PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity

BMC Health Serv Res. 2019 Jul 16;19(1):485. doi: 10.1186/s12913-019-4237-4.


Background: Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes.

Methods: The multistate life table model, PRIMEtime Cost Effectiveness (PRIMEtime CE), is developed from the Preventable Risk Integrated ModEl (PRIME) and the PRIMEtime model. PRIMEtime CE uses routinely available data to estimate how changing diet and physical activity in England affects morbidity and mortality from heart disease, stroke, diabetes, liver disease, and cancers either directly or via raised blood pressure, cholesterol, and body weight.

Results: Model outcomes are change in quality adjusted life years, and change in English National Health Service and social care costs.

Conclusion: This paper describes PRIMEtime CE and highlights its main strengths and limitations. The model can be used to compare any number of public policies affecting diet and physical activity, allowing decision makers to understand how they can maximise population health with limited financial resources.

Keywords: Diet; Economic modelling; Modelling; Non-communicable disease; Physical activity; Public health; Public health economics.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Diet*
  • England
  • Exercise*
  • Female
  • Health Promotion / economics*
  • Humans
  • Infant
  • Infant, Newborn
  • Life Tables*
  • Male
  • Middle Aged
  • National Health Programs / economics
  • Public Policy
  • Quality-Adjusted Life Years
  • Risk Factors
  • State Medicine / economics
  • Young Adult