E c o no mic E va lua tio ns o f Die t a nd Supple me nta tio n DR MI CHE L E SADL E R, CONSUL T ANT NUT RI T I ONI ST DI RE CT OR, RANK NUT RI T I ON L T D
Spe nding o n he a lth Gr owing population Age ing population – ne xt 15 ye a rs +4.4 millio n 65+ ye a rs; +1.3 millio n 85+ ye a rs e atme nt c osts – spe nding o n c hro nic dise a se s e xpe c te d to do ub le Inc r e asing tr in ne xt 15 ye a rs ugs – rise s b y 5% e a c h ye a r Inc r e asing e xpe nditur e on dr T e c hnologic al de ve lopme nts Me dic al advanc e me nts £ £ £ All add to pr e ssur e for inc r e ase d spe nding on the NHS: Re c e nt a nno unc e me nt : E xtra £20b n a ye a r b y 2023 Ave ra g e a nnua l funding inc re a se o f 3.4%
Po lic y o ptio ns “Brexit dividend” Institute for F isc al Studie s R e por t May 2018 Inc re a se ta xe s Pr opose d tax r ise s of up to 2.6% of national Inc re a se b o rro wing inc ome (£34-£56 billion in today’s terms) Re duc e se rvic e s r e quir e d by the mid 2030s Priva tisa tio n Additional r ise of 0.4% of national inc ome to Cut o the r pub lic se rvic e s me e t the pr e ssur e s on soc ial c ar e Impro ve NHS pro duc tivity
Re duc e de ma nd fo r he a lth se rvic e s? L ife style : I mpro ve d die t Sto pping / re duc ing smo king I nc re a sing physic a l a c tivity Re duc ing o ve r-c o nsumptio n o f a lc o ho l Re duc ing re c re a tio na l drug use Pe r sonal r e sponsibility Se lf-he lp
Die t a nd c hro nic dise a se Ro le o f die t in pre ve ntio n o f die t-re la te d dise a se s is we ll-e sta b lishe d Die ta ry g uide line s a ime d a t pro mo ting g o o d he a lth He a lthy die ts - ma ke a n impo rta nt c o ntrib utio n to he a lth ma inte na nc e a twe ll Guide – F UK E o o d-b a se d die ta ry g uide line s fo r g e ne ra l po pula tio n fro m a g e 2+ ye a rs
E c o no mic b urde n o f ill he a lth due to life style c ho ic e s E stima te d e c o no mic c o sts to the UK NHS fo r 2006-2007 Of risk fa c to rs fo r c hro nic dise a se : CHD, dia b e te s, c a nc e rs, a rthritis, c irrho sis, Sc a rb o ro ug h e t a l, 2011. de nta l c a rie s e tc T he e c o no mic burde n o f ill £5.8 billion: Ill he alth r e late d to poor die t he alth due to die t, physic al inac tivity, [£5.1 billion: Ove r we ight and obe sity] smo king , alc o ho l and o bse ity in the UK: an £3.3 billion: Smoking update to 2006-07 NHS £3.3 billion: Alc ohol c o nsumptio n c o sts. J Pub l He a lth 33 (4) 5278-535 . £0.9 billion: Physic al inac tivity Of b e ha vio ura l risk fa c to rs po o r die t ha d hig he st impa c t o n NHS b udg e t, fo llo we d b y a lc o ho l c o nsumptio n, smo king a nd physic a l ina c tivity Good die t and nutr ition has pote ntial for vast c ost savings for the NHS
Po te ntia l impa c t o f a simple die ta ry c ha ng e L lo yd-Willia ms e t a l, 2007 c a lc ula te d the po te ntia l pub lic he a lth impa c t o f replacing one ‘unhealthy’ snack with one ‘healthy’ snack per person per da y a c ro ss the UK Ca lc ula te d the e xpe c te d c ha ng e s to die ta ry inta ke impa c t o n b lo o d c ho le ste ro l a nd sa lt le ve ls CHD a nd stro ke mo rta lity T his mig ht pre ve nt ~6000 c a rdio va sc ula r de a ths e ve ry ye a r in the UK Re pre se nt a la rg e c o st sa ving to the NHS L lo yd-Willia ms e t a l, 2007. Sma ll c ha ng e s in sna c king b e ha vio ur: the po te ntia l impa c t o n CVD mo rta lity. Pub lic He a lth Nutritio n 2007, 12(6): 871-876.
