SummaryNon-communicable diseases (NCDs), particularly type 2 diabetes, cardiovascular disease, and cancer are the leading cause of morbidity and mortality in Germany. Unhealthy behavioral factors such as smoking, unhealthy diets, and physical inactivity play an important role in the etiology of these diseases because they may lead to obesity, hypertension, hyperglycemia, and dyslipidemia. These factors impact health-related quality of life and are further patterned along a social gradient leading to substantial health inequalities. In addition to their health burden, NCDs also place a significant burden on the economy and social care systems through increased health service use, treatment costs, early retirement, and premature mortality. This is particularly the case in Germany, where a third of the population will be above 60 years in 2035. Importantly, the potential for population-based prevention policies to address behavioral risk factors in Germany and reduce related health inequalities is not exploited. Research on the potential long-term health and economic effects of such prevention policies is therefore needed to provide decisionmakers with actionable evidence and compare different NCD prevention approaches. However, it is methodologically challenging to produce such evidence. Using public health economic simulation models to evaluate the health and economic impacts of prevention policies over time can play an important role in this context. Yet, no modern comprehensive simulation model to perform such tasks is available in Germany. In this project, we will use nationally representative data from the baseline examination of the NAKO cohort to update and extend key input parameters of a state-of-the-art German microsimulation model (IMPACTNCD Germany). We developed IMPACTNCD Germany in a previous project where it was used to simulate the health and economic impacts of a taxation of sugar-sweetened beverages in Germany. However, the model is currently based on data from comparably old and often regional sources (e.g., the Kooperative Gesundheitsforschung in der Region Augsburg (KORA) and Nationale Verzehrsstudie II (NVS II) studies) and lacks several important clinical, behavioral, and sociodemographic variables. Therefore, our objectives for this project are: 1) To use modern statistical techniques to estimate distributions and correlations of behavioral and clinical NCD risk factors, health-related quality of life, and health care costs across socioeconomic groups; 2) To use this information to construct a synthetic German population with realistic sociodemographic, epidemiological, and economic properties for the IMPACTNCD Germany model; 3) To estimate incremental costs and health-related quality of life decrements associated with NCDs and their complications across sociodemographic groups as model input parameters; 4) To use the thus updated and newly parameterized IMPACTNCD Germany model to evaluate the long-term health, economic, and equity consequences of unhealthy lifestyles including unhealthy diets, physical inactivity, and smoking in Germany in a case study. The results of these scenario and policy simulations from IMPACTNCD Germany can provide important information to policymakers and stakeholders to guide public health policy decisions and improve population health in Germany. A previous project using this model-based approach for public health policy analysis generated a large media echo and interest from the public (https://www.hs.mh.tum.de/php/unsere-forschung-in-den-medien/).

Keywords policy-evaluation prevention public-health-policy simulation-modeling unhealthy-lifestyles

InstitutionsTechnische Universität München, Professorship of Public Health and Prevention, Technische Universität München, Lehrstuhl für Epidemiologie, Universtitätsklinikum Augsburg, Technical University of Munich, Helmholtz Zentrum München