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An economic evaluation of the Sustainable Farm Families Program
by Jonathan Boymal, Patricia Rogers, Susan Brumby and Stuart Willder
October 2007
RIRDC Publication No 07/094 RIRDC Project No WDH-3A
Executive Summary
What the report is about
This report presents the
results of an economic evaluation of the Sustainable Farm Families (SFF)
project, which is designed to influence farmers’ behaviours with respect
to health, safety and well being. The report sets out four different types
of economic analysis:
Who is the report
targeted at?
The report is targeted at
those involved in rural health, agricultural industries and the rural workforce,
particularly those with responsibilities for policy development and resource
allocation. It provides specific information about a particular project
and provides a methodology that could be adapted and further developed
for similar projects.
Background
The general health of rural
people is, by urban standards, poor, with rural and farming populations
having above average rates of premature morbidity and mortality through
heart disease, cancer and suicide. Improvements in rural health can be
expected to generate benefits that include: greater farm output, financial
benefits to all three levels of government related to reduced health and
other service expenditure and healthier farming communities and reduced
morbidity and premature mortality.
The SFF project is designed for people who have farmed for more than five years and are aged between 18 and 75 years. It is open to any member of a farming family business and participants are self -selecting. The SFF project engages with farming families through annual workshops, newsletters and their industry associations. Participants are tracked over three years using baseline health data, pre and post-knowledge surveys and personal action plans.
Aims
The aim of the project was
to provide an economic model of the impact and cost effectiveness of the
Sustainable Farm Families program which can then be used in a number of
industries, for example sugar, dairy and cotton.
Methods used
Data were collected on 128
participants involved in broad acre farming in five locations: Benalla,
Clare (SA), Hamilton, Horsham and Swan Hill. Evidence of changes in clinical
indicators came from three annual health assessments which provided data
on fasting cholesterol; fasting blood sugar; four indicators related to
obesity – body mass index, waist hip ratio, waist measurement, and percentage
of fat in body mass; systolic and diastolic blood pressure; and pulse rate.
In addition, the evaluation is based on analysis of the costs of implementing
the project (from records and reported purchases), evidence about changes
in behaviour (from self-report), projected changes to morbidity and mortality
(based on published research on risk factors), and on the estimated value
of these changes in terms of quality of life (based on published research)
and cost-savings (based on published research about the costs of cardiovascular
events and diabetes).
Figure 1 Overview of evidence and economic analyses of the SFF project
Results
The total costs of running
the project, consisting of project delivery costs, direct costs to participants,
and costs of additional health service utilisation, were calculated as
$141,189 for 128 participants across five sites. Participants in the SFF
project reported behaviour changes in terms of eating healthier food, undertaking
more exercise and safer farming work practices.
Measured clinical indicators, including body mass index, systolic blood pressure, total cholesterol level, waist circumference and waist hip ratio, showed statistically significant (p ? 0.05) average improvements over 12 and 24 months. Costs per risk factor eliminated ranged from $1,426 (total cholesterol) to $4,706 (weight).
On the basis of these changes in clinical indicators, it is projected that eight cases of diabetes per year and two cardio-vascular events over 10 years have been avoided.
In order to facilitate a comparison of the SFF project with other health projects that may involve qualitatively different outputs, a ‘Quality Adjusted Life Year’ (QALY) outcome measure was used. A Quality Adjusted Life Year is a measure of the additional length of life produced by health interventions, adjusted for the quality of life. Perfect health is rated as 1; death is rated as zero; different health states are rated with reference to these – usually some number between 0 and 1 but a negative score for health states was considered to be worse than death! QALYs can be added and compared – so that an intervention that leads to 10 extra years of life rated as 0.5 in quality would produce a total outcome of 5 QALYs.
Published weights in the literature were utilised for this report. In order to explicitly compare QALYs that are gained at different points in time, future QALYs are ‘factored down’ so that they can be expressed in present values. This ‘factoring down’ is known as ‘discounting’, and is consistent with the treatment of future benefits and costs in all economic evaluations.
The total gain in discounted QALYs over 10 years from the SFF project is calculated to be 4.33. This means that the equivalent of nearly 4 ½ years of perfect health.
Where half of the total costs of the SFF project are attributed to these outcomes (and half to other outcomes), the cost per discounted QALY gained is $16,304. These costs per QALY do not include downstream cost savings. The SFF project therefore achieves the $40,000 per QALY acceptability threshold (used as a standard for drug approvals) largely due to its contribution to reduced incidence of Type 2 diabetes.
Cost savings from the predicted reduced incidence of Type 2 diabetes (and subsequent savings in related health care) over 10 years are estimated at $154,929, which exceeds the total cost of the SFF project itself. This indicates that the SFF project generates net cost savings, even if we only consider its outcome in terms of diabetes incidence.
Implications for relevant
stakeholders
The economic analysis indicates
that the SFF project is good value for money in terms of changing behaviours
and thus improving health outcomes for rural Australians and saving government’s
money. This suggests it may be worthwhile expanding the project beyond
the study group.
In order for the economic analysis to be undertaken a robust methodology was developed that can be readily adapted to other projects that seek to influence health-related behaviours.
This report will assist in informing resource allocation decisions to ensure the greatest contribution to rural health improvement possible from a limited budget, by determining whether interventions designed to influence health related behaviours are particularly effective. Evaluation results will be used to inform future implementation of the SFF project and to inform the development of other projects to reduce morbidity and mortality among farming families.
Recommendations
Based on the findings of
this report, it is recommended that:
 
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