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Ride J, Kasteridis P, Gutacker N, Gravelle H, Rice N, Mason A, Goddard M, Doran T, Jacobs R. Impact of prevention in primary care on costs in primary and secondary care for people with serious mental illness. HEALTH ECONOMICS 2023; 32:343-355. [PMID: 36309945 PMCID: PMC10092448 DOI: 10.1002/hec.4623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
A largely unexplored part of the financial incentive for physicians to participate in preventive care is the degree to which they are the residual claimant from any resulting cost savings. We examine the impact of two preventive activities for people with serious mental illness (care plans and annual reviews of physical health) by English primary care practices on costs in these practices and in secondary care. Using panel two-part models to analyze patient-level data linked across primary and secondary care, we find that these preventive activities in the previous year are associated with cost reductions in the current quarter both in primary and secondary care. We estimate that there are large beneficial externalities for which the primary care physician is not the residual claimant: the cost savings in secondary care are 4.7 times larger than the cost savings in primary care. These activities are incentivized in the English National Health Service but the total financial incentives for primary care physicians to participate were considerably smaller than the total cost savings produced. This suggests that changes to the design of incentives to increase the marginal reward for conducting these preventive activities among patients with serious mental illness could have further increased welfare.
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Affiliation(s)
- Jemimah Ride
- Health Economics UnitMelbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | | | | | | | - Nigel Rice
- Centre for Health EconomicsUniversity of YorkYorkUK
| | - Anne Mason
- Centre for Health EconomicsUniversity of YorkYorkUK
| | | | - Tim Doran
- Health SciencesUniversity of YorkYorkUK
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Kumar R, Sahu M, Rodney T. Efficacy of Motivational Interviewing and Brief Interventions on tobacco use among healthy adults: A systematic review of randomized controlled trials. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e03. [PMID: 36867776 PMCID: PMC10017134 DOI: 10.17533/udea.iee.v40n3e03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/06/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults. METHODS For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trialson the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. RESULTS A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. CONCLUSIONS The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.
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Affiliation(s)
- Rajesh Kumar
- All India Institute of Medical Sciences (AIIMS) Rishikesh Uttarakhand, India. . Corresponding author
| | - Maya Sahu
- College of Nursing Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India.
| | - Tamar Rodney
- Johns Hopkins School of Nursing, Baltimore MD, USA.
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Veldhuizen S, Zawertailo L, Noormohamed A, Hussain S, Selby P. Treatment use patterns in a large extended-treatment tobacco cessation program: predictors and cost implications. Tob Control 2022; 31:549-555. [PMID: 33419946 DOI: 10.1136/tobaccocontrol-2020-056203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tobacco dependence follows a chronic and relapsing course, but most treatment programmes are short. Extended care has been shown to improve outcomes. Examining use patterns for longer term programmes can quantify resource requirements and identify opportunities for improving retention. METHODS We analyse 38 094 primary care treatment episodes from a multisite smoking cessation programme in Ontario, Canada that provides free nicotine replacement therapy (NRT) and counselling. We calculate distributional measures of weeks of NRT used, clinical visits attended and total length of care. We then divide treatment courses into four exclusive categories and fit a multinomial logistic regression model to measure associations with participant characteristics, using multiple imputation to address missing data. RESULTS Time in treatment (median=50 days), visits (median=3) and weeks NRT used (median=8) were well below the maximum available. Of all programme enrolments, 28.8% (95% CI=28.3% to 29.3%) were single contacts, 31.3% (30.8% to 31.8%) lasted <12 weeks, 19.2% (18.8% to 19.6%) were ≥12 weeks with an 8-week interruption and 20.7% (20.3%-21.1%) were ≥12 weeks without interruptions. Care use was most strongly associated with participant age and whether the nicotine patch was dispensed at the first visit. CONCLUSION Treatment use results imply that the marginal costs of extending treatment programmes are relatively low. The prevalence of single contacts supports additional engagement efforts at the initial visit, while interruptions in care highlight the ability of longer term care to address relapse. Results show that use of the nicotine patch is associated with retention in care, and that improving engagement of younger patients should be a priority.
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Affiliation(s)
- Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aliya Noormohamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarwar Hussain
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Goffin JR, Pond GR, Puksa S, Tremblay A, Johnston M, Goss G, Nicholas G, Martel S, Bhatia R, Liu G, Schmidt H, Atkar-Khattra S, McWilliams A, Tsao MS, Tammemagi MC, Lam S. Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population. BMC Pulm Med 2020; 20:300. [PMID: 33198781 PMCID: PMC7670711 DOI: 10.1186/s12890-020-01344-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008) Supplementary Information The online version contains supplementary material available at 10.1186/s12890-020-01344-y.
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Affiliation(s)
- John R Goffin
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada.
| | - Gregory R Pond
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada
| | - Serge Puksa
- Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON, L8V 5C2, Canada
| | - Alain Tremblay
- University of Calgary, 3300 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Michael Johnston
- Dalhousie University, 5850 College St, PO Box 15000, Halifax, NS, B3J 3Z3, Canada
| | - Glen Goss
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Rd, Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Garth Nicholas
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Rd, Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Simon Martel
- Centre de recherche de l'Institut universitaire de cardiologie et pneumonolgie de Québec, Université Laval, QC, Québec, G1V 4G5, Canada
| | - Rick Bhatia
- Health Sciences Centre - General Hospital, Memorial University, 300 Prince Phillip Dr, St. John's, NF, A1B 3V6, Canada
| | - Geoffrey Liu
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Sukhinder Atkar-Khattra
- British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, University of Western Australia, 11 Robin Warren Dr, Murdoch, W Australia, 6150, Australia
| | - Ming-Sound Tsao
- University Health Network and Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, Walker Complex South, Rm 306, 500 Glenridge Ave, St. Catharines, ON, L2S 3A1, Canada
| | - Stephen Lam
- British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
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Chalati W, Crilly P, Fletcher J, Kayyali R. A Comparative Study of the Cost and Uptake of Community Pharmacy "Stop Smoking and Emergency Contraception" Services from the Perspective of the National Health Service. J Res Pharm Pract 2020; 9:73-87. [PMID: 33102381 PMCID: PMC7547741 DOI: 10.4103/jrpp.jrpp_20_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/21/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective. METHODS This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant. FINDINGS SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness. CONCLUSION Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.
