Bayesian multistate modelling of incomplete chronic disease burden data

Jackson, Christopher; Zapata-Diomedi, Belén; Woodcock, James

doi:10.1093/jrsssa/qnac015

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…For PRIMEtime analyses, we derived baseline incidence, prevalence and case fatality rates for each of the modelled diseases in the UK using incidence, prevalence and mortality data from the Global Burden of Disease (GBD) and the disbayes R package to derive epidemiologically consistent rates of case fatality, which are not explicitly reported in the GBD reports (see details in Text S1). 44 45 To estimate background trends in disease incidence and case fatality rates, we estimated rates for 2015 (the baseline year) and 2005 and allowed a linear annual progression between these years to continue into the forecast range for ten years at which point incidence and case fatality rates remain constant.…”

Section: Methodsmentioning

confidence: 99%

Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study

Cobiac,

Law,

Smith

et al. 2023

Preprint

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ObjectiveTo model future impacts of the UK Soft Drinks Industry Levy (SDIL) on population health and health sector costs, and to estimate net monetary benefit to the health system.DesignProportional multi-state lifetable modelling studySettingUnited KingdomPopulationAll children and adultsInterventionThe SDIL is a two-tier levy of £0.18 per litre on drinks with between 5g and 8g of total sugars per 100mL, and £0.24 per litre on drinks with 8g or more of total sugars per 100mL. We estimated a per person reduction in sugar from previous interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval: 2.4 to 13.6) reduction in sugar in purchased drinks at one year after implementation.Main outcome measuresWe evaluated impact of the sugar reduction on: (a) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050; and (b) lifetime population health (measured in quality-adjusted life years [QALYs]), change in costs to the health sector and the resulting net monetary benefit.ResultsThe model predicts that the SDIL will reduce prevalence of overweight and obesity in the UK by 0.18 percentage points (95% uncertainty interval: 0.059 to 0.31) for males and 0.20 percentage points (0.064 to 0.34) for females, for as long as the sugar-reduction effects of the SDIL are sustained. In the first ten years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000 to 600,000) dental caries, 12,000 (3,700 to 20,000) cases of type 2diabetes, 3,800 (1,200 to 6,700) cases of cardiovascular diseases, and 350 (110 to 590) cases of obesity-related cancer. For the current UK population, it is estimated the SDIL will add 200,000 QALYs (63,500 to 342,000) over their lifetime and avert £174 million (£53.6 to £319) in their costs of health care (discounted at UK Treasury rates). At a UK Treasury value of £60,000 per QALY, it is estimated the SDIL will produce a net monetary benefit of £12.2 billion (£3.88 to £20.8) for the health system.ConclusionThis study of the UK SDIL tiered tax on sugar content provides further evidence that sugar- sweetened beverage taxes have the potential to achieve meaningful improvements in population health and reduce health sector spending.What is already known on this topicNumerous modelling studies have shown that sugar-sweetened beverage taxes are likely to be cost-effective and improve population health, whether the tax is applied on the volume of product or to the sugar content (absolute or tiered), but there have been few modelling studies that have been informed by evaluation of real-world taxes.A volumetric sugar-sweetened beverage tax of 1 peso per litre, implemented in Mexico in 2014, reduced purchases of sugar-sweetened beverages by 7.6% in the first two years, and health economic modelling estimated that it would be cost-effective from a health sector perspective.In the UK, the Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was designed as a tiered levy to encourage soft drink manufacturers to reduce sugar content. Follow-up at one year indicates that it has reduced purchases of sugar from drinks by 8.0 g/household/week (95% confidence interval: 2.4 to 13.6).What this study addsPopulation health modelling suggests that changes in sugar consumption due to the SDIL will reduce prevalence of overweight/obesity and related diseases and improve dental health in the UK, including 12,000 (95% uncertainty interval: 3,700 to 20,000) fewer cases of type 2 diabetes, 3,800 (1,200 to 6,700) fewer cases of cardiovascular diseases, 350 (110 to 590) fewer cases of obesity-related cancer, and 270,000 (35,000 to 600,000) fewer dental caries, in the first ten years after implementation.Health economic modelling indicates that over the lifetime of the current UK population the SDIL could add 200,000 quality-adjusted life years (63,500 to 342,000) and avert £174 million (£53.6 to £319) in health care costs, leading to a net monetary benefit of £12.2 billion (£3.88 to £20.8) for the health sector.This study of the UK SDIL tiered tax on sugar content provides further evidence that sugar- sweetened beverage taxes have the potential to achieve meaningful improvements in population health and reduce health sector spending.

