Impact of smoking on health system costs among cancer patients in a retrospective cohort study in Ontario, Canada

Preoperative Anemia Prior to Gynecologic Surgery is Associated with Increased Healthcare Costs

OBJECTIVE

To compare healthcare utilization costs between anemic and nonanemic patients undergoing elective hysterectomy and myomectomy for benign indications from the date of surgery to 30 days postoperatively.

DESIGN

Retrospective population-based cohort study.

SETTING

Single-payer publicly funded healthcare system in Ontario, Canada between 2013 and 2020.

PARTICIPANTS

Adult women (≥18 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic/laparotomy) for benign indications.

INTERVENTIONS

Our exposure of interest was preoperative anemia, defined as the most recent hemoglobin value <12 g/dL on the complete blood count measured before the date of surgery. Our primary outcome was healthcare costs (total and disaggregated) from the perspective of the single-payer publicly funded healthcare system.

RESULTS

Of the 59 270 patients in the cohort, 11 802 (19.9%) had preoperative anemia. After propensity matching, standardized differences in all baseline characteristics (N = 10 103 per group) were <0.10. In the matched cohort, the mean total healthcare cost per anemic patient was higher compared to cost per nonanemic patient ($6134.88 ± $2782.38 vs $6009.97 ± $2423.27, p < .001). Anemic patients, compared to nonanemic patients, had a higher mean difference in total healthcare cost of $124.91 per patient (95% CI $53.54-$196.29) translating to an increased cost attributable to anemia of 2.08% (95% CI 0.89%-3.28%, p < .001). In a subgroup analysis of patients undergoing hysterectomy (N = 9041), the cost was also significantly higher for anemic patients (mean difference per patient of $117.67, 95% CI $41.58-$193.75). For those undergoing myomectomy (N = 1062) the difference in cost was not statistically significant (mean difference $186.61, 95% CI -$17.42 to $390.65).

CONCLUSION

Preoperative anemia was associated with significantly increased healthcare resource utilization and costs for patients undergoing elective gynecologic surgery. Although the cost difference per case was modest, when extrapolated to the population level, this difference could result in substantially significant cost to the healthcare system, attributable to preoperative anemia.

Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis

BACKGROUND

There remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic status (SES) populations is still unknown.

OBJECTIVE

To assess the effectiveness of multicomponent tobacco dependence interventions for low SES and create a checklist tool examining multicomponent interventions.

METHODS

EMBASE and MEDLINE databases were searched to identify randomised controlled trials (RCTs) published with the primary outcome of tobacco smoking cessation measured at 6 months or post intervention. RCTs that evaluated tobacco dependence management interventions (for reduction or cessation) in low SES (experience of housing insecurity, poverty, low income, unemployment, mental health challenges, illicit substance use and/or food insecurity) were included. Two authors independently abstracted data. Random effects meta-analysis and post hoc sensitivity analysis were performed.

RESULTS

Of the 33 included studies, the number of intervention components ranged from 1 to 6, with smoking quit rates varying between 1% and 36.6%. Meta-analysis revealed that both the 6-month and 12-month outcome timepoints, multicomponent interventions were successful in achieving higher smoking quit rates than the control (OR 1.64, 95% Cl 1.41 to 1.91; OR 1.74, 95% Cl 1.30 to 2.33). Evidence of low heterogeneity in the effect size was observed at 6-month (I2=26%) and moderate heterogeneity at 12-month (I2=56%) outcomes.

CONCLUSION

Multicomponent tobacco dependence interventions should focus on inclusion of social support, frequency and duration of components. Employing community-based participatory-action research approach is essential to addressing underlying psychosocioeconomic-structural factors, in addition to the proven combination pharmacotherapies.

PROSPERO REGISTRATION NUMBER

CRD42017076650.