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Affiliation(s)
- Wail Chalati
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Philip Crilly
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - John Fletcher
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
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Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Arifin AJ, McCracken LC, Nesbitt S, Warner A, Dinniwell RE, Palma DA, Louie AV. Does free nicotine replacement improve smoking cessation rates in cancer patients? Curr Oncol 2020; 27:14-18. [PMID: 32218655 PMCID: PMC7096202 DOI: 10.3747/co.27.5267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Cigarette smoking is carcinogenic and has been linked to inferior treatment outcomes and complication rates in cancer patients. Here, we report the results of an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt). Methods In January 2017, the smoking cessation program at our institution began offering free nrt for actively cigarette-smoking patients with cancer. The cost of 4 weeks of nrt was covered by the program, and follow-up was provided by smoking cessation champions. Results From January 2017 to June 2018, 8095 patients with cancer were screened for cigarette use, of whom 1135 self-identified as current or recent smokers. Of those 1135 patients, 117 enrolled in the program and accepted a prescription for nrt. The rates of patient referral and patients attending a referral appointment were significantly higher in 2018-2018 than they had been in 2015-2016 (100% vs. 80.3%, p < 0.001, and 27.6% vs. 11.3%, p < 0.001, respectively). Median follow-up was 9.0 months (25%-75% interquartile range: 5.7-11.6 months). Of the patients who accepted nrt and who also had complete data (n = 71), 25 (35.2%) reported complete smoking cessation, and 32 (45.1%) reported only decreased cigarette smoking. On univariable analysis, no factors were significantly predictive of smoking cessation, although initial cigarette use (>10 vs. ≤10 initial cigarettes) was significantly predictive of smoking reduction (odds ratio: 5.04; 95% confidence interval: 1.46 to 17.45; p = 0.011). Conclusions This pilot study of free nrt demonstrated rates of referral and acceptance of nrt that were improved compared with historical rates, and most referred patients either decreased their use of cigarettes or quit entirely.
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Affiliation(s)
- A J Arifin
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - L C McCracken
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - S Nesbitt
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - A Warner
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - R E Dinniwell
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - D A Palma
- Division of Radiation Oncology, London Regional Cancer Program, London
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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Tutka P, Vinnikov D, Courtney RJ, Benowitz NL. Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction 2019; 114:1951-1969. [PMID: 31240783 DOI: 10.1111/add.14721] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/08/2019] [Accepted: 06/18/2019] [Indexed: 01/30/2023]
Abstract
AIMS To review cytisine's history of use, pre-clinical evidence, clinical pharmacokinetics, efficacy, adverse reactions (ARs) and safety for smoking cessation. METHODS A synoptic review of the use of cytisine as a smoking cessation medication, mechanism of action, pharmacokinetics and safety. Relevant literature on data included in these sections were identified through a search of 11 databases with additional literature obtained from reports and monographs. Three databases (PubMed, EMBASE and www.elibrary.ru) were systematically searched for studies published from 2012 to August 2018 in any language to provide an updated meta-analysis of cytisine's efficacy and ARs for smoking cessation compared with placebo. We pooled the relative risks (RR) of abstinence in the efficacy analysis and RR of ARs, either reported by the authors or calculated from the reports. RESULTS Cytisine has been in use since 1964 and is currently marketed in 18 countries. Systemic bioavailability from oral ingestion is high and clearance is primarily renal, with minimal or no metabolism. Brain uptake in animal models is moderate. The plasma half-life averages 4.8 hours. Eight studies were included for meta-analysis of efficacy. With heterogeneous results, the overall RR versus placebo of successful continuous abstinence at the longest follow-up was 1.74 [95% confidence interval (CI) = 1.38-2.19]. Nausea, vomiting, dyspepsia, upper abdominal pain and dry mouth that were mild or moderate were the most common ARs, with RR versus placebo 1.10 (95% CI = 0.95-1.28). The cost of cytisine in eastern and central Europe is several-fold less than that of other smoking cessation medications. CONCLUSIONS Cytisine is a low-cost medication found to increase the likelihood of smoking cessation. The most frequently reported ARs of cytisine involve gastrointestinal symptoms that are mostly reported as either mild or moderate in severity.
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Affiliation(s)
- Piotr Tutka
- Department of Experimental and Clinical Pharmacology, University of Rzeszów, Rzeszów, Poland.,Laboratory for Innovative Research in Pharmacology, University of Rzeszów, Rzeszów, Poland.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Denis Vinnikov
- School of Public Health, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Biological Institute, National Research Tomsk State University, Tomsk, Russia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
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Doarn CR, Vonder Meulen MB, Pallerla H, Acquavita SP, Regan S, Elder N, Tubb MR. Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care. JMIR Form Res 2019; 3:e11300. [PMID: 30924783 PMCID: PMC6460307 DOI: 10.2196/11300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. OBJECTIVE The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. METHODS A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. RESULTS Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. CONCLUSIONS Subject matter experts, although generally amenable to one another's disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.
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Affiliation(s)
- Charles R Doarn
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Mary Beth Vonder Meulen
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Harini Pallerla
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Shauna P Acquavita
- School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Saundra Regan
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Nancy Elder
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Matthew R Tubb
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
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Trapero‐Bertran M, Muñoz C, Coyle K, Coyle D, Lester‐George A, Leidl R, Németh B, Cheung K, Pokhrel S, Lopez‐Nicolás Á. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:65-75. [PMID: 29532966 PMCID: PMC6032934 DOI: 10.1111/add.14090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
AIMS To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. SETTING Spain. PARTICIPANTS Adult smoking population (16+ years). MEASUREMENTS Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. FINDINGS The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. CONCLUSIONS According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Bertalan Németh
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei‐Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Ángel Lopez‐Nicolás
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Department of Economics, Faculty of Business ScienceUniversidad Politécnica de Cartagena
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Walker N, Yang Y, Kiparoglou V, Pokhrel S, Robinson H, van Woerden H. An examination of user costs in relation to smokers using a cessation service based in the UK. BMC Health Serv Res 2018; 18:182. [PMID: 29544477 PMCID: PMC5856222 DOI: 10.1186/s12913-018-2985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking cessation services provide support to smokers who desire to quit. Published studies to date have looked at the cost and benefit of service provision but typically focus on clinical trial data. Using routinely collected observational data, this study examined the costs involved in providing a service in terms of average health care expenditure per successful quit attempt in addition to population - level cost-effectiveness measures. METHODS Data were analysed from Quit-51 smoking cessation service across five English regions between March 2013 and March 2016 (n = 9116). For each user, costs were estimated in relation to: (i) time spent with advisers; (ii) prescription of pharmacotherapy. The total costs compared against self-reported quit at 12 weeks, which represents the time period for which the service is offered. Cost per quit (CPQ), with 95% confidence interval (CI), was calculated by relating total expenditure to the number of quitters, firstly for the whole dataset and then by subgroups of key categorical variables, namely; gender, age group, the Fagerstrom test for nicotine dependence (FTND) and Index of Multiple Deprivation (IMD). Confidence intervals (CIs) for the mean estimates were derived using a non-parametric bootstrap procedure. Parameters derived from the calculation in relation to treatment were used to estimate potential long-term population outcomes under a scenario where the Quit 51 prescription was rolled out nationally. RESULTS The overall mean CPQ for this sample as estimated at 12 weeks was £403.51 (95% CI = £393.36 to £413.76). The estimated CPQs at this time point were comparable for those aged 12-19 (£423.56, 95% CI = £369.45 to £492.60) and those aged 20-29 (£430.76, 95% CI = £395.95 to £470.56). Differences were also seen in relation to other subgroups considered. The treatment parameters translated to a projected increase of 1.5 quality-adjusted life years (QALYs) per 1000 smokers in the short-term and 23.4 QALYS per 1000 smokers based on a lifetime horizon. CONCLUSIONS These figures throw light on service expenditure for each successful quit over the timeframe for which the service is offered in addition to highlighting variability in these costs across different subgroups of the user population.
