Yong Yi Lee

Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness.

The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.

The global epidemiology and burden of psychostimulant dependence: Findings from the Global Burden of Disease Study 2010

AIMS To estimate the global prevalence of cocaine and amphetamine dependence and the burden of disease attributable to these disorders. METHODS An epidemiological model was developed using DisMod-MR, a Bayesian meta-regression tool, using epidemiological data (prevalence, incidence, remission and mortality) sourced from a multi-stage systematic review of data. Age, sex and region-specific prevalence was estimated for and multiplied by comorbidity-adjusted disability weightings to estimate years of life lost to disability (YLDs) from these disorders. Years of life lost (YLL) were estimated from cross-national vital registry data. Disability-adjusted life years (DALYs) were estimated by summing YLDs and YLLs in 21 regions, by sex and age, in 1990 and 2010. RESULTS In 2010, there were an estimated 24.1 million psychostimulant dependent people: 6.9 million cocaine and 17.2 million amphetamines, equating to a point prevalence of 0.10% (0.09-0.11%) for cocaine, and 0.25% (0.22-0.28%) for amphetamines. There were 37.6 amphetamine dependence DALYs (21.3-59.3) per 100,000 population in 2010 and 15.9 per 100,000 (9.3-25.0) cocaine dependence DALYs. There were clear differences between amphetamines and cocaine in the geographic distribution of crude DALYs. Over half of amphetamine dependence DALYs were in Asian regions (52%), whereas almost half of cocaine dependence DALYs were in the Americas (44%, with 23% in North America High Income). CONCLUSION Dependence upon psychostimulants is a substantial contributor to global disease burden; the contribution of cocaine and amphetamines to this burden varies dramatically by geographic region. There is a need to scale up evidence-based interventions to reduce this burden.

Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention.

Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5-18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohens d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37-0.60], selective (RR 0.61, 95% CI 0.43-0.85) or indicated (RR 0.48, 95% CI 0.29-0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.).

GBD 2010 country results: a global public good

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) constitutes an unprecedented collaboration of 488 scientists from 303 institutions in 50 countries, focusing on describing the state of health around the world using a uniform method. Results for the world and 21 regions for 1990 and 2010 have been reported for 291 diseases and injuries, 1160 sequelae of these causes, and 67 risk factors or clusters of risk factors. The burden of each disease, injury, or risk factor has been quantifi ed in terms of deaths, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). Although only global and regional results have been reported so far, the underlying unit of analysis for GBD 2010 was 187 countries. Age-specifi c mortality was analysed for each country for each year from 1970 to 2010. Causes of death were estimated for each country from 1990 to 2010 with country-specifi c data and models. Disease and injury sequelae were estimated in most cases with a Bayesian meta-regression method (DisMod-MR) that includes estimation of systematic diff erences in incidence, prevalence, or excess mortality between countries within regions. Systematic analysis of risk factor exposure, excess health risks associated with each risk–outcome pair, and counterfactual minimum risk levels of exposure were used to compute attributable burden. On the basis of these analyses, GBD 2010 provides a complete assessment of the burden of diseases, injuries, and risk factors for 187 countries including quantifi cation of uncertainty in the estimates for 1990 and 2010, albeit with important limitations because of the scarcity of data for some outcomes in some countries and the need to use a range of statistical models to generate estimates. The availability of standardised estimates for each of the 187 countries over time provides an unprecedented opportunity to undertake comparative assessments, to benchmark country performance in control of critical diseases, injuries, and risks, and to stimulate evidencebased action. Most of the scientists in the GBD 2010 collaboration volunteered their own time or raised their own funds to participate. A key motivation for them was the opportunity to publish more detailed analyses of data, methods, and results for specifi c diseases, injuries, and risk factors. Many reports are in submission or in preparation and provide more detail for specifi c diseases, injuries, risk factors, and countries. Although we expect that these reports will be important contributions to the scientifi c literature, we recognise that country results from the GBD are a global public good that could be a useful or even critical input into a more informed national, regional, and global dialogue about health challenges. Already, governments of several developed and developing countries have approached us seeking access to more detailed results. Because we believe that the dissemination and rapid availability of the detailed results is a moral imperative, we are providing global access to these details on March 5, 2013, through a series of online visualisations. To allow suffi cient time for members of the GBD 2010 collaboration to report their own research fi ndings, we will defer dissemination of public-use datasets of the underlying results presented in the visualisations until Sept 1, 2013. In this way, we believe that we can provide global access to these important results while at the same time respecting the intellectual investment of the collaboration’s members. Nonetheless, anticipating that some governments might wish to have immediate access to more detailed information as an input to national policy dialogue, we have provided and will continue to provide detailed national disease burden results on request. We also encourage use of the visualisations or snapshots of their images for teaching, communication, and other educational purposes. Alongside the reporting of global and regional results in The Lancet, fi ve data visualisations were made available in December, 2012. For visualisation of country-level data, the Institute for Health Metrics and Evaluation (IHME) has developed new visualisations with expanded scope and functionality, which are being launched on March 5. Data visualisations can make complex information accessible and interpretable without advanced statistical or epidemiological training. The primary purpose of these visualisations is to allow health specialists, policy makers, the media, donors, and the general public to explore the patterns of health in diff erent age and sex groups, countries, and time periods. Providing information on patterns of health to this broad audience could enhance the scope and quality of national, regional, and global dialogue about the main For data visualisations see http://www.ihmeuw.org/ GBDregionalviz

The cost-effectiveness of laparoscopic adjustable gastric banding in the morbidly obese adult population of Australia

Background To examine the cost-effectiveness of providing laparoscopic adjustable gastric banding (LAGB) surgery to all morbidly obese adults in the 2003 Australian population. Methods and Findings Analyzed costs and benefits associated with two intervention scenarios, one providing LAGB surgery to individuals with BMI >40 and another to individuals with BMI >35, with each compared relative to a ‘do nothing’ scenario. A multi-state, multiple cohort Markov model was used to determine the cost-effectiveness of LAGB surgery over the lifetime of each cohort. All costs and health outcomes were assessed from an Australian health sector perspective and were discounted using a 3% annual rate. Uncertainty and sensitivity analyzes were conducted to test the robustness of model outcomes. Incremental cost-effectiveness ratios (ICERs) were measured in 2003 Australian dollars per disability adjusted life year (DALY) averted. The ICER for the scenario providing LAGB surgery to all individuals with a BMI >40 was dominant [95% CI: dominant -

Modelled Cost-Effectiveness of a Package Size Cap and a Kilojoule Reduction Intervention to Reduce Energy Intake from Sugar-Sweetened Beverages in Australia

588] meaning that the intervention led to both improved health and cost savings. The ICER when providing surgery to those with a BMI >35 was

Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia

2 154/DALY averted [95% CI: dominant -

Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review

6 033]. Results were highly sensitive to changes in the likelihood of long-term complications. Conclusion LAGB surgery is highly cost-effective when compared to the

Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study

50 000/DALY threshold for cost-effectiveness used in Australia. LAGB surgery also ranks highly in terms of cost-effectiveness when compared to other population-level interventions for weight loss in Australia. The results of this study are in line with other economic evaluations on LAGB surgery. This study recommends that the Australian federal government provide a full subsidy for LAGB surgery to morbidly obese Australians with a BMI >40.

Developing a Service Platform Definition to Promote Evidence-Based Planning and Funding of the Mental Health Service System

Interventions targeting portion size and energy density of food and beverage products have been identified as a promising approach for obesity prevention. This study modelled the potential cost-effectiveness of: a package size cap on single-serve sugar sweetened beverages (SSBs) >375 mL (package size cap), and product reformulation to reduce energy content of packaged SSBs (energy reduction). The cost-effectiveness of each intervention was modelled for the 2010 Australia population using a multi-state life table Markov model with a lifetime time horizon. Long-term health outcomes were modelled from calculated changes in body mass index to their impact on Health-Adjusted Life Years (HALYs). Intervention costs were estimated from a limited societal perspective. Cost and health outcomes were discounted at 3%. Total intervention costs estimated in AUD 2010 were AUD 210 million. Both interventions resulted in reduced mean body weight (package size cap: 0.12 kg; energy reduction: 0.23 kg); and HALYs gained (package size cap: 73,883; energy reduction: 144,621). Cost offsets were estimated at AUD 750.8 million (package size cap) and AUD 1.4 billion (energy reduction). Cost-effectiveness analyses showed that both interventions were “dominant”, and likely to result in long term cost savings and health benefits. A package size cap and kJ reduction of SSBs are likely to offer excellent “value for money” as obesity prevention measures in Australia.