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Banstola A, Anokye N, Pokhrel S. The economic burden of multimorbidity: Protocol for a systematic review. PLoS One 2024; 19:e0301485. [PMID: 38696497 PMCID: PMC11065216 DOI: 10.1371/journal.pone.0301485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024] Open
Abstract
Multimorbidity, also known as multiple long-term conditions, leads to higher healthcare utilisation, including hospitalisation, readmission, and polypharmacy, as well as a financial burden to families, society, and nations. Despite some progress, the economic burden of multimorbidity remains poorly understood. This paper outlines a protocol for a systematic review that aims to identify and synthesise comprehensive evidence on the economic burden of multimorbidity, considering various definitions and measurements of multimorbidity, including their implications for future cost-of-illness analyses. The review will include studies involving people of all ages with multimorbidity without any restriction on location and setting. Cost-of-illness studies or studies that examined economic burden including model-based studies will be included, and economic evaluation studies will be excluded. Databases including Scopus (that includes PubMed/MEDLINE), Web of Science, CINAHL Plus, PsycINFO, NHS EED (including the HTA database), and the Cost-Effectiveness Analysis Registry, will be searched until March 2024. The risk of bias within included studies will be independently assessed by two authors using appropriate checklists. A narrative synthesis of the main characteristics and results, by definitions and measurements of multimorbidity, will be conducted. The total economic burden of multimorbidity will be reported as mean annual costs per patient and disaggregated based on counts of diseases, disease clusters, and weighted indices. The results of this review will provide valuable insights for researchers into the key cost components and areas that require further investigation in order to improve the rigour of future studies on the economic burden of multimorbidity. Additionally, these findings will broaden our understanding of the economic impact of multimorbidity, inform us about the costs of inaction, and guide decision-making regarding resource allocation and cost-effective interventions. The systematic review's results will be submitted to a peer-reviewed journal, presented at conferences, and shared via an online webinar for discussion.
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Affiliation(s)
- Amrit Banstola
- Department of Health Sciences, Brunel University London, Uxbridge, Middlesex, United Kingdom
| | - Nana Anokye
- Department of Health Sciences, Brunel University London, Uxbridge, Middlesex, United Kingdom
| | - Subhash Pokhrel
- Department of Health Sciences, Brunel University London, Uxbridge, Middlesex, United Kingdom
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Banstola A, Pokhrel S, Hayhoe B, Nicholls D, Harris M, Anokye N. Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review. BMJ Open 2023; 13:e069270. [PMID: 36854591 PMCID: PMC9980364 DOI: 10.1136/bmjopen-2022-069270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective. DESIGN A systematic review. DATA SOURCES MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022. ELIGIBILITY CRITERIA We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted. RESULTS A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods. CONCLUSIONS Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions. PROSPERO REGISTRATION NUMBER CRD42022302036.
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Affiliation(s)
- Amrit Banstola
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Subhash Pokhrel
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Nana Anokye
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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Siddiqi K, Elsey H, Khokhar MA, Marshall AM, Pokhrel S, Arora M, Crankson S, Mehra R, Morello P, Collin J, Fong GT. FCTC 2030 - a programme to accelerate the implementation of WHO Framework Convention for Tobacco Control in low- and middle-income countries: A mixed-methods evaluation. Nicotine Tob Res 2023; 25:1074-1081. [PMID: 36757326 DOI: 10.1093/ntr/ntad022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/27/2022] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND FCTC 2030 Programme (2017-2021) was launched to accelerate WHO Framework Convention on Tobacco Control (FCTC) implementation in 15 low- and middle-income countries (LMICs). We evaluated the Programme in six domains: Governance; Smoke-Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising, Promotion and Sponsorship (TAPS) bans; International and Regional Cooperation. METHODS Following a mixed-methods design, we surveyed (Jun-Sept 2020) FCTC focal persons in 14 of the 15 countries, to understand the Programme's financial and technical inputs and progress made in each of the six domains. The data were coded in terms of inputs (financial=1, technical=1, or both=2) and progress (none=1, some=2, partial=3, or strong=4) and a correlation was computed between the inputs and progress scores for each domain. We conducted semi-structured interviews with key stakeholders in five countries. We triangulated between the survey and interview findings. RESULTS FCTC 2030 offered substantial financial and technical inputs, responsive to country-needs, across all six domains. There was a high positive correlation between technical inputs and progress in five of the six domains, ranging from r=0.61 for Taxation (p<0.05) to r=0.91 for Smoke-Free Policies (p<0.001). The interviews indicated that the Programme provided timely and relevant evidence and created opportunities for influencing tobacco control debates. CONCLUSIONS The FCTC 2030 Programme might have led to variable but significant progress in advancing FCTC implementation in the 15 countries. As expected, much of the progress was in augmenting existing structures and resources for FCTC implementation. The resulting advances are likely to lead to further progress in FCTC policy implementation. IMPLICATIONS What this study adds: In many low- and middle-income countries (LMICs), WHO Framework Convention for Tobacco Control (WHO FCTC) policies are not in place; and even when enshrined in law, they are poorly enforced.It is not clear how financial and technical assistance to high tobacco-burden LMICs can most effectively accelerate the implementation of WHO FCTC policies and offer value for money. Bespoke and responsive assistance, both financial and technical, to LMICs aimed at accelerating the implementation of WHO FCTC policies is likely to lead to progress in tobacco control.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, York, UK
