Title: Guidance for health economic modellers for incorporating individual and aggregate behaviour into models of Public Health interventions
Funder: Department of Health and Social Care

Abstract: Background Commissioners of Public Health interventions need to decide where best to spend their money in order to maximise health gains and/or reduce health inequalities. Health economic models use evidence from multiple sources to predict all important differences in outcomes between the intervention(s) and current practice, which can inform policy decisions. Health economic models of behaviour-change interventions typically either exclude behaviour from the model, including only risk factors such as cholesterol, or they make simplified assumptions based on limited or no evidence, for example that behaviour remains constant over each individual's lifetime. However, in other disciplines, like psychology, theories have been developed to try to explain how and why an individual's behaviour changes. In other disciplines, like sociology, different types of models are used to predict the behaviour of a group based on understanding the behaviour of individuals and their interaction with their environment. Model predictions could be improved by drawing upon research from these other disciplines, which would decrease the risk of making wrong decisions about how best to spend limited public funds. Aims and objectives The aim of the research is to develop guidance for health economic modellers for incorporating behaviour into models which compare the effectiveness and cost-effectiveness of behaviour-change interventions. The guidance will consider modelling of individual behaviours and the impact of social groupings and factors within a person's environment upon their behaviour. This will provide modellers with tools to make better predictions. Specific objectives are: To identify and critically review existing methods for incorporating behaviour within quantitative models (across disciplines). To use an iterative approach to develop a taxonomy of methods for modelling individual and aggregate behaviour within health economic models of behaviour-change interventions, setting out requirements for each method including data, resources and technical skill. To test the taxonomy and methods within case studies assessing the cost-effectiveness of behaviour-change interventions in order to improve them. To extend an existing conceptual modelling framework of Public Health interventions to provide guidance to health economic modellers about incorporating behaviour into a health economic model. To disseminate the research to modellers, decision makers and members of the public.Anticipated impact and dissemination This research has the potential to improve predictions of the effectiveness and cost-effectiveness of behaviour-change interventions, and hence improve resource allocation decisions. This would result in improved health and wellbeing of the general public overall. It could also facilitate decisions about targeting specific populations, hence aiming to reduce inequalities. The research findings will be disseminated via a broad range of methods, including presenting at conferences, publishing in high impact peer-reviewed journals, within ScHARR and collaborators' websites, commissioners' forums, and other social media (eg. via existing blogs and twitter accounts). I will connect with relevant commissioning bodies and academic departments throughout the project with the aim of increasing the impact of the research. I will consult with stakeholders, including public representatives, to understand the best approach to dissemination to achieve the biggest impact of the research.

Lay abstract: Background to the research: The government and local commissioners fund efforts to prevent disease and promote health, many of which aim of change behaviour. Examples include media campaigns to stop smoking and GP advice to exercise. Commissioners need to decide where best to spend their money to improve health, and trial results do not usually provide enough information. Health economic models use computer software to bring together information about all of the expected costs and outcomes of different options, so that their long-term effectiveness and cost-effectiveness can be compared. This allows decision makers to make more informed decisions about which options to fund, given their budget. At present, human behaviour is often not included in a health economic model, and when it is, it is usually based on little information. However, in some areas, like psychology, theories have been developed to try to explain how and why people's behaviour changes. In other areas, like sociology, different types of models are used to predict the behaviour of a group based on understanding the behaviour of individuals and their interaction with their environment. Not many attempts have been made to include this work in health economic models, yet model predictions could be improved by including it. Aim of the research: To develop guidance for health economic modellers for incorporating behaviour into models which compare the effectiveness and cost-effectiveness of behaviour-change interventions. The guidance will consider modelling of individual behaviours and the impact of social groupings and factors within a person's environment upon their behaviour. It will provide modellers with tools to make better predictions, which will enable policy makers to make more informed decisions about where to spend limited public resources. This could increase the overall health and wellbeing of the general public. The research could also help with decisions about targeting specific groups of people who may be more vulnerable, which could lead to a decrease in inequalities. Design and methods used: The methods used within the research will be: A literature review of existing methods for incorporating behaviour within quantitative models across disciplines. An iterative approach, based on existing research and stakeholder engagement, to developing a set of methods for modelling behaviour within health economic models, including when to use each method in terms of data, resources and technical skill needed. Testing the use of the methods within case studies assessing the cost-effectiveness of behaviour-change interventions in order to improve them. Extending existing guidance about developing the structure of Public Health models to provide guidance to health economic modellers about incorporating behaviour into a model. Sharing the guidance with modellers, decision makers and members of the public.Patient and public involvement: Members of the public have already been involved in research design and they will input throughout the project. Part of their involvement will be in defining how they can best help at each stage of the project. They will be involved in particular in informing the selection and design of models of behaviour, the case studies and in dissemination of the research. Dissemination: I will publish at least three journal articles about the different parts of the project and it will be presented at relevant conferences and using social media. I will also connect with relevant commissioning bodies and academic departments throughout the project with the aim of increasing the impact of the research. I will consult with stakeholders, including public representatives, to understand the best approach to dissemination to achieve the biggest impact of the research.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE