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Economic evaluation of a real life public health intervention: Natural England


Economic evaluation of a real life public health intervention: Natural England s Walking for Health Scheme Marc Suhrcke University of East Anglia, – PowerPoint PPT presentation

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Title: Economic evaluation of a real life public health intervention: Natural England

Economic evaluation of a real life public health
intervention Natural Englands Walking for
Health Scheme
Marc SuhrckeUniversity of East Anglia, Norwich
Medical School
Why does it matter?
  • Economic evaluation as one important input into
  • Wanless (2004) Highlighted the need for economic
    evaluations of public health interventions
  • Confirmed by other studies, incl. systematic
    reviews (e.g. Schwappach/Boluarte/Suhrcke 2007)
  • Fairly careless treatment of the costing side in
    existing economic evaluations of similar public
    health interventions

Economic evaluation studies of primary prevention
of CVD, by prevention category (n195)
Source Schwappach/Boluarte/Suhrcke 2007
Intervention targets by study setting (n195)
of studies
1. Dyslipidemia 31
2. Smoking 22
3. High blood pressure 13
4. High blood glucose levels 7
5. Dietary intake 7
6. Obesity 6
7. Physical inactivity 3
8. Atrial fibrillation 2
9. Various 11
Source Schwappach/Boluarte/Suhrcke 2007
What is the Walking for Health (WfH)
  • The largest led walk intervention and one of the
    largest public health interventions for physical
    activity in the UK
  • Natural England (NE) launched WfH in 2000.
  • WfH supported over 520 local schemes with over
    60,000 organised walks in the 2010-2011 financial
    year almost 100,000 registered participants
  • WfH schemes are developed in local areas, led by
    volunteers, supported and funded through local
    partnerships (e.g. primary care trusts, local
    authorities or voluntary community groups).
  • Predominantly elderly, retired participants
  • Substantial variation in size
  • Supported by certain national level resources and

Steps in the costing methodology
  • Selection of schemes (2 pilots, 6 for main study)
  • Identification of resource use ? development of a
    resource use inventory and questionnaire
  • Measuring and/or estimation of resource use
  • Resource valuation
  • Estimation of local level costs (at scheme level)
  • Estimation of national costs of WfH
  • Estimation of individual travel costs for
  • (Modest) sensitivity analysis

Counting beans A number of slightly more
involved issues to tackle
  • Cost perspective
  • Economic costs, not financial costs ?
    opportunity costs
  • Voluntary workers
  • Donated goods services (eg office space)
  • Productivity costs
  • What are set-up, what are operating costs
  • Costs to participants
  • Costs attributable to the interventions
  • Data gaps

Information sources
  • WfH Database
  • Natural England central budget
  • Relevant literature
  • Questionnaires / interviews

Resource use inventory
Main characteristics of the six selected WfH

Scheme name Local Authority Region Provider Location Scheme size Number of registered walks Total attendance Number of walk hours
Breckland and Brandon Breckland EA CSP Rural districts Large 557 9,383 11,508
Heart and Sole Chelmsford EA Local Authority Other urban and significant rural Large 367 4,283 2,224
Stepping out in Suffolk Suffolk Coastal EA Local Authority Rural districts Large 371 4,842 4,970
Horsforth Healthy Walking Group Leeds Yo Voluntary community group Major urban and large urban Small 62 1,964 3,425
Havering Walking for Health Initiative Havering Lo Local Authority Major urban and large urban Medium 280 8,891 12,852
Mayfair Walking for Health South Shropshire WM Community Centre, PCT, Local Authority Rural districts Medium 322 2,633 3,476
  • What gaps have we identified and what assumptions
    are used?

