Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study

Abstract

The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multistate life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability.

The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia

“…The ACE-Obesity Policy model, full methods published elsewhere [5,24], estimated differences in HALYs pre-and post-reduction of the discretionary items. These differences were based on predicted variations in nine diseases related to obesity.…”

“…It was assumed that the reduction in energy intake was as a result of policies that were in steady state and weight loss had already occurred. The evidence indicates that the estimated weight loss will occur approximately three years after policy implementation [24].…”

Increasing the Price of Alcohol as an Obesity Prevention Measure: The Potential Cost-Effectiveness of Introducing a Uniform Volumetric Tax and a Minimum Floor Price on Alcohol in Australia

“…For example, an analysis of the potential cost-effectiveness of a 20% SSB tax in Australia, using equivalent methods and the same model as used in this paper, found it was also likely to be dominant. However, the HALYs gains and cost offsets were more than double for a uniform volumetric tax on alcohol, compared to a 20% SSB tax [27]. This is largely because energy intake from alcohol is higher than from SSBs in the Australian population, and alcohol is primarily consumed by middle aged groups who are at higher risk of developing chronic diseases associated with obesity.…”

“…A previously developed model, the ACE-Obesity Policy model, was used to estimate the health outcomes that resulted from changes to BMI [27].…”

“…The ACE-Obesity Policy model is a multi-state, multiple cohort life table model that simulates the incidence, prevalence, and mortality related to nine obesity related diseases (i.e., type 2 diabetes, hypertensive heart disease, ischemic heart disease, stroke, osteoarthritis of the hip and knee, kidney cancer, colorectal cancer, endometrial cancer, and breast cancer) over the lifetime of the 2010 Australian population. The ACE-Obesity Policy model has been used to evaluate the economic credentials of various obesity policies in Australia [28][29][30][31] and details of the model have been previously published [27,32,33]. In brief, the model uses the prevalence of overweight and obesity taken from the Australian Health Survey 2010 [34] and relative risk estimates from the Global Burden of Disease (GBD) 2010 [35] to calculate the population impact fractions for nine obesity-related diseases.…”