What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020-2029.
Ontology highlight
ABSTRACT: Background
There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability.Methods
Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau-age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall-age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY).Findings
The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs.Interpretation
After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links between COVID-19 and cardiovascular health, effective cardiovascular prevention policies need to be revitalised urgently.
SUBMITTER: Collins B
PROVIDER: S-EPMC9242440 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundReliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.MethodsWe developed and validated the IMPACT-Better Ageing Model-a probabilistic model that tracks the population aged 35-100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year.FindingsBetween 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7-20·9), from 10·4 million (10·37-10·41 million) to 12·4 million (12·23-12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3-28·2), from 2·25 million (2·24-2·27 million) to 2·81 million (2·72-2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5-21·8) in 2015 and 21·6% (21·3-21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1-3·6), from 20·1 years (19·9-20·3) to 21·8 years (20·2-23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1-1·9), from 15·4 years (15·3-15·5) to 16·4 years (15·5-17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6-4·8) to 2025 (5·4 years, 4·7-6·4).InterpretationThe number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.FundingBritish Heart Foundation.
| S-EPMC5500313 | biostudies-literature
Project description:BackgroundThe recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap.Methods and findingsAnalysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness ('mental illness') and 7781(13.9%) had one or more disabilities excluding mental illness ('non-mental disability'). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3-3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5-2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7-9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability.ConclusionsPeople with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.
| S-EPMC3577814 | biostudies-literature
Project description:BackgroundAchieving health benefits while reducing greenhouse gas emissions from transport offers a potential policy win-win; the magnitude of potential benefits, however, is likely to vary. This study uses an Integrated Transport and Health Impact Modelling tool (ITHIM) to evaluate the health and environmental impacts of high walking and cycling transport scenarios for English and Welsh urban areas outside London.MethodsThree scenarios with increased walking and cycling and lower car use were generated based upon the Visions 2030 Walking and Cycling project. Changes to carbon dioxide emissions were estimated by environmental modelling. Health impact assessment modelling was used to estimate changes in Disability Adjusted Life Years (DALYs) resulting from changes in exposure to air pollution, road traffic injury risk, and physical activity. We compare the findings of the model with results generated using the World Health Organization's Health Economic Assessment of Transport (HEAT) tools.ResultsThis study found considerable reductions in disease burden under all three scenarios, with the largest health benefits attributed to reductions in ischemic heart disease. The pathways that produced the largest benefits were, in order, physical activity, road traffic injuries, and air pollution. The choice of dose response relationship for physical activity had a large impact on the size of the benefits. Modelling the impact on all-cause mortality rather than through individual diseases suggested larger benefits. Using the best available evidence we found fewer road traffic injuries for all scenarios compared with baseline but alternative assumptions suggested potential increases.ConclusionsMethods to estimate the health impacts from transport related physical activity and injury risk are in their infancy; this study has demonstrated an integration of transport and health impact modelling approaches. The findings add to the case for a move from car transport to walking and cycling, and have implications for empirical and modelling research.
| S-EPMC3541403 | biostudies-literature
Project description:To quantify the economic investment required to increase bariatric surgery (BaS) capacity in National Health Service (NHS) England considering the growing obesity prevalence and low provision of BaS in England despite its high clinical effectiveness. Data were included for the patients with obesity who were eligible for BaS. We used a decision-tree approach including four distinct steps of the patient pathway to capture all associated resource use. We estimated total costs according to the current capacity (current scenario) and three BaS scaling up strategies over a time horizon of 20 years (projected scenario): maximising NHS capacity (strategy 1), maximising NHS and private sector capacity (strategy 2) and adding infrastructure to NHS capacity to cover the entire prevalent and incident obesity populations (strategy 3). BaS centres based in NHS and private sector hospitals in England. Number of BaS procedures (including revision surgery), cost (GBP) and resource utilisation over 20 years. At current capacity, the number of BaS procedures and the total cost over 20 years were estimated to be 140 220 and £1.4 billion, respectively. For strategy 1, these values were projected to increase to 157 760 and £1.7 billion, respectively. For strategy 2, the values were projected to increase to 232 760 and £2.5 billion, respectively. Strategy 3 showed the highest increase to 564 784 and £6.4 billion, respectively, with an additional 4081 personnel and 49 facilities required over 20 years. The expansion of BaS capacity in England beyond a small proportion of the eligible population will likely be challenging given the significant upfront economic investment and additional requirement of personnel and infrastructure.
