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Wang SS, Glied S, Williams S, Will B, Muennig PA. Impact of aeroplane noise on mental and physical health: a quasi-experimental analysis. BMJ Open 2022; 12:e057209. [PMID: 35501087 PMCID: PMC9062823 DOI: 10.1136/bmjopen-2021-057209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Historically, departures at New York City's LaGuardia airport flew over a large sports complex within a park. During the US Open tennis games, flights were diverted to fly over a heavily populated foreign-born neighbourhood for roughly 2 weeks out of the year so that the tennis match was not disturbed (the 'TNNIS' departure). In 2012, the use of the TNNIS departure became year-round to better optimise flight patterns around the metropolitan area. METHODS We exploited exogenously induced spatial and temporal variation in flight patterns to examine difference-in-difference effects of this new exposure to aircraft noise on the health of individual residents in the community relative to individuals residing within a demographically similar community that was not impacted. We used individual-level Medicaid records, focusing on conditions associated with noise: sleep disturbance, psychological stress, mental illness, substance use, and cardiovascular disease. RESULTS We found that increased exposure to aeroplane noise was associated with a significant increase in insomnia across all age groups, but particularly in children ages 5-17 (OR=1.64, 95% CI=1.12 to 2.39). Cardiovascular disease increased significantly both among 18-44-year-old (OR=1.45, 95% CI=1.41 to 1.49) and 45-64-year-old Medicaid recipients (OR=1.15, 95% CI=1.07 to 1.25). Substance use and mental health-related emergency department visits also increased. For ages 5-17,rate ratio (RR) was 4.11 (95% CI=3.28 to 5.16); for ages 18-44, RR was 2.46 (95% CI=2.20 to 2.76); and for ages 45-64, RR was 1.48 (95% CI=1.31 to 1.67). CONCLUSION We find that increased exposure to aeroplane noise was associated with an increase in diagnosis of cardiovascular disease, substance use/mental health emergencies and insomnia among local residents.
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Affiliation(s)
- Scarlett Sijia Wang
- Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Sherry Glied
- Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Sharifa Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Brian Will
- Queens Quiet Skies, New York, New York, USA
| | - Peter Alexander Muennig
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
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2
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Danchenko N, Johnston KM, Whalen J. The cost-effectiveness of abobotulinumtoxinA (Dysport) and onabotulinumtoxinA (Botox) for managing spasticity of the upper and lower limbs, and cervical dystonia. J Med Econ 2022; 25:919-929. [PMID: 35730362 DOI: 10.1080/13696998.2022.2092354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the costs and benefits associated with the use of abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) for lower limb spasticity in children, upper and lower limb spasticity in adults, and cervical dystonia in adults. METHODS This pharmacoeconomic analysis compared aboBoNT-A with onaBoNT-A. A decision tree model with a 1-year time horizon was conducted from a UK National Health Service (NHS) perspective using data from a variety of sources: randomized controlled trials (RCTs), network meta-analyses (NMAs), observational studies, and a physician survey investigating treatment patterns and resource utilization. Four patient populations were included: pediatric patients with lower limb spasticity (PLL), and adults with upper limb spasticity (AUL), lower limb spasticity (ALL), and cervical dystonia (CD). Outcomes included costs, quality-adjusted life years (QALYs) gained, cost per responder, and incremental cost per QALY gained. The effectiveness of each treatment was evaluated as a response to treatment. The base case assumption was that all patients in the model continued to receive botulinum toxin type A (BoNT-A) treatments at regular intervals regardless of treatment response status. Scenario analysis evaluated the impact of discontinuing BoNT-A for patients without a response to the first injection. RESULTS The model found that aboBoNT-A resulted in greater quality-of-life and lower costs compared with onaBoNT-A for the management of spasticity and CD in all included indications. Across populations, cost savings ranged from £304 to £3,963 and QALYs gained ranged from 0.010 to 0.02 over a 1-year time horizon. Results were robust to scenario analyses and were driven by the impact of treatment response on health-related quality-of-life. CONCLUSIONS AboBoNT-A was associated with higher treatment response, improved quality-of-life, and reduced costs in spasticity and CD versus onaBoNT-A. These findings could help deliver more effective and efficient healthcare in the NHS.
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Kim S, Xiao C, Platt I, Zafari Z, Bellanger M, Muennig P. Health and economic consequences of applying the United States' PM 2.5 automobile emission standards to other nations: a case study of France and Italy. Public Health 2020; 183:81-87. [PMID: 32445933 PMCID: PMC7252081 DOI: 10.1016/j.puhe.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The US has among the world's strictest automobile emission standards, but it is now loosening them. It is unclear where a nation should draw the line between the associated cost burden imposed by regulations and the broader societal benefits associated with having cleaner air. Our study examines the health benefits and cost-effectiveness of introducing stricter vehicle emission standards in France and Italy. STUDY DESIGN Quasi-experimental study. METHODS We used cost-effectiveness modeling to measure the incremental quality-adjusted life years (QALYs) and cost (Euros) of adopting more stringent US vehicle emission standards for PM2.5 in France and Italy. RESULTS Adopting Obama era US vehicle emission standards would likely save money and lives for both the French and Italian populations. In France, adopting US emission standards would save €1000 and increase QALYs by 0.04 per capita. In Italy, the stricter standards would save €3000 and increase QALYs by 0.31. The results remain robust in both the sensitivity analysis and probabilistic Monte Carlo simulation model. CONCLUSIONS Adopting more stringent emission standards in France and Italy would save money and lives.
