Suchergebnisse

Objective To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England. Design A microsimulation study of a close-to-reality synthetic population. In the first period, 2003-2015, we compared the impact of current policy against a counterfactual 'no intervention' scenario, which assumed salt consumption persisted at 2003 levels. For 2016-2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. Setting Synthetic population with similar characteristics to the non-institutionalised population of England. Participants Synthetic individuals with traits informed by the Health Survey for England. Main measure CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation. Results Since 2003, current salt policies have prevented or postponed 52 000 CVD cases (IQR: 34 000-76 000) and 10 000 CVD deaths (IQR: 3000-17 000). In addition, the current policies have prevented 5000 new cases of GCa (IQR: 2000-7000) resulting in about 2000 fewer deaths (IQR: 0-4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone 19 000 CVD cases (IQR: 8000-30 000) and 3600 deaths by 2030 (IQR: '400-8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: '200-3000) and 700 deaths (IQR: '900-2300) could be prevented or postponed with a neutral impact on inequalities. Conclusions Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits.

Objective To estimate the impact and equity of existing and potential United Kingdom salt reduction policies on primary prevention of cardiovascular disease and gastric cancer in England. Design A microsimulation study of a close-to-reality synthetic population. In the first period, 2003-2015, we compared the impact of current policy against a counterfactual 'no intervention' scenario, which assumed salt consumption persisted at 2003 levels. For 2016–2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. Setting Synthetic population with similar characteristics to the non-institutionalised population of England. Participants Synthetic individuals with traits informed by the Health Survey for England. Main measure Cardiovascular disease and gastric cancer cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the index of multiple deprivation. Results Since 2003, current salt policies have prevented or postponed approximately 52,000 CVD cases (interquartile range (IQR): 34,000 to 76,000) and 10,000 CVD deaths (IQR: 3,000 to 17,000). In addition, the current policies have prevented approximately 5,000 new cases of GCa (IQR: 2,000 to 7,000) resulting in about 2,000 fewer deaths (IQR: 0 to 4,000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in gastric cancer. Additional legislative policies from 2016 could further prevent or postpone approximately 19,000 CVD cases (IQR: 8,000 to 30,000) and 3,600 deaths by 2030 (IQR: -400 to 8,100) and may reduce inequalities. Similarly, for GCa 1,200 cases (IQR: -200 to 3,000) and 700 deaths (IQR: -900 to 2,300) could be prevented or postponed with a neutral impact on inequalities. Conclusions Current salt reduction policies are powerfully effective in reducing the cardiovascular and gastric cancer disease burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits.

Objectives To examine how much of the observed rapid decrease in mortality from coronary heart disease in Poland after the political, social, and economic transformation in the early 1990s could be explained by the use of medical and surgical treatments and how much by changes in cardiovascular risk factors.

Distributional cost effectiveness analysis is a new method that can help to redesign prevention programmes by explicitly modelling the distribution of health opportunity costs as well as the distribution of health benefits. Previously we modelled cardiovascular disease (CVD) screening audit data from Liverpool, UK to see if the city could redesign its cardiovascular screening programme to enhance its cost effectiveness and equity. Building on this previous analysis, we explicitly examined the distribution of health opportunity costs and we looked at new redesign options co-designed with stakeholders. We simulated four plausible scenarios: a) no CVD screening, b) 'current' basic universal CVD screening as currently implemented, c) enhanced universal CVD screening with 'increased' population-wide delivery, and d) 'universal plus targeted' with top-up delivery to the most deprived fifth. We also compared assumptions around whether displaced health spend would come from programmes that might benefit the poor more and how much health these programmes would generate. The main outcomes were net health benefit and change in the slope index of inequality (SII) in QALYs per 100,000 person years. 'Universal plus targeted' dominated 'increased' and 'current' and also reduced health inequality by −0.65 QALYs per 100,000 person years. Results are highly sensitive to assumptions about opportunity costs and, in particular, whether funding comes from health care or local government budgets. By analysing who loses as well as who gains from expenditure decisions, distributional cost effectiveness analysis can help decision makers to redesign prevention programmes in ways that improve health and reduce health inequality. ; Peer reviewed

Distributional cost effectiveness analysis is a new method that can help to redesign prevention programmes by explicitly modelling the distribution of health opportunity costs as well as the distribution of health benefits. Previously we modelled cardiovascular disease (CVD) screening audit data from Liverpool, UK to see if the city could redesign its cardiovascular screening programme to enhance its cost effectiveness and equity. Building on this previous analysis, we explicitly examined the distribution of health opportunity costs and we looked at new redesign options co-designed with stakeholders. We simulated four plausible scenarios: a) no CVD screening, b) 'current' basic universal CVD screening as currently implemented, c) enhanced universal CVD screening with 'increased' population-wide delivery, and d) 'universal plus targeted' with top-up delivery to the most deprived fifth. We also compared assumptions around whether displaced health spend would come from programmes that might benefit the poor more and how much health these programmes would generate. The main outcomes were net health benefit and change in the slope index of inequality (SII) in QALYs per 100,000 person years. 'Universal plus targeted' dominated 'increased' and 'current' and also reduced health inequality by −0.65 QALYs per 100,000 person years. Results are highly sensitive to assumptions about opportunity costs and, in particular, whether funding comes from health care or local government budgets. By analysing who loses as well as who gains from expenditure decisions, distributional cost effectiveness analysis can help decision makers to redesign prevention programmes in ways that improve health and reduce health inequality.

POLICY POINTS: The World Health Organization has recommended sodium reduction as a "best buy" to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years. We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036. Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation. CONTEXT: The US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers. METHODS: We employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets. We modeled four close‐to‐reality populations: food system "ever" workers; food system "current" workers in 2017; and subsets of processed food "ever" and "current" workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036. FINDINGS: Among food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) ...