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Affiliation(s)
- Neil Walker
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.,Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University, Uxbridge, UB8 3PH, UK
| | | | - Hugo van Woerden
- Institute of Primary Care & Public Health, Cardiff University, Cardiff, UK.,Centre for Health Science, University of the Highlands and Islands, Inverness, IV2 3JH, UK
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12
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Rejas-Gutiérrez J, Bruguera E, Cedillo S. Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain. Eur Psychiatry 2017; 45:41-49. [PMID: 28728094 DOI: 10.1016/j.eurpsy.2017.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD. METHODS The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness. RESULTS The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios. CONCLUSIONS Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation.
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Affiliation(s)
- J Rejas-Gutiérrez
- Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas (Madrid), Spain.
| | - E Bruguera
- Addictive Behaviour Unit of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Cedillo
- Trial Form Support Develop, Madrid, Spain
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Berg ML, Cheung KL, Hiligsmann M, Evers S, de Kinderen RJA, Kulchaitanaroaj P, Pokhrel S. Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review. Addiction 2017; 112:946-967. [PMID: 28060453 PMCID: PMC5434798 DOI: 10.1111/add.13748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022]
Abstract
AIMS To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. METHODS A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist-based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider adult population and not from a high-income country were excluded. FINDINGS Among the 64 economic evaluations included in the review, the state-transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life-time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35-0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. CONCLUSION All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.
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Affiliation(s)
- Marrit L. Berg
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Kei Long Cheung
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Reina J. A. de Kinderen
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | | | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
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Goffin JR, Flanagan WM, Miller AB, Fitzgerald NR, Memon S, Wolfson MC, Evans WK. Biennial lung cancer screening in Canada with smoking cessation-outcomes and cost-effectiveness. Lung Cancer 2016; 101:98-103. [PMID: 27794416 DOI: 10.1016/j.lungcan.2016.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Guidelines recommend low-dose CT (LDCT) screening to detect lung cancer among eligible at-risk individuals. We used the OncoSim model (formerly Cancer Risk Management Model) to compare outcomes and costs between annual and biennial LDCT screening. METHODS OncoSim incorporates vital statistics, cancer registry data, health survey and utility data, cost, and other data, and simulates individual lives, aggregating outcomes over millions of individuals. Using OncoSim and National Lung Screening Trial eligibility criteria (age 55-74, minimum 30 pack-year smoking history, smoking cessation less than 15 years from time of first screen) and data, we have modeled screening parameters, cancer stage distribution, and mortality shifts for screen diagnosed cancer. Costs (in 2008 Canadian dollars) and quality of life years gained are discounted at 3% annually. RESULTS Compared with annual LDCT screening, biennial screening used fewer resources, gained fewer life-years (61,000 vs. 77,000), but resulted in very similar quality-adjusted life-years (QALYs) (24,000 vs. 23,000) over 20 years. The incremental cost-effectiveness ratio (ICER) of annual compared with biennial screening was $54,000-$4.8 million/QALY gained. Average incremental CT scan use in biennial screening was 52% of that in annual screening. A smoking cessation intervention decreased the average cost-effectiveness ratio in most scenarios by half. CONCLUSIONS Over 20 years, biennial LDCT screening for lung cancer appears to provide similar benefit in terms of QALYs gained to annual screening and is more cost-effective. Further study of biennial screening should be undertaken in population screening programs. A smoking cessation program should be integrated into either screening strategy.
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Affiliation(s)
- John R Goffin
- Department of Oncology, McMaster University, 699 Concession St., Hamilton, ON, L8V 5C2, Canada.
| | | | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Natalie R Fitzgerald
- Canadian Partnership Against Cancer, 1 University Ave., Suite 300, Toronto, ON M5J 2P1, Canada.
| | - Saima Memon
- Canadian Partnership Against Cancer, 1 University Ave., Suite 300, Toronto, ON M5J 2P1, Canada.
| | - Michael C Wolfson
- Department of Epidemiology and Community Medicine, University of Ottawa, 600 Peter Morand Crescent, Room 301 K, Ottawa, ON, K1G 5Z3, Canada.
| | - William K Evans
- Department of Oncology, McMaster University, 699 Concession St., Hamilton, ON, L8V 5C2, Canada.
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15
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Warren GW, Ostroff JS, Goffin JR. Lung Cancer Screening, Cancer Treatment, and Addressing the Continuum of Health Risks Caused by Tobacco. Am Soc Clin Oncol Educ Book 2016; 35:223-9. [PMID: 27249702 DOI: 10.1200/edbk_158704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tobacco use is the largest preventable risk factor for the development of several cancers, and continued tobacco use by patients with cancer and survivors of cancer causes adverse outcomes. Worldwide tobacco control efforts have reduced tobacco use and improved health outcomes in many countries, but several countries continue to suffer from increased tobacco use and associated adverse health effects. Continued tobacco use by patients undergoing cancer screening or treatment results in continued risk for cancer-related and noncancer-related health conditions. Although integrating tobacco assessment and cessation support into lung cancer screening and cancer care is well justified and feasible, most patients with cancer unfortunately do not receive evidence-based tobacco cessation support. Combining evidence-based methods of treating tobacco addiction, such as behavioral counseling and pharmacotherapy, with practical clinical considerations in the setting of lung cancer screening and cancer treatment should result in substantial improvements in access to evidence-based care and resultant improvements in health risks and cancer treatment outcomes.