| S-EPMC11293411 | biostudies-literature
Project description:The polio endgame remains complicated, with many questions about future polio vaccines and national immunization policies. We simulated possible future poliovirus vaccine routine immunization policies for countries stratified by World Bank Income Levels and estimated the expected costs and cases using an updated integrated dynamic poliovirus transmission, stochastic risk, and economic model. We consider two reference cases scenarios: one that achieves the eradication of all wild polioviruses (WPVs) by 2023 and one in which serotype 1 WPV (WPV1) transmission continues. The results show that the addition of inactivated poliovirus vaccine (IPV) to routine immunization in all countries substantially increased the expected costs of the polio endgame, without substantially increasing its expected health or economic benefits. Adding a second dose of IPV to the routine immunization schedules of countries that currently include a single IPV dose further increases costs and does not appear economically justified in the reference case that does not stop WPV transmission. For the reference case that includes all WPV eradication, adding a second IPV dose at the time of successful oral poliovirus vaccine (OPV) cessation represents a cost-effective option. The risks and costs of needing to restart OPV use change the economics of the polio endgame, although the time horizon used for modeling impacts the overall economic results. National health leaders will want to consider the expected health and economic net benefits of their national polio vaccine strategies recognizing that preferred strategies may differ.
| S-EPMC7895457 | biostudies-literature
Project description:OBJECTIVES:To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. DESIGN:A modelling study based on a combination of published data and clinical practice. SETTING:NHS hospitals in England. PRIMARY AND SECONDARY OUTCOME MEASURES:Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. RESULTS:In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8?million adult inpatients in NHS general and teaching hospitals in England, of which 22?800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810?000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6?million occupied hospital bed days and 62?500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1?billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7?billion, and accounting for 28?500 patient deaths, 7.1?million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79?700 days of absenteeism among front-line HCPs. CONCLUSION:This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.
| S-EPMC7045184 | biostudies-literature
Project description:Loneliness has been associated with poor mental health and wellbeing. In England, a 2018 national strategy on loneliness was published, and public health guidelines recommend participation in social activities. In the absence of existing economic evidence, we modelled the potential cost effectiveness of a service that connects lonely older people to social activities against no-intervention. A 5-year Markov model was constructed from a health and social care perspective. Parameters were drawn from the literature, with the intervention structure based on an existing loneliness alleviation programme implemented in several settings across England. Univariate and probabilistic sensitivity analyses were undertaken. The total expected cost per participant in the intervention group is £ 7131 compared to £ 6783 in the usual care group with 0.45 loneliness free years (LFY) gained. The incremental cost per LFY gained is £ 768; in the probabilistic sensitivity analysis the intervention is cost saving in 3.5% of iterations. Potentially such interventions may be cost-effective but are unlikely to be cost-saving even allowing for sustained effects and cumulative adverse health and social care events averted. Empirical studies are needed to determine the cost-effectiveness of these interventions, ideally mapping changes in loneliness to the quality of life, in order to allow the key metric in health economic studies, cost per quality adjusted life year to be estimated.
