Eight associated partner organisations and ten collaborating partner organisations are involved in the project and eight European countries (Bulgaria, Finland, Greece, Lithuania, the Netherlands, Poland, Portugal and the UK) will be studied. The range of countries was chosen to provide a geographical spread and to examine the impacts of economic and health systems differences in feasibility and applicability of interventions. The work is planned to be concluded in two and a half years, starting in April 2013 and ending September 2015.
EConDA comprises of seven work packages:
Development of a disease model
Development of a cost-effectiveness model
Work on each of the packages will be split between the eight associated partners with one of the partners leading on a selected package. The first three will incorporate administrative matters, including regular meetings, accountability and dissemination of project development stages and results. Methods of the four remaining work packages (4–7) are discussed in more detail below.
Consensus building – work package 4
Work package 4 will be implemented in three phases. Firstly, a literature review will be conducted to identify the studies which critically assess the methods used to measure the cost-effectiveness of interventions for the selected diseases. The results of the review will be used in shaping the questions of the interviews with leading health economists.
In the second phase, international health economics experts will be consulted in order to enrich the review and gain a deeper understanding of the methods of measuring cost-effectiveness of chronic disease interventions.
In the third phase, a consensus meeting will be held, bringing together a group of European experts including health economists, policy makers and experts from the European Chronic Disease Alliance. This meeting will discuss the themes emerging from the first and the second phases of this work package and will aim to establish consensus on which method/s provide the greatest utility, as well as to address the question of how we measure the cost-effectiveness and the impact of integrated approaches to chronic disease prevention on economies.
Consultation with experts and the consensus meeting will be conducted in line with the European Commission guidelines for European Commission funded projects which are underpinned by the EU Charter of the Fundamental Rights . Since the experts will be consulted in their professional capacity as stakeholders in this EU project the consultations and the consensus meeting are exempt from ethical approval.
Development of a disease model – work package 5
Work package 5 will include two phases. Firstly, disease and risk data will be collected by reviewing open access papers in PubMed and Science Direct databases, supplemented by Google Scholar search. If necessary additional data will be collected by searching statistical data bases and reports as well as contacting disease registries and individual researchers in the field.
For the purpose of this project, epidemiological data need to be stratified by age groups and sex, socio-economic groups and where possible should be nationally representative. We will collect the most recent incidence, prevalence, mortality, and survival data. In addition, if available, we will collect country-specific remission and recurrence data for the selected diseases.
Risk data will be collected in a similar manner. BMI prevalence data will be collected if, in addition to the inclusion criteria above, they are categorised according to the WHO definition: normal weight (<25 kg/m2), pre-obese (25–29.9 kg/m2), and obese (≥30 kg/m2). Hypertension data will be included if they are defined according to WHO criteria of 140 mmHg systolic and/or 90 mmHg diastolic blood pressure. In addition to age and sex specific incidence and prevalence, data on hypertension stages will be included if available. Smoking patterns will be assessed by collecting data on frequency, the length of smoking in years and exposure to second hand smoke.
Furthermore, we will identify other possible risk factors for each of the four diseases. The literature assessing the significance of each risk factor will be examined to determine the inclusion of a risk factor into the model. The data on relative risks will be taken from clinical trials and meta-analyses and assumed to have worldwide applicability. Same data collection procedures will apply to all participating countries.
Secondly, the project will develop a demonstration micro-simulation model. The model will apply the methods developed by the National Heart Forum for the English Government Tackling Obesities enquiry [12, 13]. This model has been subsequently applied to other risk factors and diseases and validated in over 70 countries both nationally and locally including the US, Russia, Mexico and Brazil. In short, a dual-module Markov-style micro-simulation model will be used. Module 1 uses multi-variate non-linear regression to project risk trends to 2030. Module 2 utilises a micro-simulation model to simulate a virtual population and estimate the future incidence, prevalence and mortality of the diseases of interest.
We will project the trends of hypertension, obesity and tobacco use to 2030 and estimate the number of selected diseases’ cases related to these risk factors. We will then test the impact of effective risk interventions on the future incidence and mortality using several risk reduction scenarios. As an example, previously tested scenarios included testing the effect of mean population BMI reduction by 1% and 5% on the occurrence of obesity-related chronic diseases. Similarly, we would be able to test the effects of reductions in population levels of hypertension and the effects of increase in smoking cessation rates.
Development of a cost-effectiveness model – work package 6
Work package 6 will be implemented in three phases. Firstly, the data on both direct and indirect costs for each selected disease will be collected for each of the eight countries. The process of data collection will be the same as the disease data collection procedure. Secondly, the intervention scenarios will be developed using information collected in work package 4 and the suggestions arising from the further discussion with partners and experts. Thirdly, following phases one and two an economic model will be developed. A demonstration model will enable to test the cost-effectiveness of interventions to prevent, screen and treat CHD, COPD, type 2 diabetes and CKD.
Validation of the models – work package 7
We will validate the models using the best available data from one of the eight countries involved in the project. The model will be able to demonstrate the future health impact of positive and negative changes in risk factors as well as indicate the most cost-effective interventions to reduce the burden of chronic disease. Moreover, the model will allow for any specified risk reduction or intervention to be modelled and it could be subsequently updated as new data for current or other countries become available.
This study has been approved by the European Commission Health Programme and the Executive Agency for Health and Consumers.