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Affiliation(s)
- Graham W Warren
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jamie S Ostroff
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - John R Goffin
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Jiménez-Ruiz CA, Solano-Reina S, Signes-Costa J, de Higes-Martinez E, Granda-Orive JI, Lorza-Blasco JJ, Riesco-Miranda JA, Altet-Gomez N, Barrueco M, Oyagüez I, Rejas J. Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain. Int J Chron Obstruct Pulmon Dis 2015; 10:2027-36. [PMID: 26451100 PMCID: PMC4590338 DOI: 10.2147/copd.s87597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain.
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Affiliation(s)
- Carlos A Jiménez-Ruiz
- Specialised Tobacco Unit, Community of Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Segismundo Solano-Reina
- Tobacco Unit, Department of Pulmonary Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jaime Signes-Costa
- Department of Pulmonary Medicine, Hospital Universitario San Juan, Alicante, Madrid, Spain
| | - Eva de Higes-Martinez
- Department of Pulmonary Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - José I Granda-Orive
- Department of Pulmonary Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José J Lorza-Blasco
- Department of Pulmonary Medicine, Complejo Hospitalario de Navarra, Pamplona, Navarre, Spain
| | | | - Neus Altet-Gomez
- Drassanes Tobacco Unit, Hospital Universitari Vall-d'Hebron-Drassanes, The Jordi Gol University Institute for Research Primary Healthcare, Barcelona, Spain
| | - Miguel Barrueco
- Department of Pulmonary Medicine, Hospital Universitario de Salamanca, Biomedical Research Institute, Salamanca, Alcobendas, Madrid, Spain
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Sociedad Limitada Unificada, Alcobendas, Madrid, Spain
| | - Javier Rejas
- Department of Pharmacoeconomics and Health Outcomes Research, Pfizer, Sociedad Limitada Unificada, Alcobendas, Madrid, Spain
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Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2015; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
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Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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18
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Treatment Outcome Assessment of the Pharmacist-Managed Quit Smoking Clinic in Malaysia. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Evaluating a new health service is different from evaluating a new drug, as the former depends on the local delivery structure and culture. No data are available on the effectiveness of the existing pharmacist-managed quit smoking clinic (PM-QSC) in Malaysia. We evaluated the effectiveness in terms of the quit and default rate, the cost per quitter, cost per patient and the number of days of the patient remained in the managed care of the pharmacist.Methods: The patients’ medical records at the PM-QSC in a tertiary hospital in Melaka, Malaysia, were examined retrospectively from January 2009 to December 2010. Patients were grouped into current smokers, attempted to quit and quitters. Costs were calculated per patient visit on the basis of resource used (smoking cessation agents (SCAs)) and the personnel involved (time spent by the pharmacist). This study was reviewed and approved by the Malaysia Research Ethics Committee (MREC).Results: The quit rate between January 2009 and December 2010 was 5.8%, and the default rate was 71.8%. The average quit period for all smokers enrolled was 298 days. From the health provider perspective, the average costs per quitter, per patient and per quit attempt were MYR 953.28 (USD 308), MYR 55.71 (USD 18) and MYR 34.74 (USD 11), respectively.Conclusion: The pharmacist delivery of cessation services at a public-funded QSC was associated with a high default rate. The pharmacist could not be dismissed entirely as an ineffective health care professional (HCP) for the provision of the cessation service based solely on this preliminary data, but these findings stress the need to address the high default rate prior to the expansion of the service.
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19
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Harrington KF, Bailey WC. Smoking cessation through the utilization of pharmacotherapy. Expert Rev Respir Med 2014; 3:475-85. [DOI: 10.1586/ers.09.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Caraci F, Drago F. New definition of addiction proposed by the American Society of Addiction Medicine: which implications for the treatment of tobacco dependence? Eur Neuropsychopharmacol 2014; 24:1-4. [PMID: 23778079 DOI: 10.1016/j.euroneuro.2013.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/01/2013] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Filippo Caraci
- Department of Educational Sciences, University of Catania, Catania, Italy; IRCCS Associazione Oasi Maria S.S., Institute for Research on Mental Retardation and Brain Aging, 94018 Troina, Enna, Italy
| | - Filippo Drago
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy.
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Carson KV, Brinn MP, Robertson TA, To-A-Nan R, Esterman AJ, Peters M, Smith BJ. Current and emerging pharmacotherapeutic options for smoking cessation. Subst Abuse 2013; 7:85-105. [PMID: 23772176 PMCID: PMC3668891 DOI: 10.4137/sart.s8108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking remains the single most preventable cause of morbidity and mortality in developed countries and poses a significant threat across developing countries where tobacco use prevalence is increasing. Nicotine dependence is a chronic disease often requiring multiple attempts to quit; repeated interventions with pharmacotherapeutic aids have become more popular as part of cessation therapies. First-line medications of known efficacy in the general population include varenicline tartrate, bupropion hydrochloride, nicotine replacement therapy products, or a combination thereof. However, less is known about the use of these products in marginalized groups such as the indigenous, those with mental illnesses, youth, and pregnant or breastfeeding women. Despite the efficacy and safety of these first line pharmacotherapies, many smokers continue to relapse and alternative pharmacotherapies and cessation options are required. Thus, the aim of this review is to summarize the existing and developing pharmacotherapeutic and other options for smoking cessation, to identify gaps in current clinical practice, and to provide recommendations for future evaluations and research.
