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Presentation

Session: Risk Preferences
Room: Meeting Rooms 25+26
Time: Fri 10:15-11:30

Presenter: Dominique Cadilhac (National Stroke Reseach Institute. )

Abstract

Introduction: Given the concerns of the impact of an ageing Australian population; increasing health expenditure; and the proportional growth in health expenditure devoted to preventable chronic disease, there is an increased focus on estimating the value of prevention. Six behavioural risk factors (tobacco smoking, high risk alcohol consumption, elevated body mass index (BMI), inadequate fruit and vegetable consumption, physical inactivity and intimate partner violence) contributed 16% of the total burden of disease and injury in Australia in 2003 (Begg et al 2008). We identified by how much we can expect to reduce these risk factors in the population and what the benefit would be to society in health status and economic terms.
Methods: We used an EXCEL-based cohort model of the 2008 Australian population to estimate health status, economic and financial benefits of potential risk factor prevalence reductions. Health benefits were measured in Disability Adjusted Life Years. Life time health sector costs and cost-offsets were estimated using a health sector perspective. Productivity effects were assessed in both the paid and unpaid sectors using the Friction Cost Method. Leisure effects were also included. The realistic targets for reduction in the prevalence of the risk factors of interest were selected in an iterative process based on a combination of methods which included comparisons to appropriate Arcadian means, expert consensus and literature reviews to identify the scope of potential effective interventions. Thus a feasible absolute change in risk factor prevalence was determined e.g. 3% decrease in prevalence of BMI > 25. An important adjustment downwards was made for the joint effects of risk factors on health to avoid overestimation by double counting benefits when multiple changes in risk factors occur simultaneously. Multivariable probabilistic uncertainty analyses and sentivity anlyses were undertaken to incorporate uncertainty ranges in the results.
Results: We found that large potential opportunity cost savings were possible from the avoidable disease burden associated with the risk factors examined, if the feasible prevalence reductions were to be achieved. Over the lifetime of the 2008 Australian adult population, savings of between $2 and $3 billion have been conservatively estimated to follow from reduced mortality and incidence of risk-related illness. Overall, health sector gains were the largest component followed by production and leisure gains. Individual risk factors contributed differentially to the mix of potential gains depending on the size of the reduction targets selected and the demographic profile of the population with the risk factor.

Discussion: The research provides new information for policy makers aiming to prevent chronic disease in Australia and setting realistic targets to achieve that goal. The potential benefits of reducing risk factors were substantial. The technique adopted for realistic target setting is potentially applicable in other settings where benchmarking internationally is of importance. Future directions include an assessment of what might be the best interventions to achieve these reductions and their costs of implementation to achieve these health status and economic benefits.

Key Terms

risk factors, target setting, economic benefits, prevention

Authors:

Dominique Cadilhac (National Stroke Research Institute) , Anne Magnus (Deakin University. Deakin Health Economics) , Toby Cumming (National Stroke Research Institute) , Lauren Sheppard (Deakin University. Deakin Health Economics) , Dora Pearce (National Stroke Research Institute) and Rob Carter (Deakin University. Deakin Health Economics)

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