| S-EPMC7913744 | biostudies-literature
Project description:IntroductionOvarian Hyperstimulation Syndrome (OHSS) is a life-threatening iatrogenic complication of In vitro fertilisation (IVF). This study aimed to quantify rates of Ovarian Hyperstimulation Syndrome (OHSS) requiring intensive care unit (ICU) admission and assess whether trends have changed between 1996-2020 commensurate with the introduction of safer IVF practices.MethodsData regarding Intensive Care Unit (ICU) admission across England, Wales and Northern Ireland was gathered retrospectively from the Intensive Care National Audit and Research Centre (ICNARC) database. 38,957 female patients aged between 18-55 years were admitted to ICU for OHSS or related conditions between 1996-2020. The primary outcome was the rate of OHSS requiring ICU admission expressed as a proportion of the number of fresh IVF cycles conducted in that year according to Human Fertility and Embryology Authority (HFEA) records. Baseline characteristics (for example, age, ethnicity, BMI), biochemical parameters (such as renal function, serum electrolytes), length of ICU stay and duration and need for organ support, were also compared between ICU patients with 'confirmed OHSS' and those 'without OHSS'.ResultsThere were 238 cases of 'confirmed OHSS' requiring ICU admission recorded between 1996-2020. Rates of OHSS requiring ICU admission declined over the study period (P=0.006); the annual rate of severe OHSS requiring intensive care admission halved when comparing those occurring between 1996-2007 and 2008-2020 (OR=0.37, 95% CI 0.37-0.45; P<0.0001). Patients spent a mean of 3.5 days in the ICU, with 86.3% of patients with 'confirmed OHSS' requiring at least 2 days of higher level (i.e., level 2 or 3) care. Patients with 'confirmed OHSS' required a shorter duration of renal, advanced cardiovascular, and advanced respiratory support than patients 'without OHSS' (P<0.0001 for all comparisons). There was no significant difference in BMI or ethnicity between those with 'confirmed OHSS' and those 'without OHSS', however women with 'confirmed OHSS' were younger (34 versus 41 years old, p<0.0001).DiscussionAlthough absolute rates of OHSS requiring ICU admission recorded in this study are likely to represent a significant underestimate of all clinically significant OHSS, rates of OHSS requiring ICU admission have decreased since 1996 in concordance with the introduction of modern IVF practices.
| S-EPMC9797661 | biostudies-literature
Project description:Background and aimsWhen measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time.DesignCause-deleted life table analysis of national mortality records.SettingEngland and Wales, 2001-16.CasesAll-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD).MeasurementsLife expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'.FindingsIn 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men.ConclusionsDeaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.
| S-EPMC7687183 | biostudies-literature
Project description:Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.Design Modelling study.Setting General adult population of England and Wales.Participants The English Longitudinal Study of Ageing (ELSA) is a representative panel study with six waves of data across 2002-13. Men and women aged 50 or more years, selected randomly, and their cohabiting partners were recruited to the first wave of ELSA (2002-03). 11392 adults participated (response rate 67%). To maintain representativeness, refreshment participants were recruited to the study at subsequent waves. The total analytical sample constituted 17?906 people. Constant objective criteria based on cognitive and functional impairment were used to ascertain dementia cases at each wave.Main outcome measures To estimate calendar trends in dementia incidence, correcting for bias due to loss to follow-up of study participants, a joint model of longitudinal and time-to-event data was fitted to ELSA data. To forecast future dementia prevalence, the probabilistic Markov model IMPACT-BAM (IMPACT-Better Ageing Model) was developed. IMPACT-BAM models transitions of the population aged 35 or more years through states of cardiovascular disease, cognitive and functional impairment, and dementia, to death. It enables prediction of dementia prevalence while accounting for the growing pool of susceptible people as a result of increased life expectancy and the competing effects due to changes in mortality, and incidence of cardiovascular disease.Results In ELSA, dementia incidence was estimated at 14.3 per 1000 person years in men and 17.0/1000 person years in women aged 50 or more in 2010. Dementia incidence declined at a relative rate of 2.7% (95% confidence interval 2.4% to 2.9%) for each year during 2002-13. Using IMPACT-BAM, we estimated there were approximately 767?000 (95% uncertainty interval 735?000 to 797?000) people with dementia in England and Wales in 2016. Despite the decrease in incidence and age specific prevalence, the number of people with dementia is projected to increase to 872?000, 1?092?000, and 1?205?000 in 2020, 2030, and 2040, respectively. A sensitivity analysis without the incidence decline gave a much larger projected growth, of more than 1.9 million people with dementia in 2040.Conclusions Age specific dementia incidence is declining. The number of people with dementia in England and Wales is likely to increase by 57% from 2016 to 2040. This increase is mainly driven by improved life expectancy.
| S-EPMC5497174 | biostudies-literature