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Affiliation(s)
- Kristin V. Carson
- The Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
| | - Malcolm P. Brinn
- The Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
- Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Thomas A. Robertson
- Therapeutics Research Centre, School of Pharmacy and Medical Sciences, University of South Australia and The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
| | - Rachada To-A-Nan
- Therapeutics Research Centre, School of Pharmacy and Medical Sciences, University of South Australia and The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
| | - Adrian J. Esterman
- School of Nursing and Midwifery, The University of South Australia, Adelaide, Australia
| | - Matthew Peters
- Thoracic Medicine, The Concord Hospital, Sydney, Australia
| | - Brian J. Smith
- The Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
- Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
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Rodríguez Barrios JM, Pérez Alcántara F, Crespo Palomo C, González García P, Antón De Las Heras E, Brosa Riestra M. The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:723-740. [PMID: 21660565 DOI: 10.1007/s10198-011-0326-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 05/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain, since 1990, which include LYG as an outcome to measure the incremental cost-effectiveness ratio. METHODS A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyse the cost per LYG results in relation with a commonly accepted Spanish cost-effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they both were calculated for the same economic evaluation. RESULTS A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529<euro> and a median of 11,490<euro> (standard deviation of 183,080). Since 2003, a commonly accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). CONCLUSIONS There is an increasing interest for economic health care evaluations in Spain, and the quality of the studies is also improving. Although a commonly accepted threshold exists, further information is needed for decision-making as well as to identify the relationship between the costs per LYG and per QALY gained.
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Chevreul K, Cadier B, Durand-Zaleski I, Chan E, Thomas D. Cost effectiveness of full coverage of the medical management of smoking cessation in France. Tob Control 2012. [PMID: 23197369 DOI: 10.1136/tobaccocontrol-2012-050520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incremental cost effectiveness of full coverage of the medical management of smoking cessation from the perspective of statutory health insurance (SHI) in France. DESIGN AND POPULATION Cost-effectiveness analysis based on a Markov state-transition decision analytic model was used to compare full SHI coverage of smoking cessation and actual coverage based on an annual €50 lump sum per insured person among current French smokers aged 15-75 years. We used a scenario approach to take into account the many different behaviours of smokers and the likely variability of SHI policy choices in terms of participation rate and number and frequency of attempts covered. INTERVENTIONS Drug treatments for smoking cessation combined with six medical consultations including individual counselling. MAIN OUTCOMES MEASURES The cost effectiveness of full coverage was expressed by the incremental cost-effectiveness ratio (ICER) in 2009 euros per life-year gained (LYG) at the lifetime horizon. RESULTS The cost effectiveness per LYG for smokers ranged from €1786 to €2012, with an average value of €1911. The minimum value was very close to the maximum value with a difference of only €226. The cost-effectiveness ratio was only minimally sensitive to the participation rate, the number of attempts covered and the cessation rate. CONCLUSIONS Compared to other health measures in primary and secondary prevention of cardiovascular disease already covered by SHI, full coverage of smoking cessation is the most cost-effective approach.
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Affiliation(s)
- Karine Chevreul
- Department of Public Health, AP-HP, Henri Mondor-Albert Chenevier Hospitals, , Créteil, France
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Marti J. Assessing preferences for improved smoking cessation medications: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:533-48. [PMID: 21706307 DOI: 10.1007/s10198-011-0333-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 06/07/2011] [Indexed: 05/15/2023]
Abstract
BACKGROUND The use of smoking cessation medications can considerably enhance the long-term abstinence rate at a reasonable cost, but only a small proportion of quitters seek medical assistance. The objective of this study was to evaluate the factors that influence the decision to use such treatments and the willingness-to-pay of smokers for improved cessation drugs. METHOD A discrete choice experiment was conducted amongst smokers in the French-speaking part of Switzerland. Choice sets consisted of two hypothetical medications described via five attributes (price, efficacy, possibility of minor side effects, attenuation of weight gain and availability) and an opt-out option. Various discrete choice models were estimated to analyse both the factors that influence treatment choice and those that influence the overall propensity to use a smoking cessation medication. RESULTS Our results indicate that smokers are willing to pay for higher efficacy, less-frequent side effects and prevention of weight gain. Whether the drug is available over-the-counter or on medical prescription is of secondary importance. In addition, we show that there are several individual-specific factors influencing the decision to use such medications, including education level. Results also indicate substantial preference heterogeneity. CONCLUSION This study shows that there is a potential demand for improved cessation medications. Broader usage could be reached through lower out-of-pocket price and greater efficacy. Secondary aspects such as side effects and weight gain should also be taken into consideration.
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Affiliation(s)
- Joachim Marti
- Faculty of Economics, Institute for Research in Economics, University of Neuchâtel, 2000, Neuchâtel, Switzerland.
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Bolin K. Economic evaluation of smoking-cessation therapies: a critical and systematic review of simulation models. PHARMACOECONOMICS 2012; 30:551-64. [PMID: 22591112 DOI: 10.2165/11590120-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Smoking is probably the most important among preventable health risks. Health economic evaluation of smoking-cessation interventions, applying a lifetime perspective, is made possible by available epidemiological knowledge. The well established method of performing cost-effectiveness analyses of smoking-cessation interventions involves mathematical modelling (both deterministic and stochastic) of future events important for cost effectiveness. OBJECTIVES This study surveys cost-effectiveness analyses of smoking cessation, with a particular focus on the mathematical modelling and simulation analyses performed. DATA SOURCES A systematic literature search was performed using the databases MEDLINE, Econlit and Academic Search Complete. STUDY SELECTION Health economic evaluations, published as full-length journal articles, were searched for. RESULTS 423 studies were identified and 78 were finally included, of which 30 were assessed as being highly relevant, based on the application of simulation modelling. CONCLUSIONS In general, studies are well performed as regards modelling. Common weaknesses include reporting of modelling details; validation of used simulation models; and the handling of structural uncertainty and different types of heterogeneity.