Po te ntia l impa c t o f the Sug a r Re duc tio n Stra te g y Da ta c o urte sy o f Dr Be n Amie s, Ma nc he ste r Government call for 20% Less sugar in Less calories sugar reduction in foods peoples’ diets consumed +23,000 years of healthy life -£135m to the NHS over 10 years Reduction in weight -£62m to social services over 10 years Reduction in gain chronic diseases e.g. diabetes, obesity 90,000 fewer cases of diabetes
Mic ro nutrie nts a nd e c o no mic e va lua tio ns Sc ie ntific lite rature inc lude s e c o no mic e va lua tio ns fo r b e ne fits o f supple me nta tio n with mic ro nutrie nts, a nd lo ng c ha in o me g a -3 fa tty a c ids I nve stig a te impa c t o f supple me nta tio n o n he a lth c a re e xpe nditure in a ta rg e t po pula tio n I nsig ht into re la tive c o sts a nd a sso c ia te d he a lth g a ins Summa rise d a s e stimate s o f c o st-e ffe c tive ne ss o r c o st sa ving s
E xa mple : Vita min D a nd fa lls Vita min D supple me nta tio n sho wn to re duc e fa lls in o lde r pe o ple – ha s a utho rise d E U he a lth c la im - e ffe c tive , we ll-to le ra te d a nd a ffo rda b le A third 65+ ye a r-o lds a nd ha lf 80+ ye a r-o lds fa ll a t le a st 1/ ye a r injurie s & fra c ture s Co sts to the NHS e stima te d a t o ve r £2b illio n a nd o ve r 4 millio n b e d da ys ( F e nto n, PHE Blo g , 2014 ) Due to a g e ing po pula tio n, a nnua l dire c t c o sts a rising fro m fa lls in 65+ ye a r o lds pre dic te d to rise sub sta ntia lly E c o no mic s o f the ra pe utic inte rve ntio n ha ve b e e n inve stig a te d ( Bisc ho ff-F e rra ri HA & Sa dle r M, 2018. Autho rise d E U he a lth c la im fo r vita min D a nd re duc e d risk o f fa lls. In F o o ds, Nutrie nts and d. M. J. Sa dle r. Wo o dhe a d Pub lishing , 2018, Cha pte r 4, 49-63 ) F o o d I ng re die nts with Autho rise d E U He alth Claims , Vo lume 3. E
E va lua tio n: 3-Ste p pro c e ss ffic ac y asse ssme nt (b e ne fit) fo r he a lth re la tio nship b e twe e n mic ro nutrie nt a nd E 1. o utc o me o f inte re st – e ffic a c y a sse sse d fro m huma n tria l da ta , c o ho rt studie s, me ta - a na lysis, mo de lling Clinic al be ne fit – pre dic t c ha ng e in numb e r o f c linic a l e ve nts, pre va le nc e o f 2. de fic ie nc y e tc stimate c osts – mo de lling o f c o st sa ving s/ c o st e ffe c tive ne ss a rising fro m inte rve ntio n E 3. with the mic ro nutrie nt
Re lia b ility o f e c o no mic e va lua tio ns De pe nds o n a c c ura c y o f da ta / e stima te s a t e a c h ste p ffe c tive ne ss - stre ng th o f e vide nc e fo r he a lth b e ne fits – E E .g . E U a utho rise d he a lth c la im? T ria l da ta vs o b se rva tio na l (c o ho rt da ta )? Se nsitivity a na lysis – use d to q ua ntify unc e rta inty a ro und the re sults Use a lte rna tive , mo re / le ss c ha lle ng ing , e vide nc e -b a se d va lue s to sho w the ra ng e o f po ssib le re sults Qua lity o f re po rting o f the e va lua tio n - tra nspa re nc y
Wha t da ta is the re fo r mic ro nutrie nts? Syste matic r e vie w of pe e r -r e vie we d lite r atur e E xplo re d e c o no mic e va lua tio ns o f po te ntia l b e ne fits o f mic ro nutrie nt o r lo ng - c ha in o me g a -3 fa tty a c id supple me nta tio n L ite ra ture se a rc h Re le va nt studie s – pe e r-re vie we d pa pe rs, fro m 2000 o nwa rds, in de ve lo pe d c o untrie s, inve stig a te d he a lth b e ne fit o f die ta ry supple me nta tio n a nd e va lua te d dire c t o r indire c t c o sts o f die ta ry-re la te d dise a se / diso rde r Outc o me o f inte re st: pote ntial for c ost savings or c ost e ffe c tive ne ss Na rra tive re vie w - me ta -a na lysis (po o le d sta tistic a l a na lysis) no t po ssib le due to diffe re nt inte rve ntio ns & o utc o me s, diffe re nt a ppro a c he s to c o sts a sse ssme nt, diffe re nt wa ys re sults e xpre sse d Sa dle r MJ, 2017 A re vie w o f e c o no mic e va lua tio ns fo r b e ne fic ia l he a lth o utc o me s o f mic ro nutrie nt a nd lo ng -c ha in o me g a -3 fa tty a c id supple me nta tio n. Int J F d Sc i & Nutr
Re sults: Ove rvie w o f inc lude d pa pe rs Clinic al outc ome Inte r ve ntion / Supple me nt Pape r s Re duc tio n o f ne ura l tub e de fe c ts F o lic a c id 2 (6) I Q g a ins in c hildre n I o dine 1 (2) Re duc tio n o f fa lls in o lde r pe o ple Vita min D 3 (3) Re duc e d hip fra c ture risk - o lde r pe o ple Vita min D 1 (1) Re duc tio n o f o ste o po ro tic fra c ture s - Vita min K 2; Vita min D a nd c a lc ium; Vita min 3 (6) prima ry a nd se c o nda ry pre ve ntio n D, c a lc ium a nd vita min K 2 ; Vita min D, c a lc ium a nd vita min K 2 Surviva l fo llo wing he a rt a tta c k; DHA/ E PA 2 (3) re duc tio n o f se c o nda ry CV e ve nts Re duc tio n o f mo rb idity fro m infe c tio ns Co mme rc ia l multivita min/ mine ra l supple me nt 1 (1) T OT AL 13 (22)
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