Estimating the effectiveness and cost-effectiveness of body weight interventions for the prevention of non-communicable disease in local authority areas of England

Thesis

Background

Non-Communicable Diseases related to Body Mass Index (BMI) account for approximately 10% of all disease burden in England. Addressing this burden and its associated health inequalities are major challenges for local and national policymakers, with increasing need to also understand how BMI interventions might affect local areas differently. The aim was set to develop a new local authority-level health model to estimate the disease burden and healthcare cost implications of BMI interventions.

Methods

Diseases included in the new model were asthma, low back pain, osteoarthritis of the hip, osteoarthritis of the knee, Ischaemic Heart Disease, stroke, hypertensive heart disease, type-2 diabetes mellitus, atrial fibrillation/ flutter, colorectal cancer, breast cancer and oesophageal cancer. Local-level data were estimated via different approaches: adult BMI distributions were produced via individual-level synthetic estimation, child BMI distributions were interpolated from measured BMI and healthcare costs estimated using new high-quality cost collection data. Disease epidemiology was estimated at the Index of Multiple Deprivation quintile level using a Bayesian modelling tool. A scenario on restricting television advertising of unhealthy foods in each of 315 local authorities in England was then used to explore the new model’s capabilities.

Findings

Patterns to adult and child BMI supported conventional ideas that raised BMI is associated with age and deprivation. Healthcare costs formed very positively skewed distributions without an obvious geographic pattern. Disease epidemiology showed burden was broadly higher in more deprived quintiles.

Modelling showed that restricting the advertising of unhealthy foods is likely to benefit more deprived areas more overall, but with overlaps between quintiles of deprivation. It is estimated that 0.0222-0.0521 Quality-Adjusted Life-Years per person could be saved over the lifetime of the 2018 population of children and £11.7-£42.8 per person in healthcare costs.

Conclusions

This model offers the most local-specific health modelling for BMI interventions in England. Some areas may be harder to reach with a given intervention, creating mismatch between need and ability to intervene.

Authors: Amies-Cull, B

• DOI: 10.5287/ora-8nxjoqojw
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: disease prevention; non-communicable disease; health economics; obesity; public health
• Subjects: Public health; Obesity; Chronic diseases; Medical economics; Medicine, Preventive