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Lutz MA, Lovato P, Cuesta G. Cost-effectiveness analysis of varenicline versus existing smoking cessation strategies in Central America and the Caribbean using the BENESCO model. Hosp Pract (1995) 2012; 40:24-34. [PMID: 22406880 DOI: 10.3810/hp.2012.02.945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In Central American countries, the economic burden of tobacco has not been assessed. In Costa Rica, a study demonstrated that tobacco-related diseases represent high costs for the health care system. The aim of this study was to assess the cost-effectiveness of varenicline compared with other existing strategies for smoking cessation within a 10-year time horizon in an adult population cohort from Central American and Caribbean countries using the health care payer's perspective. METHODS The Benefits of Smoking Cessation on Outcomes simulation model was used for an adult cohort in Costa Rica (n = 2 474 029), Panama (n = 2 249 676), Nicaragua (n = 3 639 948), El Salvador (n = 4 537 803), and the Dominican Republic (n = 6 528 125) (N = 19 429 581). Smoking cessation therapies compared were varenicline (0.5-2 mg/day) versus bupropion (300 mg/day), nicotine replacement therapy (5-15 mg/day), and unaided cessation. Effectiveness measures were: life-years (LYs) gained and quality-adjusted life-years (QALYs) gained. Resource use and cost data were obtained from a country's Ministry of Health and/or Social Security Institutions (2008-2010). The model used a 5% discount rate for costs (expressed in 2010 US$) and health outcomes. Probabilistic sensitivity analyses were conducted and acceptability curves were constructed. RESULTS Varenicline reduced smoking-related morbidity, mortality, and health care costs in each country included in the study. Accumulatively, mortality in the varenicline arm was reduced by 1190, 1538, and 2902 smoking-related deaths compared with bupropion, nicotine replacement therapy, and unaided cessation, respectively. The net average cost per additional quitter showed that varenicline was cost-saving when compared with competing alternatives. Regarding LYs and QALYs gained in 10 years, varenicline obtained the greatest number of QALYs and LYs in each country, while unaided cessation obtained the fewest. Cost-effectiveness analyses in all 5 countries showed that varenicline was the dominant strategy. Acceptability curves showed that, independent of the willingness to pay, the probability that varenicline is cost-effective was 99% for this region. The results of the probabilistic sensitivity analyses support the robustness of the findings. CONCLUSION Smoking cessation therapy with varenicline is cost-saving for the Central American and Caribbean countries included. These results could help to reduce the tobacco-related disease burden and align cost-containment policies.
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Affiliation(s)
- Manfred A Lutz
- Medical Manager and Outcomes Research Specialist, Pfizer Central America and the Caribbean, Escazú, Costa Rica.
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Higashi H, Barendregt JJ. Cost-effectiveness of tobacco control policies in Vietnam: the case of personal smoking cessation support. Addiction 2012; 107:658-70. [PMID: 21883602 DOI: 10.1111/j.1360-0443.2011.03632.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To examine the cost-effectiveness of personal smoking cessation support in Vietnam. DESIGN, SETTING AND PARTICIPANTS We followed-up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost-effective. A multi-state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health-care perspective was employed. MEASUREMENTS Cost-effectiveness is measured in 2006 Vietnamese Dong (VND) per disability-adjusted life year (DALY) averted. We adopted the World Health Organization thresholds of being 'cost-effective' if less than three times gross domestic product (GDP) per capita (VND 34,600,000) and 'very cost-effective' if less than GDP per capita (VND 11,500,000). FINDINGS The cost-effectiveness result of physician brief advice was VND 1,742,000 per DALY averted (international dollars 543), which was 'very cost-effective'. Varenicline dominated bupropion and nicotine-replacement therapies, although it did not fall within the range of being 'cost-effective' under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost-effective in Vietnam. CONCLUSIONS Physician brief advice is a cost-effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost-effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.
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Affiliation(s)
- Hideki Higashi
- The University of Queensland, School of Population Health, Herston, QLD 4006, Australia.
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Ruger JP, Lazar CM. Economic evaluation of pharmaco- and behavioral therapies for smoking cessation: a critical and systematic review of empirical research. Annu Rev Public Health 2012; 33:279-305. [PMID: 22224889 DOI: 10.1146/annurev-publhealth-031811-124553] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Economic evaluations are an important tool to improve our understanding of the costs and effects of health care services and to create sustainable health care systems. This article critically assesses empirical evidence from economic evaluations of pharmaco- and behavioral therapies for smoking cessation. A comprehensive literature review of PubMed and the British National Health Service Economic Evaluation Database was conducted. The search identified 15 articles on nicotine-based pharmacotherapies, 12 articles on nonnicotine based pharmacotherapies, no articles on selegiline, and 10 articles on brief counseling for smoking cessation treatment. Results show that both pharmaco- and behavioral therapies for smoking cessation are cost-effective or even cost-saving. The review highlights several shortcomings in methodology and a lack of standardization of current economic evaluations. Efforts to improve methodology will help make future studies more comparable and increase the evidence base so that such evaluations can be more useful to public health practitioners and policy makers.
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Affiliation(s)
- Jennifer Prah Ruger
- School of Public Health, School of Medicine, Yale University, New Haven, Connecticut 06520-8034, USA.
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Abstract
Promoting smoking cessation is among the key medical interventions aimed at reducing worldwide morbidity and mortality in this century. Both behavioural counselling and pharmacotherapy have been shown to significantly increase long-term abstinence rates, and combining the two treatment modalities is recommended. This article provides an update on pharmacotherapy for smoking cessation in the general population. Current first-line agents used to support quit attempts are nicotine replacement therapy (NRT), bupropion and varenicline. Research suggests that abstinence rates can be increased by combining different forms of NRT or simultaneously administering NRT and non-nicotine medications. New treatments targeting the nicotinic acetylcholine receptor as well as other pathophysiological pathways involved in nicotine addiction are being developed, with nicotine vaccines now being tested in phase III clinical trials. Among the numerous research topics currently addressed, pharmacogenetics and tailoring therapy to specific groups of smokers look most promising. However, substantial progress is unlikely to be made unless social gradients impeding effective treatment of all smokers are overcome. In addition, public smoking bans and reimbursement of medication costs are crucial in reducing the future burden of disease caused by smoking on a global level.
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Affiliation(s)
- Tobias Raupach
- Department of Cardiology and Pneumology, University Hospital Gttingen, Gttingen, Germany.
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Wasserfallen JB, Digon P, Cornuz J. Medical and pharmacological direct costs of a 9-week smoking cessation programme. Eur J Prev Cardiol 2011; 19:565-70. [DOI: 10.1177/1741826711406059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Medical and pharmacological direct costs of cigarette smoking cessation programmes are not covered by health insurance in several countries despite documented cost-effectiveness. Design: prospective cost identification study of a 9-week programme in Switzerland. Methods: A total of 481 smokers were followed-up for 9 weeks. Socio-demographic characteristics, number of outpatient visits, dosage and frequency of use of nicotine replacement therapy (NRT) as well as date of relapse were prospectively collected. Individual cost of care until relapse or programme end as well as cost per week of follow-up were computed. Comparisons were carried out between the groups with or without relapse at the end of the programme. Results: Of the 209 men and 272 women included, 347 patients (72%) finished the programme. Among them, 240 patients (70%) succeeded in quitting and 107 patients (30%) relapsed. As compared with the group relapsing by the end of the programme, the group succeeding in quitting was more often living in a couple (68% vs. 55%, p = 0.029). Their mean weekly costs of visits were higher (CHF 81.2 ± 6.1 vs. 78.4 ± 7.6, p = 0.001), while their mean weekly costs for NRT were similar (CHF 24.2 ± 12.6 vs. 25.4 ± 15.9, p = 0.711). Mean total costs per week were similar (CHF 105.4 ± 15.4 vs. 103.8 ± 19.4, p = 0.252). More intensive NRT at week 4 increased the probability not to relapse at the end of the programme. Conclusions: Over 9 weeks, medical and pharmacological costs of stopping smoking are low. Good medical and social support as well as adequate NRT seem to play a role in successful quitting.
