Article
A Decision-Analytic Model to Evaluate the Long-term Impacts of Nature-Based Social Prescribing Against Loneliness in Spain Informed by the RECETAS Study
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Authors
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Veronika Papon
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Beate Jahn
- Institute of Public Health, Medical Decision Making and HTA, Department of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Sibylle Puntscher
- Institute of Public Health, Medical Decision Making and HTA, Department of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Marjan Arvandi
- Institute of Public Health, Medical Decision Making and HTA, Department of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Jill S. Litt
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
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Montse Masó-Aguado
- Research Group On Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
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Kaisu Pitkälä
- Department of General Practice and Helsinki University Hospital, Unit of Primary Care, University of Helsinki, Helsinki, Finland
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Iva iff Kolářová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
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Blanka Novotna
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
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Alzbeta Bartova
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
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Mat Jones
- Centre for Public Health and Wellbeing, University of the West of England, Bristol, United Kingdom
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Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria; Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard Chan School of Public Health, Boston, United States; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| Published: | September 6, 2024 |
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Outline
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Introduction: Loneliness is linked to diseases such as depression, diabetes, or cardiovascular diseases. Nature-based social prescribing (NBSP) targets loneliness by connecting people to nature-based group activities. This study aims to provide a framework and modelling concept for the health-economic evaluation of NBSP vs. no NBSP.
Methods: We developed a conceptual framework and decision-analytic model (DAM) structure based on a systematic literature review and expert panel focus groups, linking a three-month clinical trial in Barcelona of the EU-Horizon 2020 project RECETAS (no. 945095, https://www.recetasproject.eu/) with long-term outcomes [1], [2]. The framework specifies the intervention, comparator, target population, setting, health states, perspective, time horizon, cycle length, model type, outcomes, and planned analyses. Model input includes data derived from the trial (such as the intervention, setting or target population) complemented by data from national databases and published literature (such as health states or epidemiological data). Health consequences of loneliness were searched and hierarchically sorted based on their impact on mortality, utilities, and costs reflecting disease severity. Face validity of the model structure and framework was ensured by experts on DAM and NBSP.
Results: Model outcomes include life-long benefits (loneliness-free years, quality-adjusted life years, years of full capability), harms, and costs measured from a societal perspective. A Markov-state-transition model structure was chosen combining three loneliness states (i.e., ‘Lonely’, ‘Reduced loneliness’, ‘Final lonely’), with a healthy or a loneliness-related disease state, identified in alignment to the WHO 2021 [3], including 'Depression&Anxiety', 'Diabetes', 'Dementia', and 'Cardiovascular Diseases&Stroke', not considering further comorbidities explicitly. Two absorbing states, death from background mortality and loneliness-disease-related death (including suicide) were modeled. Reflecting the RECETAS trial, the simulated closed cohort of adults living in Spain will have the participants' average age. A cycle length of three months was chosen to represent the duration of the NBSP intervention. Participants start lonely and healthy, receiving either NBSP or no NBSP in the first cycle. At the end of each cycle, participants can remain remain lonely, become reduced lonely, develop a disease, or die. If lonely with a disease, participants can stay, become reduced lonely within the respective disease, or die. Reduced lonely individuals can relapse to final lonely within the life-long time horizon, with no possibility becoming reduced lonely again as this would need a second intervention. Intervention costs, utility values for the loneliness states and transition probabilities between loneliness states are derived from trial data, considering a sustained but decreasing intervention effect of NBSP. Other input parameters, such as costs and utility values for the diseases or loneliness-state-dependent probabilities to develop a disease or to die, will be taken from published literature, government reports, and administrative data. Negative effects and harms resulting from the NBSP intervention will be evaluated based on trial data. Finally, a cost-effectiveness, cost-capability, and cost-utility analysis will be performed to calculate the additional costs per additional unit of effectiveness, capability, or utility.
Conclusion: Our Markov model structure linking short-terms states with long-term disease consequences of loneliness can be applied to the evaluation of NBSP as loneliness-reduction strategy in Spain beyond the RECETAS trial period.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
References
- 1.
- Coll-Planas L, Carbo-Cardena A, Jansson A, Dostalova V, Bartova A, Rautiainen L, et al. Nature-based social interventions to address loneliness among vulnerable populations: a common study protocol for three related randomized controlled trials in Barcelona, Helsinki, and Prague within the RECETAS European project. BMC Public Health. 2024;24(1):172.
- 2.
- Litt JS, Coll-Planas L, Sachs A, Rochau U, Jansson A, Dostálová V, et al. Nature-based social interventions for people experiencing loneliness: the rationale and overview of the RECETAS project. Cities & Health. 2024:1-14.
- 3.
- World Health Organization. Social isolation and loneliness among older people: advocacy brief. Geneva; 2021.