| | - Helen Elsey
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, York, UK
| | | | | | | | | | | | | | - Paola Morello
- Institute for Clinical Effectiveness and Health Policy, Argentina
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Mansour MHH, Pokhrel S, Birnbaum M, Anokye N. Effectiveness of a population-based integrated care model in reducing hospital activity: an interrupted time series analysis. Integ Health J 2022. [DOI: 10.1136/ihj-2021-000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ObjectivesFirst impact assessment analysis of an integrated care model (ICM) to reduce hospital activity in the London Borough of Hillingdon, UK.MethodsWe evaluated a population-based ICM consisting of multiple interventions based on self-management, multidisciplinary teams, case management and discharge management. The sample included 331 330 registered Hillingdon residents (at the time of data extraction) between October 2018 and July 2020. Longitudinal data was extracted from the Whole Systems Integrated Care database. Interrupted time series Poisson and Negative binomial regressions were used to examine changes in non-elective hospital admissions (NEL admissions), accident and emergency visits (A&E) and length of stay (LoS) at the hospital. Multiple imputations were used to replace missing data. Subgroup analysis of various groups with and without long-term conditions (LTC) was also conducted using the same models.ResultsIn the whole registered population of Hillingdon at the time of data collection, gradual decline over time in NEL admissions (RR 0.91, 95% CI 0.90 to 0.92), A&E visits (RR 0.94, 95% CI 0.93 to 0.95) and LoS (RR 0.93, 95% CI 0.92 to 0.94) following an immediate increase during the first months of implementation in the three outcomes was observed. Subgroup analysis across different groups, including those with and without LTCs, showed similar effects. Sensitivity analysis did not show a notable change compared with the original analysis.ConclusionThe Hillingdon ICM showed effectiveness in reducing NEL admissions, A&E visits and LoS. However, further investigations and analyses could confirm the results of this study and rule out the potential effects of some confounding events, such as the emergence of COVID-19 pandemic.
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Siddiqui F, Bauld L, Croucher R, Jackson C, Kellar I, Kanaan M, Pokhrel S, Huque R, Iqbal R, Khan JA, Mehrotra R, Siddiqi K. Behavioural support and nicotine replacement therapy for smokeless tobacco cessation: protocol for a pilot randomised-controlled multi-country trial. Pilot Feasibility Stud 2022; 8:189. [PMID: 35996179 PMCID: PMC9396808 DOI: 10.1186/s40814-022-01146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Smokeless tobacco (ST) is consumed globally by more than 350 million people, with approximately 85% of all users based in South and Southeast Asia. In this region, ST products are cheap and easily accessible. Evidence-based interventions to people quit ST use are lacking. This study aims to test the feasibility of conducting a future definitive trial of ST cessation, using a culturally adapted behavioural intervention, and/or nicotine replacement therapy (NRT) in three South Asian countries. METHODS We will conduct a factorial design, randomised-controlled pilot trial in Bangladesh, India and Pakistan. Daily ST users will be recruited from primary health care settings in Dhaka, Noida and Karachi. Participants will be individually randomised to receive intervention A (4 or 6 mg NRT chewing gum for 8-weeks), intervention B (BISCA: face-to-face behavioural support for ST cessation), a combination of interventions A and B or usual care (Very Brief Advice - VBA). The participants will provide demographic and ST use related data at baseline, and at 6, 12 and 26 weeks of follow-up. Salivary cotinine samples will be collected at baseline and 26 weeks. The analyses will undertake an assessment of the feasibility of recruitment, randomisation, data collection and participant retention, as well as the feasibility of intervention delivery. We will also identify potential cessation outcomes to inform the main trial, understand the implementation, context and mechanisms of impact through a process evaluation and, thirdly, establish health resource use and impact on the quality of life through health economic data. DISCUSSION The widespread and continued use of ST products in South Asia is consistent with a high rate of associated diseases and negative impact on the quality of life. The identification of feasible, effective and cost-effective interventions for ST is necessary to inform national and regional efforts to reduce ST use at the population level. The findings of this pilot trial will inform the development of larger trials for ST cessation among South Asian users, with relevance to wider regions and populations having high rates of ST use. TRIAL REGISTRATION ISRCTN identifier 65109397.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, University of York, Heslington, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK.