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Section: Methodsmentioning

confidence: 99%

Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study

Cobiac,

Law,

Smith

et al. 2023

Preprint

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“…The linkage of national collections data and the calculation of raw incidence, prevalence and mortality rates were conducted using SAS (SAS Institute Inc., Cary, NC, USA) and Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Disease rates were processed using the disbayes package in R to generate estimates of case fatality from mortality, incidence and prevalence data [46, 47]. The multi‐state life‐table model was implemented in Python version 3.6 (http://www.python.org).…”

Section: Methodsmentioning

confidence: 99%

The estimated health impact of alcohol interventions in New Zealand: A modelling study

Chambers,

Mizdrak,

Herbert

et al. 2023

Addiction

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AimsTo estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non‐Māori in New Zealand (NZ).DesignMulti‐stage life‐table intervention modelling study. We modelled two scenarios: (1) business‐as‐usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing.Setting and participantsThe model’s population replicates the 2018 NZ population by ethnicity (Māori/non‐Māori), age and sex.MeasurementsAlcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose–response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [−30.3%, standard deviation (SD) = 0.02); tax (−7.60%, SD = 0.01); outlet density (−8.64%, SD = 0.01); outlet hours (−9.24%, SD = 0.01); and marketing (−8.98%, SD = 0.02). We measured health gain using health‐adjusted life years (HALYs) and life expectancy.FindingsCompared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000–913 000] HALYs gained during the life‐time of the modelled population. Māori experienced greater HALY gains compared with non‐Māori (0.21, 95% UI = 0.14–0.26 and 0.16, 95% UI = 0.11–0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes.ConclusionsModelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non‐Māori in New Zealand (NZ) suggest substantial population‐wide health gains and reduced health inequities between Māori and non‐Māori.

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“…Data was extrapolated to age 100+ using a polynomial trend line ( Supplementary Table S2 ). Then, health data estimates were interpolated to 1y age/sex groups using a temporal disaggregation method to obtain smooth disaggregated counts, while maintaining the aggregated total(32).…”

Section: Methodsmentioning

confidence: 99%

“…Case fatality rates were derived from cause-specific incidence, prevalence and mortality data, together with population size using a Bayesian approach, the disbayes optimization method built on the Stan software ( disbayes package available in R)(32, 34). It was assumed that case fatality was constant for all ages below 35.…”

Section: Methodsmentioning

confidence: 99%

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The potential health impact and healthcare cost savings of different sodium reduction strategies in Canada

Flexner,

Jones,

Amies-Cull

et al. 2023

Preprint

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BackgroundHigh dietary sodium is the main dietary risk factor for non-communicable diseases due to its impact on cardiovascular diseases, the leading cause of death globally. The Government of Canada has taken measures to reduce average dietary sodium intakes, such as setting voluntary sodium reduction targets for packaged foods and recently approving regulations mandating ‘high in’ front-of-pack labeling (FOPL) symbols.ObjectivesTo estimate the number of avoidable ischemic heart disease (IHD) and stroke incidence cases, and their associated healthcare cost and Quality-Adjusted Life Year (QALY) savings resulting from different sodium reduction strategies and recommendations in Canada.MethodsWe used the PRIMEtime model, a proportional multi-state lifetable model. Outcomes were modeled over the lifetime of the population alive in 2019, at a 1.5% discount rate, and from the public healthcare system perspective. Nationally representative data were used as inputs for the model.ResultsFully meeting Health Canada’s sodium reduction targets was estimated to prevent 219,490 (95% UI, 73,409–408,630) cases of IHD, and 164,435 (95% UI, 56,121–305,770) strokes. This led to a gain of 276,185 (95% UI, 85,414–552,616) QALYs, and healthcare costs savings of CAD$ 4,212(95% UI, 1,303–8,206) million over the lifetime of the 2019 cohort. Sodium reduction intake through FOPL regulations has the potential to prevent between 35,930 (95% UI, 8,058– 80,528) and 124,744 (95% UI, 40,125–235,643) cases of IHD, and between 26,869 (95% UI, 5,235–61,621) and 93,129 (95% UI, 30,296–176,014) strokes. This results in QALY gains ranging from 45,492 (95% UI, 10,281–106,579) to 157,628 (95% UI, 46,701–320,622), and healthcare costs savings ranging from CAD$ 695 (95% UI, 160–1,580) to CAD$ 2,415 (95% UI, 722–4,746) million over the lifetime of the 2019 Canadian cohort. Greater health and healthcare costs gains were estimated if Canadians were to meet the population-level sodium intake recommendations of the World Health Organization (2,000 mg/day) and the Adequate Intake recommendation (1,500 mg/day). All sodium reduction strategies tested were cost saving.ConclusionsReducing population-level sodium intakes is feasible and has the potential to improve health outcomes and save healthcare costs in Canada. From interventions tested, most health and healthcare costs gains were attributed to fully meeting sodium reduction targets, which highlights the importance of changing the voluntary nature of these targets to mandatory. A combination of strategies, mandatory sodium reduction targets and implementation of the ‘high in’ FOPL symbol would provide the most benefit from a public health standpoint.

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Bayesian multistate modelling of incomplete chronic disease burden data

Cited by 6 publications

References 29 publications

Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study

Population health and health sector cost impacts of the UK Soft Drinks Industry Levy: a modelling study

The estimated health impact of alcohol interventions in New Zealand: A modelling study

The potential health impact and healthcare cost savings of different sodium reduction strategies in Canada

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