽  
The Impact ◽  
Quality Adjusted Life ◽  
Modelling Study

AbstractObjectiveTo estimate the impact of the UK government’s sugar reduction programme on child and adult obesity, adult disease burden, and healthcare costs.DesignModelling study.SettingSimulated scenario based on National Diet and Nutrition Survey waves 5 and 6, England.Participants1508 survey respondents were used to model weight change among the population of England aged 4-80 years.Main outcome measuresCalorie change, weight change, and body mass index change were estimated for children and adults. Impact on non-communicable disease incidence, quality adjusted life years, and healthcare costs were estimated for adults. Changes to disease burden were modelled with the PRIMEtime-CE Model, based on the 2014 population in England aged 18-80.ResultsIf the sugar reduction programme was achieved in its entirety and resulted in the planned sugar reduction, then the calorie reduction was estimated to be 25 kcal/day (1 kcal=4.18 kJ=0.00418 MJ) for 4-10 year olds (95% confidence interval 23 to 26), 25 kcal/day (24 to 28) for 11-18 year olds, and 19 kcal/day (17 to 20) for adults. The reduction in obesity could represent 5.5% of the baseline obese population of 4-10 year olds, 2.2% of obese 11-18 year olds, and 5.5% of obese 19-80 year olds. A modelled 51 729 quality adjusted life years (95% uncertainty interval 45 768 to 57 242) were saved over 10 years, including 154 550 (132 623 to 174 604) cases of diabetes and relating to a net healthcare saving of £285.8m (€332.5m, $373.5m; £249.7m to £319.8m).ConclusionsThe UK government’s sugar reduction programme could reduce the burden of obesity and obesity related disease, provided that reductions in sugar levels and portion sizes do not prompt unanticipated changes in eating patterns or product formulation.

scholarly journals Exploratory comparison of Healthcare costs and benefits of the UK’s Covid-19 response with four European countries

2021 ◽  
Author(s):  
Howard Thom ◽  
Josephine Walker ◽  
Peter Vickerman ◽  
Will Hollingworth
Keyword(s):  
Healthcare Costs ◽  
Population Characteristics ◽  
Economic Losses ◽  
Quality Adjusted Life Years ◽  
Net Benefit ◽  
Payer Perspective ◽  
Life Years ◽  
Health Related ◽  
Per Capita ◽  
The Uk

Abstract Background In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalizations and deaths under ‘mitigation’ to modelled events under ‘no mitigation’ to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Results The UK saved 3.17 (0.32–3.65) million QALYs, £33 (8–38) billion healthcare costs and £1416 (220–1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1–53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Conclusions Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency.

scholarly journals Measuring the impact of delayed access to elective cholecystectomy through patient’s cost-utility: an observational cohort study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ahmer Karimuddin ◽  
Carmela Melina Albanese ◽  
Trafford Crump ◽  
Guiping Liu ◽  
Jason M Sutherland
Keyword(s):  
Elective Surgery ◽  
Care Facility ◽  
Cost Utility ◽  
Health State ◽  
Quality Adjusted Life Years ◽  
Term Care ◽  
Life Years ◽  
The Impact ◽  
Elective Cholecystectomy ◽  
Quality Adjusted Life

Abstract Background Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient’s health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient’s cost utility due to delayed elective cholecystectomy. Methods This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories. Results Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463. Conclusions There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.

scholarly journals A model framework for projecting the prevalence and impact of Long-COVID in the UK

2021 ◽  
Author(s):  
Christopher John Martin ◽  
Stuart McDonald ◽  
Michiel Luteijn ◽  
Josephine Robertson ◽  
William Letton
Keyword(s):  
Population Level ◽  
Health Impact ◽  
Quality Adjusted Life Years ◽  
Model Framework ◽  
Proactive Management ◽  
Life Years ◽  
Patient Reported ◽  
Qaly Loss ◽  
The Uk ◽  
Quality Adjusted Life

Background The objective of this paper is to model lost Quality Adjusted Life Years (QALYs) from symptoms arising from COVID-19 in the UK population, including symptoms of 'long-COVID'. The scope includes QALYs lost to symptoms, but not deaths, due to acute COVID-19 and long COVID. Methods The prevalence of symptomatic COVID-19, encompassing acute symptoms and long-COVID symptoms, was modelled using a decay function. Permanent injury as a result of COVID-19 infection, was modelled as a fixed prevalence. Both parts are combined to calculate QALY loss due to COVID-19 symptoms. Results Assuming a 60% final attack rate for SARS-CoV-2 infection in the population, we modelled 299,719 QALYs lost within 1 year of infection (90% due to symptomatic COVID-19 and 10% permanent injury) and 557,754 QALYs lost within 10 years of infection (49% due to symptomatic COVID-19 and 51% due to permanent injury). The UK Government willingness-to-pay to avoid these QALY losses would be £17.9 billion and £32.2 billion, respectively. Additionally, 90,143 people were subject to permanent injury from COVID-19 (0.14% of the population). Conclusion Given the ongoing development in information in this area, we present a model framework for calculating the health economic impacts of symptoms following SARS-CoV-2 infection. This model framework can aid in quantifying the adverse health impact of COVID-19, long COVID and permanent injury following COVID-19 in society and assist the proactive management of risk posed to health. Further research is needed using standardised measures of patient reported outcomes relevant to long COVID and applied at a population level.

