Long-term cost-effectiveness of weight management in primary care

Background:  As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively.

Methods:  Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain.

Results:  Mean weight changes in Counterweight attenders was −3 kg and −2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was £59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was ‘dominant’ (cost-saving) under ‘base-case scenario’, where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was £2017 where background weight gain was limited to 0.5 kg/year, and £2651 at 0.3 kg/year. Under a ‘best-case scenario’, where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained ‘dominant’ with background weight gains 1 kg, 0.5 kg or 0.3 kg/year.

Conclusion:  Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.

Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Cost-analysis of teledentistry in residential aged care facilities

INTRODUCTION: The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination.

METHODS: The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation; and real-time communication with a remotely located oral health professional.

RESULTS: It was estimated that if 100 residents received an asynchronous oral health assessment and treatment plan, the net cost from a healthcare perspective would be AU$32.35 (AU$27.19-AU$38.49) per resident. The total cost of the conventional face-to-face examinations by a dentist would be AU$36.59 ($30.67-AU$42.98) per resident using realistic assumptions. Meanwhile, the total cost of real-time remote oral examination would be AU$41.28 (AU$34.30-AU$48.87) per resident.

DISCUSSION: Teledental asynchronous patient assessments were the lowest cost service model. Access to oral health professionals is generally low in RACFs; however, the real-time consultation could potentially achieve better outcomes due to two-way communication between the nurse and a remote oral health professional via health promotion/disease prevention delivered in conjunction with the oral examination.

Assessing the economic costs of parental mental illness

The economics discipline is broadly concerned with the allocation of scarce societal resources in the context of unlimited societal wants. Intrinsic to economics is the concept of choice – that is, how can we best use scarce societal resources when our wants are greater than the resources available to us. If we were able to satisfy all our wants and needs with our available resources, there would be no need for the discipline of economics! In most economies, markets are used to make these decisions. Markets are basically a mechanism whereby consumers and producers interact in such a way that the “best” allocation of resources is thought to occur. This “best” allocation of resources in economics is said to be an efficient allocation. Efficiency basically assumes that the correct types of services are being produced (allocative efficiency) in the least resource-intensive way (technical efficiency). Inherent within all these concepts is not just cost but also the benefit derived from the consumption of different goods and services. A central tenant of economics is the concept of opportunity cost whereby the true cost of any given action (or service) is the benefit which would have been attained if the resources used in providing that action or service were used in an alternative way. Therefore, both costs and benefits are central to the economic way of thinking. Contrary to much public perception, economics is not necessarily about cutting costs; rather, it is about using resources in the “best” possible way. Inherent within this idea of “best” is “value,” “benefit,” or “utility” (utility is the term most often seen in economics textbooks to refer to the value of using resources). Unfortunately, there are many assumptions which need to be met for markets to operate in an ideal way. One important assumption is that consumers of goods and services need to be aware of the full impact and consequences of all consumption choices. When market failures occur, governments can sometimes intervene in the operation of markets either because the markets are not working properly (largely because the assumptions underpinning the market mechanism are not met) or for social-justice or equity considerations (Rice and Unruh, 2009).

Equity considerations for open educational resources in the glocalization of education

Open educational resources (OER) have become new buzzwords in the glocalization of education. While OER are often espoused as enabling educational equity, the reality is not always the case. Looking only at the positives of new educational methods can mask perpetuating challenges, which makes the open aspect of OER a misnomer. Taking an alternative stance, this article critically evaluates the broader notion of OER through the lens of equity. It contends that while equity reasons often underpin the provision of OER, challenges continue to be experienced by some in accessing open digital materials for learning. This article explores some of these issues and argues that equity considerations are fundamental in OER design.

The equity raw-score matrix - a multi-dimensional indicator of potential disadvantage in higher education

Issues surrounding student participation, transition, retention and successful completion in higher education are topical. While the Australian federal government has identified broad groupings of under-represented students, these do not shed light on the complexities underlying the issues of the educationally disadvantaged, such as the compounding problems of multiple equity-group membership or the overlay of the acute or chronic effects of equity sub-group membership. This paper details the Equity Raw-Score Matrix. The matrix is a multi-dimensional indicator of potential disadvantage in learners, created for the specific purposes of diagnosing the complexities of educational disadvantage and creating pre-emptive strategies for the participation, transition and retention of students who are disadvantaged. The paper also describes the qualitative research study that was the catalyst for the creation of the matrix.

‘There isn’t kind of a White History Month or anything like that for them’: equity, schooling and the problematics of group identity politics

This paper explores issues of equity and group identity at ‘Hamilton Court’, a large comprehensive multi-faith and multi-cultural school located in England. The exploration draws on data gathered from a study that examined the conditions, structures and practices associated with productively addressing issues of justice and cultural diversity. The paper focuses, in particular, on the voices of two learning mentors, ‘Rosanna’ and ‘Yasmeen’. With reference to a cultural event at the school based around an Asian-inspired Bollywood Dance Festival, the school’s approach to absence requests on the basis of religious observance, and the disadvantage experienced by a particular White British working class boy, the paper highlights tensions and problematics associated with issues of equity, schooling and group identity. The paper makes a theoretical contribution to debates in this area. Further illustrating the limitations of distributive understandings of equity that begin with group identity politics and fail to consider matters of context in struggles against cultural oppressions, it examines the possibilities of an equity approach that instead begins with a focus on overcoming these relations of oppression.

Evaluating the whole-life cost implication of revocability and disruption in office retrofit building projects

Retrofit buildings are becoming popular in the United Kingdom as well as many parts of the advanced economies. Existing whole-life costing models have however, not proven to be robust enough to deal with building retrofit scenarios. Recent research has made a case for the existence of revocability and disruption in building retrofit investments. This paper evaluates the whole-life cost implication of revocability and disruption in office retrofit building projects. The potential implication of revocability and disruption are evaluated based on probability and fuzzy logic principles respectively. Two case study projects are selected to appraise the economic potentials of revocability and disruption. It was found that the average cost of revocability relative to the initial capital cost can be up to 119% over a 60-year life. It was also found that the average cost of disruption relative to the initial capital cost can be up to 12%. Future studies will utilise sensitivity analysis in assessing the relative preference of building retrofit configurations in office building projects. The external validity of this work is moderate, as the intention is to establish analytical generalisation rather than statistical generalisation for office retrofit building projects.

Locating the intangible: integrating a sense of place into cost estimations of natural disasters

The field of disaster loss assessment attempts to provide comprehensive estimates of the cost of disasters. Assessment of intangibles remains a major weakness. Existing costing frameworks have acknowledged losses to cultural – as distinct from economic, social, human or environmental – capital. However, theinclusion of cultural line items has usually been conducted in an ad hoc and under-theorised way, withlittle empirical evidence. This paper presents the possibility of using cultural capital itself as an overarchingcategory for specifically cultural losses. It further focuses on the specific concept of sense of place asone area that has been neglected even in frameworks that consider other kinds of intangibles, and argues,on both theoretical and pragmatic grounds, that a collective or shared sense of place can be subsumedwithin cultural capital loss estimates. Christchurch provides an illustration of the idea as relevant andcomparable empirical material is available from before and since the 2011 earthquake.