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Affiliation(s)
- Jean-Blaise Wasserfallen
- Health Technology Assessment Unit, Medical Direction, University Hospital of Lausanne, Switzerland
- Institute of Health Economics and Management, University of Lausanne, Switzerland
| | - Patricia Digon
- Institute of Health Economics and Management, University of Lausanne, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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Ebbert JO, Hays JT, Hurt RD. Combination pharmacotherapy for stopping smoking: what advantages does it offer? Drugs 2010; 70:643-50. [PMID: 20394453 DOI: 10.2165/11536100-000000000-00000] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Globally, tobacco kills almost 5 million people around the world annually. Seven first-line pharmacotherapies are currently available and recommended by the United States Public Health Service (USPHS) clinical practice guideline for treating tobacco dependence, all of which have been proven to be effective for increasing tobacco abstinence rates when used as monotherapy. However, not all smokers are able to quit with single-drug therapy. Some smokers may benefit from combination therapy that includes the simultaneous use of different nicotine replacement therapies (NRTs) or medications with different mechanisms of action (e.g. NRT and bupropion). Combination therapy with different types of NRT may provide a therapeutic advantage by increasing serum nicotine concentrations, and combination therapy with different drugs may capitalize on synergy obtained from two different mechanisms of action. However, controversy exists regarding this approach. Available data suggests that combination therapy may increase abstinence rates compared with monotherapy. However, the cost effectiveness of this approach has not been clearly demonstrated.
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Affiliation(s)
- Jon O Ebbert
- Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Vemer P, Rutten-van Mölken MPMH. Crossing borders: factors affecting differences in cost-effectiveness of smoking cessation interventions between European countries. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:230-41. [PMID: 19804435 DOI: 10.1111/j.1524-4733.2009.00612.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Many different factors affect the transferability of cost-effectiveness results between countries. The objective is to quantify the impact of nine potential causes of variation in cost-effectiveness of pharmacological smoking cessation therapies (SCTs) between The Netherlands (reference case), Germany, Sweden, UK, Belgium, and France. METHODS The life-time benefits of smoking cessation were calculated using the Benefits of Smoking Cessation on Outcomes model, following a cohort of smokers making an unaided quit attempt, or using nicotine replacement therapy (NRT), bupropion, or varenicline. We investigated the impact of between-country differences in nine factors-demography, smoking prevalence, mortality, epidemiology and costs of smoking-related diseases, resource use and unit costs of SCTs, utility weights and discount rates-on the incremental net monetary benefit (INMB), using a willingness-to-pay (WTP) of euro20,000 per quality adjusted life year (QALY). RESULTS The INMB of 1000 quit attempts with NRT versus unaided, varies from euro0.39 million (Germany) to euro1.47 million (France). The differences between the countries were primarily due to differences in discount rates, causing the INMB to change between -65% to +62%, incidence and mortality rates (epidemiology) of smoking-related diseases (-43% to +35%) and utility weights. Impact also depended on the WTP for a QALY and time horizon: at a low WTP or a short time horizon, the resource use and unit costs of SCTs had the highest impact on INMB. CONCLUSIONS Although all INMBs were positive, there were significant differences across countries. These were primarily related to choice of discount rate and epidemiology of diseases.
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Affiliation(s)
- Pepijn Vemer
- Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands.
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Keiding H. Cost-effectiveness of varenicline for smoking cessation. Expert Rev Pharmacoecon Outcomes Res 2009; 9:215-21. [PMID: 19527093 DOI: 10.1586/erp.09.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smoking cessation therapies are among the most cost-effective preventive healthcare measures. Varenicline is a relatively new drug developed especially for this purpose, and it has been shown to achieve better quit rates than nicotine replacement therapies and the non-nicotine-based drug, bupropion, which has been in use for some years. The cost-effectiveness of varenicline depends on the cost of the therapy and the cost-savings achieved through reduced morbidity and mortality; several investigations, based on the situation in different countries, indicate that varenicline either finances itself fully through the cost-savings achieved or offers additional life-years at a lower price than that paid elsewhere in the healthcare sector.
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Affiliation(s)
- Hans Keiding
- Department of Economics, University of Copenhagen, Studiestraede 6, DK-1455 Copenhagen K, Denmark.
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Bolin K, Wilson K, Benhaddi H, de Nigris E, Marbaix S, Mork AC, Aubin HJ. Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation—results from four European countries. Eur J Public Health 2009; 19:650-4. [DOI: 10.1093/eurpub/ckp075] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ritzwoller DP, Sukhanova A, Gaglio B, Glasgow RE. Costing behavioral interventions: a practical guide to enhance translation. Ann Behav Med 2009; 37:218-27. [PMID: 19291342 DOI: 10.1007/s12160-009-9088-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Cost and cost effectiveness of behavioral interventions are critical parts of dissemination and implementation into non-academic settings. Due to the lack of indicative data and policy makers' increasing demands for both program effectiveness and efficiency, cost analyses can serve as valuable tools in the evaluation process. METHODS To stimulate and promote broader use of practical techniques that can be used to efficiently estimate the implementation costs of behavioral interventions, we propose a set of analytic steps that can be employed across a broad range of interventions. RESULTS/CONCLUSIONS Intervention costs must be distinguished from research, development, and recruitment costs. The inclusion of sensitivity analyses is recommended to understand the implications of implementation of the intervention into different settings using different intervention resources. To illustrate these procedures, we use data from a smoking reduction practical clinical trial to describe the techniques and methods used to estimate and evaluate the costs associated with the intervention. Estimated intervention costs per participant were $419, with a range of $276 to $703, depending on the number of participants.
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Affiliation(s)
- Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066, USA.