scholarly journals Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis

2018 ◽  
Vol 100-B (4) ◽  
pp. 527-534 ◽  
Author(s):  
E. Hansson ◽  
K. Hagberg ◽  
M. Cawson ◽  
T. H. Brodtkorb
Keyword(s):  
Quality Of Life ◽  
Prospective Clinical Study ◽  
Quality Adjusted Life Years ◽  
Transfemoral Amputation ◽  
Healthcare Perspective ◽  
Life Years ◽  
The Cost ◽  
The Impact ◽  
Quality Adjusted Life

Aims The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation. Patients and Methods A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years. Results OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years. Conclusion From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527–34.

scholarly journals Comparison of Healthcare costs and benefits of the UK's Covid-19 response with four European countries: Decision Modelling Study

2020 ◽  
Author(s):  
Howard Thom ◽  
Josephine Walker ◽  
Peter Vickerman ◽  
Will Hollingworth
Keyword(s):  
Healthcare Costs ◽  
Population Characteristics ◽  
Economic Losses ◽  
Quality Adjusted Life Years ◽  
Net Benefit ◽  
Payer Perspective ◽  
Life Years ◽  
Health Related ◽  
Per Capita ◽  
The Uk

Background In responding to covid-19, governments have tried to balance protecting health while minimising Gross Domestic Product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain, and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalisations, and deaths under "mitigation" to modelled events under "no mitigation" to 20th July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at GBP 20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared to Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Findings The UK saved 3.17 (0.32-3.65) million QALYs, GBP 33 (8-38) billion healthcare costs, and GBP 1416 (220-1637) HRNB per capita at GBP 20,000/QALY. Per capita, this is comparable to GBP 1,455 GDP loss using Sweden as comparator and offsets 46.1 (7.1-53.2)% of total GBP 3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Interpretation The benefit of government covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency. Funding Elizabeth Blackwell Institute; UK MRC; UK NIHR.

scholarly journals PCN199 - HOW DO QUALITY-ADJUSTED LIFE YEARS IMPACT REIMBURSEMENT DECISION-MAKING IN THE UK?

2018 ◽  
Vol 21 ◽  
pp. S47-S48
Author(s):  
M. Farinella ◽  
J. Rubinstein ◽  
R.V. Inumerable ◽  
N. Gizaw ◽  
Y. Ho
Keyword(s):  
Decision Making ◽  
Reimbursement Decision ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
The Uk ◽  
Quality Adjusted Life

The impact of a breast cancer screening programme on quality-adjusted life-years

1991 ◽  
Vol 49 (4) ◽  
pp. 538-544 ◽  
Author(s):  
J. C. J. M. de Haes ◽  
Harry J. de Koning ◽  
Gerrit J. van Oortmarssen ◽  
Heleen M. E. van Agt ◽  
Arry E. de Bruyn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Screening Programme ◽  
Quality Adjusted Life Years ◽  
Breast Cancer Screening Programme ◽  
Life Years ◽  
Cancer Screening Programme ◽  
The Impact ◽  
Quality Adjusted Life

The Adoption of Cost-Effectiveness Acceptability Curves in Cost-Utility Analyses

2009 ◽  
Vol 30 (3) ◽  
pp. 314-319 ◽  
Author(s):  
Lisa M. Meckley ◽  
Dan Greenberg ◽  
Joshua T. Cohen ◽  
Peter J. Neumann
Keyword(s):  
Cost Effectiveness ◽  
Medical Center ◽  
Cost Effective ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Study Methodology ◽  
The Uk ◽  
Quality Adjusted Life

