University of Sheffield, Sheffield, UK.
University of Cambridge, Cambridge, UK.
BMC Public Health. 2024 Mar 12;24(1):764. doi: 10.1186/s12889-024-18134-4.
Health economic modelling indicates that referral to a behavioural weight management programme is cost saving and generates QALY gains compared with a brief intervention. The aim of this study was to conduct a cross-model validation comparing outcomes from this cost-effectiveness analysis to those of a comparator model, to understand how differences in model structure contribute to outcomes.
The outcomes produced by two models, the School for Public Health Research diabetes prevention (SPHR) and Health Checks (HC) models, were compared for three weight-management programme strategies; Weight Watchers (WW) for 12 weeks, WW for 52 weeks, and a brief intervention, and a simulated no intervention scenario. Model inputs were standardised, and iterative adjustments were made to each model to identify drivers of differences in key outcomes.
The total QALYs estimated by the HC model were higher in all treatment groups than those estimated by the SPHR model, and there was a large difference in incremental QALYs between the models. SPHR simulated greater QALY gains for 12-week WW and 52-week WW relative to the Brief Intervention. Comparisons across socioeconomic groups found a stronger socioeconomic gradient in the SPHR model. Removing the impact of treatment on HbA1c from the SPHR model, running both models only with the conditions that the models have in common and, to a lesser extent, changing the data used to estimate risk factor trajectories, resulted in more consistent model outcomes.
The key driver of difference between the models was the inclusion of extra evidence-based detail in SPHR on the impacts of treatments on HbA1c. The conclusions were less sensitive to the dataset used to inform the risk factor trajectories. These findings strengthen the original cost-effectiveness analyses of the weight management interventions and provide an increased understanding of what is structurally important in the models.
健康经济学模型表明，与简短干预相比，将患者转介到行为体重管理项目可以节省成本并增加 QALY 收益。本研究的目的是通过比较两种模型的结果来进行跨模型验证，以了解模型结构的差异如何导致结果的不同。
比较了两种模型（公共卫生研究糖尿病预防（SPHR）和健康检查（HC）模型）的结果，比较了三种体重管理计划策略的结果：Weight Watchers（WW）12 周、WW 52 周和简短干预，以及模拟无干预情景。对模型输入进行了标准化，并对每个模型进行了迭代调整，以确定关键结果差异的驱动因素。
HC 模型估计的总 QALYs 在所有治疗组中均高于 SPHR 模型估计的总 QALYs，并且两个模型之间的增量 QALYs 存在很大差异。SPHR 模拟了 12 周 WW 和 52 周 WW 相对于简短干预的更大 QALY 收益。在社会经济群体的比较中，SPHR 模型中存在更强的社会经济梯度。从 SPHR 模型中删除治疗对 HbA1c 的影响，仅使用模型共有的条件运行两个模型，并且在较小程度上更改用于估计风险因素轨迹的数据，会导致模型结果更加一致。
模型之间差异的主要驱动因素是 SPHR 中包含了更多关于治疗对 HbA1c 的影响的循证详细信息。结论对用于告知风险因素轨迹的数据集中使用的数据集的敏感性较低。这些发现增强了体重管理干预的原始成本效益分析，并提高了对模型中结构重要性的理解。