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Affiliation(s)
- S Kim
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
| | - C Xiao
- Ecole des Hautes Etudes en Sante Publique, 15 Avenue du Professeur Léon Bernard, 35043, Rennes, France.
| | - I Platt
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
| | - Z Zafari
- Global Research Analytics for Population Health, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032, New York, New York, United States; School of Pharmacy, University of Maryland, 772 West 168th Street, 10032, New York, New York, United States
| | - M Bellanger
- Ecole des Hautes Etudes en Sante Publique, 15 Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - P Muennig
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
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van der Vliet N, Suijkerbuijk AW, de Blaeij AT, de Wit GA, van Gils PF, Staatsen BA, Maas R, Polder JJ. Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062160. [PMID: 32213919 PMCID: PMC7142580 DOI: 10.3390/ijerph17062160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from other sectors, should be developed and implemented. Investing in these preventive health policies is challenging as budgets have to compete with other governmental expenditures. The current study aimed to identify, compare and rank cost-effective preventive interventions targeting metabolic, environmental, occupational and behavioral risk factors. To identify these interventions, a literature search was performed including original full economic evaluations of Western country interventions that had not yet been implemented in the Netherlands. Several workshops were held with experts from different disciplines. In total, 51 different interventions (including 13 cost saving interventions) were identified and ranked based on their incremental cost-effectiveness ratio (ICER) and potential averted disability-adjusted life years (DALYs), resulting in two rankings of the most cost-effective interventions and one ranking of the 13 cost saving interventions. This approach, resulting in an intersectoral ranking, can assist policy makers in implementing cost-effective preventive action that considers not only the health sector, but also other sectors.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
- Correspondence: ; Tel.: +3130-274-3816
| | - Anita W.M. Suijkerbuijk
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Adriana T. de Blaeij
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - G. Ardine de Wit
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Paul F. van Gils
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Brigit A.M. Staatsen
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Rob Maas
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Johan J. Polder
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
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Yu W, Chen C, Jiao B, Zafari Z, Muennig P. The Cost-Effectiveness of Bike Share Expansion to Low-Income Communities in New York City. J Urban Health 2018; 95:888-898. [PMID: 30397819 PMCID: PMC6286277 DOI: 10.1007/s11524-018-0323-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The "Citi Bike" bike share program in New York City is the largest bike share program in the USA. We ask whether expanding this program to lower-income communities is cost-effective means of encouraging exercise and reducing pollution in New York City. We built a stochastic Markov model to evaluate the cost-effectiveness of the Citi Bike expansion program, an effort to extend bike share to areas with higher costs and risks over a 10-year time horizon. We used one-way sensitivity analyses and Monte Carlo simulation to test the model uncertainty. The incremental cost-effectiveness ratio of the Citi Bike expansion program relative to the current program (status quo) was $7869/quality-adjusted life year gained. The Citi Bike expansion program in New York City offers good value relative to most health interventions.
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Affiliation(s)
- Wenya Yu
- College of Military Health Service Management, Second Military Medical University, Shanghai, China. .,Mailman School of Public Health, Columbia University, New York, USA.
| | - Chen Chen
- Mailman School of Public Health, Columbia University, New York, USA
| | - Boshen Jiao
- Mailman School of Public Health, Columbia University, New York, USA.,School of Pharmacy, University of Washington, Seattle, USA
| | - Zafar Zafari
- Mailman School of Public Health, Columbia University, New York, USA
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, USA
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The Trade-Off between Optimizing Flight Patterns and Human Health: A Case Study of Aircraft Noise in Queens, NY, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081753. [PMID: 30111739 PMCID: PMC6121545 DOI: 10.3390/ijerph15081753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/02/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022]
Abstract
Objectives: Airports in the U.S. have gradually been transitioning to automated flight systems. These systems generate new flight paths over populated areas. While they can improve flight efficiency, the increased noise associated with these novel flight patterns potentially pose serious health threats to the overflown communities. In this case study, we estimated the monetary benefits relative to health losses associated with one significant change in flight patterns at LaGuardia Airport, year-round use of “TNNIS Climb”, which happened in 2012 as a result of flight automation in New York City. Prior to that, the use of the TNNIS Climb was limited to the U.S. Open tennis matches. Methods: We developed a decision-analytic model using Markov health states to compare the costs and quality-adjusted life years (QALYs) gained associated with the limited use of TNNIS (old status quo) and the year-round use of TNNIS (current status quo). The TNNIS Climb increases airplane noise to above 60 decibels (dB) over some of the most densely populated areas of the city. We used this increased exposure to noise as the basis for estimating ground-level health using data from sound monitors. The total costs (including both direct and indirect costs), QALYs, and the incremental cost-effectiveness ratio (ICER) were estimated for the limited versus the year-round use of the TNNIS Climb. Results: The incremental lifetime costs and QALYs per person exposed to noise associated with the limited versus the year-round use of TNNIS was $11,288, and 1.13, respectively. Therefore, the limited use of TNNIS had an ICER of $10,006/QALY gained relative to the year-round of TNNIS. Our analyses were robust to changes in assumptions and data inputs. Conclusions: Despite increases in efficiency, flight automation systems without a careful assessment of noise might generate flight paths over densely populated areas and cause serious health conditions for the overflown communities.
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