Background. Cost-effectiveness acceptability curves (CEACs) plot the probability that one health intervention is more cost-effective than alternatives, as a function of societal willingness to pay for additional units of health (e.g., life-years or quality-adjusted life-years gained). Objectives. To quantify the adoption of CEACs in published cost-utility analyses (CUAs), and to identify factors associated with CEAC use. Methods. Data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a database with detailed information on approximately 1,400 CUAs published in the peer reviewed literature through 2006, was analyzed. The registry includes data on study origin, study methodology, reporting of results, whether CEACs were presented, and a subjective quality score. Univariate and multivariate logistic regression analyses were used to identify factors predicting CEAC use, from their introduction in 1994 through 2006. Results. Approximately 15% of CUAs published since 1994 present a CEAC. The use of CEACs has increased rapidly in recent years, from 2.1% of published CUAs in 2001 to 32.6% in 2006 (P < 0.0001). The most significant predictors of CEAC use were study quality (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.80, 2.85), recent publication (OR: 1.99; 95% CI: 1.73, 2.29), and whether studies pertain to the UK (OR: 5.66; 95% CI: 3.67, 8.72) or Sweden (OR: 3.76; 95% CI: 1.67, 8.44). Conclusions. CEAC use is increasing in the published cost-effectiveness literature, especially in UK-based studies.

Economic Evaluation of Lenalidomide Combined with Dexamethasone for the Treatment of Multiple Myeloma in the UK

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2400-2400 ◽  
Author(s):  
Baris Deniz ◽  
Gareth Morgan ◽  
Steve Schey ◽  
Jack Ishak ◽  
Peter Dale ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Health Outcomes ◽  
Incremental Cost ◽  
Cost Effective ◽  
High Dose ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Previously Treated ◽  
The Uk ◽  
Quality Adjusted Life

Abstract INTRODUCTION: Lenalidomide combined with high-dose dexamethasone (Len+Dex), yields improved time-to-progression (TTP) and survival compared to Dex alone in previously treated patients with multiple myeloma (Weber et. al., NEJM2007, 357:21 and Dimopoulos et. al., NEJM2007, 357:21). It is also effective in patients previously treated with thalidomide. This study aimed to estimate long-term health and cost consequences of Len+Dex versus Dex in patients with multiple myeloma (MM) previously treated with at least two prior therapies, including prior thalidomide. METHODS: A discrete event simulation of a patient’s disease-course following initiation of Len+Dex or Dex was developed. The model uses patient’s response (complete response, partial, stable disease or progression) and estimates corresponding TTP and subsequent survival based on Weibull functions derived from pooled data from two phase III trials (MM-009/MM-010). Long-term results from the UK MRC MM IV, V, VI, and VIII trials were used to estimate Dex survival, as 47% of Dex patients crossed-over to lenalidomide treatment in MM-009/MM-010. Time-dependent adverse event rates were derived from pooled MM-009/MM-010 data and associated management costs reflecting UK NHS practice were applied. Health utilities by response level were obtained from the literature. Patients remained on treatment until disease progression. Disease management costs were reflective of clinical practice in the UK NHS. As recommended by the UK treasury, costs and health outcomes were discounted at 3.5% per annum in order to adjust to present values. A life-time horizon was used to model costs and health outcomes, including survival and quality adjusted life-years (QALYs). RESULTS: Use of Len+Dex is associated with a substantial improvement in survival and QALYs. Although estimated incremental costs are large, the improvements in health outcomes yield incremental cost-effectiveness ratios (ICERs) below £30,000 per QALY. Len/Dex is similarly cost-effective when used to treat patients previously treated with thalidomide. Undiscounted ICERs are lower because survival benefits are not fully realized until end-of-life and so are subject to a higher degree of compound discounting than the costs which are incurred relatively early. Univariate and probabilistic sensitivity analyses showed that results remain consistent through broad changes in model parameters. CONCLUSIONS: Lenalidomide in combination with high-dose dexamethasone in patients with at least two prior therapies delivers substantial improvements in quality-adjusted survival in a life-limiting orphan disease and yields an estimated incremental cost per QALY which falls within a cost-effective range. ≥2 prior therapies Undiscounted Discounted Len+Dex Dex Len+Dex Dex Life Years (projected mean) 5.92 1.08 4.76 1.05 Quality Adjusted Life Years (QALYs) 3.98 0.79 3.23 0.77 Average Cost (per patient) £63,809 £707 £61,171 £694 Incremental cost per Life Year Gained £13,038 £16,301 Incremental cost per QALY Gained £19,781 £24,584 ≥2 prior therapies (including thalidomide) Undiscounted Discounted Len+Dex Dex Len+Dex Dex Life Years (projected mean) 5.42 1.03 4.43 1.01 Quality Adjusted Life Years (QALYs) 3.60 0.72 2.96 0.70 Average Cost (per patient) £53,719 £706 51,745 694 Incremental cost per Life Year Gained £9,727 £14,927 Incremental cost per QALY Gained £18,407 £22,589

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