Gaps and assumptions
Gaps Assumptions
Set-up resources costs Set-up resources costs Set-up resources costs
Labour No statistics to determine variable labour resources (eg nr of walk leaders, nr walks) --
No estimates provided on the economic cost of volunteers Used 2010 median gross hourly earnings (Annual Survey of Hour s Earnings, ONS) For 2010 7.97
No split by gender and by age Treated all volunteers equally
Non-labour All in kind/ donated (own or Council) --
Investment in office space per FTE Covered under recurring cost through depreciation
One-time purchases of office equipment Covered under recurring cost through depreciation
Other costs (supplies material, marketing, transport, etc) Assumed other set-up costs are negligible
Description e.g. Small
Starting the idea Meeting to set-up the scheme, objectives, etc Negligible
Recruiting volunteers Preparing the course, collating application forms and booking a venue plus giving the training course. 1 day assistance to training course by walk leaders (varies from 6-20) 2 days 6 people attending the course 6 days
Marketing and promotion The following figures vary greatly. The costs depend on a number of factors such as size of the community and what established network exists already in the community (GPs, local community 3rd sector organisations (e.g. Age Concern), schools, etc Travelling to promote the Scheme Produce posters 1 day 0.5 day Negligible
Route planning and risk assessment Setting up the routes and risk assessing the routes. The latter consists of walking the route, and then completing the associate risk assessment paperwork. Costs are variable and depend on the number of routes that need to be risk assessed (0.5 h per route) and the length of the walk. 1.5h 1 day
Funding Time spend applying for funding Negligible
Description e.g. Small
Facilities, incl rent and utilities Coordinators of small voluntary led schemes use their own houses Included under recurring
Office equipment (e.g. telephones, computers, fax machines, desks, chairs) The minimum office equipment to run a scheme effectively is a desk and a chair, a computer (mainly for emailing info to people), a printer, to print off the posters, and a telephone to get in contact with people. Included under recurring
Supplies and materials (e.g. office supplies such as paper, ink, pens) Includes mainly paper, and print cartridges Negligible
Marketing promotion Mostly word of mouth. Poster templates and promotional leaflets are downloaded from the NE website. There is also a promotional DVD provided by NE Negligible
Transportation Variable costs it includes mileage for distributing posters (which depends on size of local area), mileage to training venue, etc 0.40 per mile
Educational materials Insurance Provided by NE (and thus included under costs NE) None
Gaps and assumptions recurring costs
Gaps Assumptions
Recurring resources costs Recurring resources costs Recurring resources costs
Labour No estimates provided on the economic cost of volunteers Used 2010 median gross hourly earnings (Annual Survey of Hour s Earnings, ONS) For 2010 7.97
No homogeneous units of work reported by the schemes Used OECD average of1.640,6 working hours per year
Non-labour Mostly in kind/ donated --
Cost of office space per square meter or per FTE was unavailable When not reported, used the office space cost per FTE for the 67 buildings of the Communities and local government and as per OCG report
When not reported, prorated the office space cost per FTE by the part-time hours worked
Lack of info on costs of office equipment Depreciation office equipment per coordinator(s) (1 computer, 1 printer, 1 phone) plus recurring costs of cartridges, broadband and phone estimated at average market price
Other resources Represent a small percentage of total costs
Supplies and materials Walking equipment Transportation Variable depending on multiple factors Donated/ paid depending on funding available
Estimating travel costs.
  • Why travel costs?
  • Starting point info from WfH database
  • Postcodes of (almost) all walks
  • Postcodes of (almost) all walkers
  • Number of participants in each walk (but we dont
    know who participated!)
  • Estimate distance and time (based on car travel
    times) that each walker participating in the
    scheme would need to travel to reach each walk
    within their region (using GIS methods/software)
  • Travel cost calculation
  • Travel expenditure Travel time (minutes)
    speed (miles per minutes) cost per mile
  • Time costs Travel time (awage) 0ltalt1

What are the costs of WfH?
  • Total recurring (economic) costs for a local
    scheme 15,000 60,000 p.a.
  • Costs per organised walk 231 - 368
  • Costs per hour walked 14.4 - 22.8
  • Costs per participant 17.2 - 27.3
  • Labour costs make up ca. 2/3 of annual total
  • Volunteer costs account for ½ of total labour
  • No straightforward link between size and costs of
  • Total national economic cost 14.3 - 22.7

Example of travel costs Havering WfH scheme
 C1I dont understand what is contained in (1)
and (2)? Are the costs of car use both time and
out-of-pocket costs? What is then included in
Type of costs Costs ()
(1) Total travel time costs 4,672
(2) Costs of car use 26,471 
(3) Total travel costs (1)(2) 31,143
(4) Costs per registered walk (organised walk) 111
(5) Costs per attendee 3.50
(6) Costs per hour walked 2.42
Concluding remarks
  • Is WfH a costly intervention? Probably not.
  • Is WfH an efficient use of financial resources?
    We cannot (yet) say, without info on
  • If local authorities want to develop more of a
    value for money argument, there is a great
    need for more transparent mechanisms for
    collecting/identifying economic costs
  • What health (and other) benefits might there be?
    (as reported by WfH scheme contacts)
  • Friendship, company and community cohesion
  • Improvements in physical and mental health
  • Modelling the short and long term health and
    expenditure effects using the Multi-disease
    Model built for public health interventions
  • Need an estimate of individuals additional
  • Need estimates of uptake
  • Can incorporate information on relationship
    between exercise and different diseases

ACKNOWLEDGEMENT This work was undertaken by the
Centre for Diet and Activity Research (CEDAR), a
UKCRC Public Health Research Centre of
Excellence. This project has been funded by
Natural England. Funding from the British Heart
Foundation, Economic and Social Research Council,
Medical Research Council, the National Institute
for Health Research, and the Wellcome Trust,
under the auspices of the UK Clinical Research
Collaboration, is gratefully acknowledged.
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