1. Evaluating the cost-effectiveness of interventions with an impact on ageing
P. Breeze, P. Thokala, L. Lafortune, C. Brayne, A. Brennan
07/12/2018

2. Develop a comprehensive whole disease model for Dementia.
Aims
The aim of this project was to develop a model to evaluate interventions impacting on cardiovascular and dementia outcomes in later life.
Develop a comprehensive whole disease model for Dementia.
Incorporate broad range of health outcomes in older age.
Enable comprehensive evaluation of cost-effectiveness of public health and healthcare interventions.
Whole disease Dementia Model
Risk factor trajectories
Dementia incidence
Dementia diagnosis
Dementia progression
SPHR Diabetes Prevention Model
Risk factor trajectories
Diabetes disease model
Cardiovascular disease model
Obesity related outcomes
SPHR Prevention Model

3. School for Public Health Diabetes Prevention Model
Individual patient simulation designed to model type 2 diabetes prevention.
Projected costs/savings and health related quality of life are obtained for each year following the intervention

4. Modelling Dementia Metabolic risk factor trajectories
Dementia Risk Models
Dementia Diagnosis
Disease progression, costs and health benefits
Modelling Dementia

5. Metabolic risk factor trajectories
Dementia Risk Models
Dementia Diagnosis
Disease progression, costs and health benefits
Modelling Dementia
Phase I
Metabolic risk factor trajectories for BMI, HbA1c, systolic blood pressure, HDL cholesterol and total cholesterol are based on two longitudinal cohort studies.
Metabolic risk factor trajectories estimated from the Whitehall II cohort (Age <60) and English Longitudinal Study of Ageing (Age >60)
Trajectories individualised based on starting value from Health survey for England.
Trajectories conditional on age, gender, smoking, ethnicity, family history (Whitehall only) and deprivation (ELSA only).

6. Modelling Dementia Phase II
Metabolic risk factor trajectories
Dementia Risk Models
Dementia Diagnosis
Disease progression, costs and health benefits
Modelling Dementia
Phase II
Individual dementia risk is estimated annually and updated each year according to risk factors.
Five year dementia incidence is estimated from THIN dementia risk models (aged years and years)
THIN data is representative of a UK population (930,395 individuals aged years from UK general practice).
Data for mid-life risk factors on long term dementia risk is estimated from Finnish Risk Score (CAIDE)
CAIDE estimates 20 year probability of dementia conditional on obesity, hypertension, hyperdyslipidemia and physical activity.
Used to estimate mid-life intervention effect on long-term dementia risk.

7. Modelling Dementia Phase III
Metabolic risk factor trajectories
Dementia Risk Models
Dementia Diagnosis
Disease progression, costs and health benefits
Modelling Dementia
Phase III
Identify the severity of dementia at diagnosis.
MMSE score is specified to match summary statistics from the Cognitive Function and Ageing Study.
Institutionalisation at diagnosis conditional on MMSE score.

8. Disease progression, costs and health benefits
Metabolic risk factor trajectories
Dementia Risk Models
Dementia Diagnosis
Disease progression, costs and health benefits
Modelling Dementia
Phase IV
Annual declining rate for MMSE score derived
from analysis of the Consortium to Establish A
Registry for Alzheimer’s Disease (CERAD).
Institutionalisation based on MMSE severity.
Data for health care, and informal care costs
were from cost study for dementia in the UK.
Utilities decline with decreasing MMSE score
and institutionalisation.
Mortality rates are gender and age specific,
with a relative risk of mortality due to
Dementia.

9. Case Study: NHS Diabetes Prevention Programme
 DPP outcomes at 12 months
Weight (kg)
-3.24
BMI (kg/m2)
-1.47
HbA1c (%)
-0.20
Systolic Blood Pressure (mmHg)
-6.57
Total Cholesterol (mmol/l)
-0.28
Intervention cost
£270
Duration of effect
5 years
The NHS DPP is an intensive lifestyle intervention focussing on dietary advice, physical activity and weight loss, aimed at individuals with Impaired Glucose Regulation in England.
DPP no Dementia
DPP with Dementia
Net Benefit (£20000 willingness to pay)
£1384
£1701
Incremental Health and Social Care cost (per person)
-£281
-£284
Incremental Health care cost (per person)
-£254
-£201
Incremental Social care cost (per person)
-£27
-£83
Incremental Dementia cost (per person) £0
-£30
Incremental Cardiovascular cost (per person)
-£112
-£76
Incremental QALYs (per person)
0.055
0.071
Incremental Life Years (per 1000 people)
0.064
0.099
Incremental Diabetes diagnoses (per 1000 people)
-11
-10
Incremental CVD events (per 1000 people) -3 -1
Incremental Dementia Diagnosis (per 1000 people) -4