1. Investing in a healthy community: making the most of NICE’s ROI tools Judith Richardson Health & Social Care Directorate

2. Step 1 Cost effectiveness –To determine whether the benefits from public health interventions are worth the costs

3. NICE public health guidance 2006-2010 (Owen et al 2012): 200 cost effectiveness estimates modelled for various interventions

4. Step 2 Resource Impact –estimates the impact on annual healthcare use and cost for the first, second and subsequent years after the introduction of the new product for a population –helps estimate the cost of implementation

5. NICE resource impact tools Aim to identify key resource issues for each piece of guidance Not just the costs – savings too where possible Build business cases

6. Step 3 Return on Investment –designed to support investment decisions by commissioners and policy makers in local authorities and the NHS. –Evaluate a portfolio of interventions in a geographical area (e.g. region, county or local authority) and models the economic returns that can be expected in different payback timescales

7. Approach to ROI Cost impact project – to inform approach taken Key elements of the tools –Report health and non-health outcomes and costs in disaggregated format –Report a range of economic metrics for short, medium and long term time horizons –Develop scenario analyses around different intervention options

8. What can ROI tools be used for? Build a business case for investment Protect what is currently being done Inform allocation of resource within a programme Inform allocation of resource across programmes

9. “…essentially, all models are wrong, but some are useful” Not the full answer Needs interpretation and contextualising Full awareness of assumptions in models Starting point for discussions Part of the evidence base to support decision making

10. NICE Return on Investment Tools 3 tools (MS Excel) –Tobacco –Alcohol Use –Physical Activity 2 in development –Mental wellbeing across the life-course –Children & young people Available from http://www.nice.org.uk/about/what- we-do/into-practice/return-on-investment-toolshttp://www.nice.org.uk/about/what- we-do/into-practice/return-on-investment-tools

11. Example questions the ROI tool can help you to answer What is physical inactivity/Tobacco/Alcohol costing in my local area? What is the ROI for my current package of services? What happens if I increase the strategies to reduce physical inactivity/alcohol/Tobacco? If I would like to improve a particular service, how does that affect the ‘value for money’ of my package of interventions? –Can I save more money? –When can I start saving money (how many years)?

12. Examples of how tools have been used In 2013 the tobacco programme lead in Kent Council secured £0.5m for tobacco control over and above existing expenditure on smoking cessation services using outputs from the tobacco ROI tool. In 2012, the regional tobacco programme manager for the South West used the tobacco ROI tool to maintain funding levels when cuts had been planned. The North East region has also used the tool to secure funding

13. Support for using the tools NICE & PHE PHE “super-users/SPOCs” – assumptions and health warnings, shared learning NICE website Technical manual/user guide Video Ongoing work Case studies (how used in local practice) Convert existing tools to web-based functionality