Douglas McKelvie Thursday 9 th February, 2012 Steve Arnold Eric - - PowerPoint PPT Presentation

Douglas McKelvie Steve Arnold Eric Wolstenholme David Monk

The “Alcohol Systems Model” System Dynamics Society UK Gathering Thursday 9th February, 2012

Department of Health (England) Alcohol Improvement Partnership

This is the population

• f England…….

ABSTAINERS

5.8m

DRINKING AT LOWER RISK

24.8m

DRINKING AT INCREASING RISK

7.6m 7.6m

HIGHER RISK DRINKING

2.9m

Dependent Drinking

1.1m

Binge Drinking

7.7m 7.7m

Sources: General Household Survey 2006 and mid-2006 population estimates (ONS). dependent drinking fig - ANARP 2005 (DH)

Common view of “alcohol problems”

• Binge drinking
• Dependence/alcoholism

This project

• Broader health problems associated

with alcohol CONSUMPTION

• “Increasing Risk” (> 2 glasses of wine

per day for men, 1.5 for women)

• “Higher Risk” (> 3.5 or 2.5 glasses)

“men who drink more than 3 to 4 units a day (2 glasses of wine) run an increasingly significant risk of illness and death from a number of conditions, including haemorrhagic stroke, some cancers, accidents and hypertension” UK General Lifestyle Survey

This is the population

• f England…….

The Good News: to tackle CONSUMPTION, as opposed to BINGE DRINKING or DEPENDENT DRINKING, relatively inexpensive treatments (brief advice, brief interventions), some of which can be implemented in primary care, can be effective. As a way of demonstrating why it is worthwhile to spend money on these interventions, the Department of Health developed a spreadsheet to be used by local commissioners.

Department of Health “Ready Reckoner” (Spreadsheet)

user input Hillingdon Select PCT in drop down box below PCT Increasing Risk Drinkers 44,751 Hillingdon 5AT Higher Risk Drinkers 10,886 Dependent 5,867 Binge 21,593 Alcohol Health Workers (AHW) N

• n-dependent drinkers

Visits/admissions averted N umber of nurses wte A&E hospital extra cost benefit 2009/10 10.00 5,500 367 £600,000 £675,000 2010/11 10.00 5,500 367 £600,000 £675,000 2011/12 10.00 5,500 367 £600,000 £675,000 Alcohol Health Workers (AHW) Dependent drinkers visits/admissions averted N umber of nurses wte A&E hospital extra cost benefit 2009/10 1.00 295 172 £60,000 £145,200 ## 2010/11 1.00 295 172 £60,000 £145,200 2011/12 1.00 295 172 £60,000 £145,200 Treatment-dependent drinkers N umber 5,867 MET or SBNT counselling packages (UKATT) Increase in treatment: percentage points of prevalence (ppop), or input extra proposed to treat extra %popextra treated A&E hospital extra cost benefit 2009/10 2.0 100 18 22 £20,000 £61,100

• Past trend

2010/11 2.0 117 21 26 £23,500 £71,700

• Projection

2011/12 2.0 117 21 26 £23,500 £71,700

• Future trend with the selected interventions

IBA - GP screening new registrants input number screened % screened who get BA 20% 16,979 screened A&E hospital extra cost benefit 2009/10 5000 1.0 20 18 £15,500 £14,600 2010/11 5000 1.0 32 20 £15,500 £16,600 2011/12 5000 1.0 45 21 £15,500 £18,700

1000 2000 3000 4000 5000 6000 7000 Admissions

Symmetric Project Brief:

• To develop a “tool” similar to

Ready Reckoner but more of a “model” with a User Friendly Interface

• Assumption that the Ready

Reckoner was probably “correct”

Increasing Risk Higher Risk

reducing reducing reducing increasing increasing increasing

Policies

£

Abstainers Lower Risk

Increasing Risk Higher Risk

reducing reducing reducing increasing increasing increasing

Services

£

Policies

£

Services Services Abstainers Lower Risk

Abstainers Lower Risk Increasing Risk Higher Risk

reducing reducing reducing increasing increasing increasing

Hospital Admissions

£ £

Services

reducing risk increasing risk

Hospital Admissions

£

Services Policies Consumption Services Services

time lag

• +

Time Period Covered – 20years

2005 2010 2020

• New services are introduced in 2010
• Further changes can be made when the model pauses
• Note the time delay before some effects register

= =

What is the Underlying Flow Rate between Consumption Groups?

• It cannot be deduced from observing the stocks

This simple insight led to the Department of Health calculating, for the first time, what the underlying rate of movement between consumption groups actually is.

The model works by enabling a user to

• Introduce a new service

capacity, at a point in time

• Make assumptions about its

impact on alcohol consumption (screen not shown) Then on the model dashboard, user can switch on these new service settings, and observe the impact on hospital admissions and total costs

Total admissions Total costs Change in admissions (pa) Change in total costs (pa)

Impact of Brief Advice Services on Whole Population over Time

• Model simulates some key dynamics that are harder to

show on a spreadsheet

• time delay between intervention and health

improvement

• Cumulative impact on Population
• Dynamic view of changing consumption, new data
• “Invest to save”, the case is made, but there will be a few

years of higher expenditure at a time when costs are tight

• Available as a “runtime” tool for commissioners in England

(and anyone else interested)

• Wider public benefits of reductions in alcohol consumption

can also be considered (some interest in the model from the criminal justice system)

• There may be less costly ways of reducing alcohol

consumption, e.g. “minimum pricing”

For further information:- douglas.mckelvie@symmetricpartnership.co.uk Model available at:- http://www.alcohollearningcentre.org.uk/Topics/Browse/Data/Datatools (or search for “alcohol systems model” “Department of Health” “Alcohol Learning Centre” “England”)