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Abstract
Tobacco dependence is a chronic relapsing disease that needs continuous treatment. In combination with behavioural support, pharmacotherapy is a proven key component for supporting smoking cessation. Effective drugs are available and recommended: nicotine replacement therapy (NRT), bupropion and varenicline. Much research into new pharmacological approaches is ongoing, combining 'old' and 'new' drugs and personalizing a pharmacological treatment for a single smoker/patient; other new medications and vaccines are in development. Overall, pharmacotherapy seems to have efficacy and cost-effectiveness in real life, thus physicians should become familiar with these medicines. Further efforts should be aimed at optimizing treatment management and increasing smoking cessation rates in the general population.
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Affiliation(s)
- Laura Carrozzi
- Cardio-Thoracic Department, University Hospital of Pisa, Pisa, Italy.
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Nicotine abstinence genotyping: assessing the impact on smoking cessation clinical trials. THE PHARMACOGENOMICS JOURNAL 2008; 9:111-5. [PMID: 18781146 DOI: 10.1038/tpj.2008.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Twin studies document substantial heritability for successful abstinence from smoking. A genome-wide association study has identified markers whose allele frequencies differ with nominal P<0.005 in nicotine-dependent clinical trial participants who were successful vs unsuccessful in abstaining from smoking; many of these results are also supported by data from two additional samples. More study is required to precisely determine the variance in quitting success that can be accounted for by the single-nucleotide polymorphisms that are currently identified and to precisely classify individuals who may display varying degrees of genetic vs environmental effects into quitters or nonquitters. However, the data at hand do allow us to model the effects of genotypic stratification in smoking cessation trials. We identify relationships between the costs of identifying and genotyping prospective trial participants vs the costs of performing the clinical trials. We quantitate the increasing savings that result from genetically stratified designs as recruiting/genotyping costs go down and trial costs increase. This model helps to define the circumstances in which genetically stratified designs may enhance power and reduce costs for smoking cessation clinical trials.
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Rodondi N, Bovet P, Hayoz D, Cornuz J. The Impact of CAROtid plaque Screening on Smoking (CAROSS) cessation and control of other cardiovascular risk factors: Rationale and design of a randomized controlled trial. Contemp Clin Trials 2008; 29:767-73. [DOI: 10.1016/j.cct.2008.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 11/16/2022]
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Cornuz J. Smoking cessation interventions in clinical practice. Eur J Vasc Endovasc Surg 2007; 34:397-404. [PMID: 17681834 DOI: 10.1016/j.ejvs.2007.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Physicians are in a unique position to advise smokers to quit by integrating the various aspects of nicotine dependence. This review provides an overview of interventions for smokers presenting in a clinical setting. RESULTS Strategies used for smoking cessation counselling differ according to patient's readiness to quit. For smokers who do not intend to quit smoking, physicians should inform and sensitise them about tobacco use and cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing barriers to cessation and their solutions. For smokers ready to quit, the physician should show strong support, help set a quit date, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, micro and sublingual tablets) and/or bupropion (atypical antidepressant thought to work by blocking neural reuptake of dopamine and/or nor epinephrine), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling cessation rates over control conditions. Varenicline is a promising new effective drug recently approved by many health authorities. CONCLUSION Physician counselling and pharmacotherapeutic interventions for smoking cessation are among the most cost-effective clinical interventions.
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Affiliation(s)
- J Cornuz
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
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Pinget C, Martin E, Wasserfallen JB, Humair JP, Cornuz J. Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling. ACTA ACUST UNITED AC 2007; 14:451-5. [PMID: 17568248 DOI: 10.1097/hjr.0b013e32804955a0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention. DESIGN AND METHODS We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective. RESULTS The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio. CONCLUSIONS Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.
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Affiliation(s)
- Christophe Pinget
- Health Technology Assessment Unit, Lausanne University Hospital, Switzerland.
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Ortendahl M. Using discounting biases, risk characteristics, and perceived control improves preventive programs. INTERNATIONAL JOURNAL OF BIOMEDICAL SCIENCE : IJBS 2007; 3:81-5. [PMID: 23675027 PMCID: PMC3614630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Health promotion often works toward remote goals with a trade-off between costs today and benefits in the future. However, for individuals using a positive discount rate for health outcomes a healthy state many years ahead has such a small value that it is difficult to motivate them to engage in preventive behaviors. The framework of time and risk for analysis can perform a useful role in health education and information where the framing of different features of risk might diminish discounting and increase motivation to change behavior. Personal versus general risk and perceived control related to preventive programs are discussed. A summary of valuation factors in preventive programs based on literature review is presented: (a) long-term decisions are sensitive to discount rates; (b) discount rates vary by level of uncertainty, individuals, and contexts; (c) personal risks from adverse health behaviors are judged as smaller than the same risks for people in general; (d) probability discounting is used, if the risk is perceived as controllable; (e) people's tendency to discount future consequences might be suppressed by lowering the amount of perceived control.
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Gordon L, Graves N, Hawkes A, Eakin E. A review of the cost-effectiveness of face-to-face behavioural interventions for smoking, physical activity, diet and alcohol. Chronic Illn 2007; 3:101-29. [PMID: 18083667 DOI: 10.1177/1742395307081732] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the evidence for the cost-effectiveness of health behaviour interventions that address the major behavioural risk factors for chronic disease, including smoking, physical inactivity, poor diet, and alcohol misuse. METHODS Medical and economic databases were searched for relevant economic evaluations. Studies were critically appraised using a published 35-point checklist, and the results are described using a narrative approach, noting methodological limitations. The review included 64 studies from 1995-2005, including 17 reports on multiple behaviour interventions. RESULTS There was considerable variation among the studies by target populations, intervention components, primary outcomes, and economic methods, but the reported incremental cost-effectiveness ratios were consistently low (e.g. <14,000 Euros per quality-adjusted life-year gained for smoking-cessation programmes in 2006 Euros) as compared to certain preventive pharmaceutical and invasive interventions. Interventions targeting high-risk-population subgroups were relatively better value for money as compared to those targeting general populations. DISCUSSION In general, the results of this review demonstrate favourable cost-effectiveness for smoking interventions, physical activity interventions and multiple behaviour interventions in high-risk groups. Although alcohol and dietary interventions appeared to be economically favourable, it is difficult to draw conclusions because of the variety in study outcomes. However, methodological limitations weaken the generalizability of findings, and suggest that the results of any given study should be considered carefully when being used to inform resource allocation.
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Affiliation(s)
- L Gordon
- Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Q4029, Australia.
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