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Deeming S, Lawrence K, Standen JC. The economic evaluation of a housing maintenance project to improve the health of Aboriginal housing tenants in NSW: A scoping literature review and protocol for an economic analysis. Heliyon 2024; 10:e34282. [PMID: 39082020 PMCID: PMC11284360 DOI: 10.1016/j.heliyon.2024.e34282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/19/2023] [Accepted: 07/07/2024] [Indexed: 08/02/2024] Open
Abstract
Considerable evidence exists regarding the role housing plays in the determination of health and well-being outcomes. Despite the scale of health concerns arising from housing considerations, there are very few economic analyses of housing programs that seek to improve health outcomes by addressing the physical infrastructure of the living environment. The NSW Housing for Health (HfH) program is an environmental health initiative funded and administered by NSW Health, that addresses health-related hardware in residential accommodation to ensure the home environment supports healthy living practices to ultimately improve health outcomes for residents. This study reviews the economic methods that have been applied to comparable programs and identifies relevant costs and benefits that should be addressed. Founded on the requirement from decision makers, and the insights from the review, the paper outlines a protocol for a cost-benefit analysis that accounts for the disparate health, social, economic and intangible benefits generated from the HfH program and the resources utilised to realise these outcomes.
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Affiliation(s)
- Simon Deeming
- Hunter Medical Research Institute, Lot 1, Kookaburra Crescent, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kerryn Lawrence
- Health Protection NSW, Locked Mail Bag 2030, St Leonards, NSW, 1590, Australia
| | - Jeffrey C. Standen
- Health Protection NSW, Locked Mail Bag 2030, St Leonards, NSW, 1590, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
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Patrick SM, Bendiane MK, Kruger T, Harris BN, Riddin MA, Trehard H, de Jager C, Bornman R, Gaudart J. Household living conditions and individual behaviours associated with malaria risk: a community-based survey in the Limpopo River Valley, 2020, South Africa. Malar J 2023; 22:156. [PMID: 37189177 DOI: 10.1186/s12936-023-04585-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Over the past decade, implementation of multiple malaria control strategies in most countries has largely contributed to advance the global malaria elimination agenda. Nevertheless, in some regions, seasonal epidemics may adversely affect the health of local populations. In South Africa, Plasmodium falciparum malaria is still present, with the Vhembe District experiencing an incidence rate of 3.79 cases/1000 person-years in 2018, particularly in the Limpopo River Valley, bordering Zimbabwe. To elucidate the complexity of the mechanisms involved in local regular malaria outbreaks, a community-based survey was implemented in 2020 that focused on the relationship between housing conditions and malaria risky behaviours. METHODS The community-based cross-sectional survey was conducted among the population of three study sites in the Vhembe District, which were selected based on malaria incidence rate, social and health characteristics of inhabitants. The household survey used a random sampling strategy, where data were collected through face-to-face questionnaires and field notes; to described the housing conditions (housing questionnaire), and focus on individual behaviours of household members. Statistical analyses were performed combining hierarchical classifications and logistic regressions. RESULTS In this study, 398 households were described, covering a population of 1681 inhabitants of all ages, and 439 adults who participated in community-based survey. The analysis of situations at risk of malaria showed that the influence of contextual factors, particularly those defined by the type of habitat, was significant. Housing conditions and poor living environments were factors of malaria exposure and history, regardless of site of investigation, individual preventive behaviours and personal characteristics of inhabitants. Multivariate models showed that, considering all personal characteristics or behaviours of inhabitants, housing conditions such as overcrowding pressures were significantly associated with individual malaria risk. CONCLUSIONS The results showed the overwhelming weight of social and contextual factors on risk situations. Considering the Fundamental Causes Theory, malaria control policies based on health behaviour prevention, should reinforce access to care or promoting health education actions. Overarching economic development interventions in targeted geographical areas and populations have to be implemented, so that malaria control and elimination strategies can be efficiently and effectively managed.
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Affiliation(s)
- Sean M Patrick
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Marc-Karim Bendiane
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Taneshka Kruger
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Bernice N Harris
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Megan A Riddin
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Helene Trehard
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Christiaan de Jager
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Riana Bornman
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Jean Gaudart
- Aix Marseille University, INSERM, IRD, APHM, ISSPAM, SESSTIM, UMR1252, Hospital La Timone, BioSTIC, Biostatistics & ICT, 13005, Marseille, France
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Turcu C, Crane M, Hutchinson E, Lloyd S, Belesova K, Wilkinson P, Davies M. A multi-scalar perspective on health and urban housing: an umbrella review. BUILDINGS & CITIES 2021; 2:734-758. [PMID: 34738085 PMCID: PMC7611930 DOI: 10.5334/bc.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.
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Affiliation(s)
- Catalina Turcu
- The Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Melanie Crane
- The Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Hutchinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Simon Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Kristine Belesova
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Paul Wilkinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Mike Davies
- UCL Institute for Environmental Design and Engineering, Faculty of the Built Environment, University College London, London, UK
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Deverall E, Kvizhinadze G, Pega F, Blakely T, Wilson N. Exercise programmes to prevent falls among older adults: modelling health gain, cost-utility and equity impacts. Inj Prev 2018; 25:258-263. [PMID: 29363590 DOI: 10.1136/injuryprev-2016-042309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 11/10/2017] [Accepted: 01/03/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Some falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one. METHODS An established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review. RESULTS The intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness. CONCLUSIONS Implementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.
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Affiliation(s)
- Eamonn Deverall
- Public Health Registrar, University of Otago, Wellington, New Zealand
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Frank Pega
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
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Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs. PLoS One 2017; 12:e0184538. [PMID: 28910342 PMCID: PMC5598974 DOI: 10.1371/journal.pone.0184538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level. Methods and findings A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, Injury Prevention) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori. Conclusions This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.
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Pega F, Kvizhinadze G, Blakely T, Atkinson J, Wilson N. Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis. Inj Prev 2016; 22:420-426. [PMID: 27222247 DOI: 10.1136/injuryprev-2016-041999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/02/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to improve on previous modelling work to determine the health gain, cost-utility and health equity impacts from home safety assessment and modification (HSAM) for reducing injurious falls in older people. METHODS The model was a Markov macrosimulation one that estimated quality-adjusted life-years (QALYs) gained. The setting was a country with detailed epidemiological and cost data (New Zealand (NZ)) for 2011. A health system perspective was taken and a discount rate of 3% was used (for both health gain and costs). Intervention effectiveness estimates came from a Cochrane systematic review and NZ-specific intervention costs were from a randomised controlled trial. RESULTS In the 65 years and above age group, the HSAM programme cost a total of US$98 million (95% uncertainty interval (UI) US$65 to US$139 million) to implement nationally and the accrued net health system costs were US$74 million (95% UI: cost saving to US$132 million). Health gains were 34 000 QALYs (95% UI: 5000 to 65 000). The incremental cost-effectiveness ratio (ICER) was US$6000 (95% UI: cost saving to US$13 000), suggesting that HSAM is highly cost-effective. Targeting HSAM only to older people with previous injurious falls and to older people aged 75 years and above were also cost-effective (ICERs=US$1000 and US$11 000, respectively). There was no evidence for differential cost-effectiveness by gender or by ethnicity (Indigenous New Zealanders: Māori vs non-Māori). CONCLUSIONS As per other studies, this modelling study indicates that the provision of an HSAM intervention produces considerable health gain and is highly cost-effective among older people. Targeting this intervention to older people with previous injurious falls is a promising initial approach before any scale up. TRIAL REGISTRATION NUMBER ACTRN12609000779279.
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Affiliation(s)
- Frank Pega
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
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