| | - Ray Croucher
- Department of Health Sciences, University of York, Heslington, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, UK
- Valid Research Ltd., Wetherby, UK
| | - Ian Kellar
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, UK
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Department of Health Sciences, Brunel University London, Uxbridge, UK
| | | | - Romaina Iqbal
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ravi Mehrotra
- Department of Health Sciences, University of York, Heslington, UK
- ICMR - India Cancer Research Consortium, New Delhi, India
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, UK
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Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, Bhandary S, Mudvari A, Dangal G. A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:351-358. [PMID: 37042379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - B Thapa
- Department of Emergency Medicine, Kirtipur Hospital, Kirtipur, Nepal
| | - S B Pathak
- Department of Intensive Care Unit and Critical care, Nepal Mediciti Hospital, Sainbu, Bhaisepati, Nepal
| | - A Pandey
- Department of General Surgery, Madhyapur Hospital, Bhaktapur, Nepal
| | - S Pokhrel
- Department of Emergency Medicine, Nidan Hospital, Lalitpur, Pulchowk, Nepal
| | - P R Shankar
- IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
| | - S Bhandary
- Department of Community Health Sciences and School of Public Health, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - A Mudvari
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - G Dangal
- Kathmandu Model Hospital, Kathmandu, Nepal
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Trapero-Bertran M, Pokhrel S, Hanney S. Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations. Health Res Policy Syst 2022; 20:67. [PMID: 35717247 PMCID: PMC9206096 DOI: 10.1186/s12961-022-00875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
WHO promotes the use of research in policy-making to drive improvements in health, including in achieving Sustainable Development Goals such as tobacco control. The European Union’s new €95 billion Horizon Europe research framework programme parallels these aims, and also includes commitments to fund economic evaluations. However, researchers often express frustration at the perceived lack of attention to scientific evidence during policy-making. For example, some researchers claim that evidence regarding the return on investment from optimal implementation of evidence-based policies is frequently overlooked. An increasingly large body of literature acknowledges inevitable barriers to research use, but also analyses facilitators encouraging such use. This opinion piece describes how some research is integrated into policy-making. It highlights two recent reviews. One examines impact assessments of 36 multi-project research programmes and identifies three characteristics of projects more likely to influence policy-making. These include a focus on healthcare system needs, engagement of stakeholders, and research conducted for organizations supported by structures to receive and use evidence. The second review suggests that such characteristics are likely to occur as part of a comprehensive national health research system strategy, especially one integrated into the healthcare system. We also describe two policy-informing economic evaluations conducted in Spain. These examined the most cost-effective package of evidence-based tobacco control interventions and the cost-effectiveness of different strategies to increase screening coverage for cervical cancer. Both projects focused on issues of healthcare concern and involved considerable stakeholder engagement. The Spanish examples reinforce some lessons from the global literature and, therefore, could help demonstrate to authorities in Spain the value of developing comprehensive health research systems, possibly following the interfaces and receptor model. The aim of this would be to integrate needs assessment and stakeholder engagement with structures spanning the research and health systems. In such structures, economic evaluation evidence could be collated, analysed by experts in relation to healthcare needs, and fed into both policy-making as appropriate, and future research calls. The increasingly large local and global evidence base on research utilization could inform detailed implementation of this approach once accepted as politically desirable. Given the COVID-19 pandemic, increasing the cost-effectiveness of healthcare systems and return on investment of public health interventions becomes even more important.
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Affiliation(s)
- Marta Trapero-Bertran
- Basic Sciences Department, Patients Institute, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Subhash Pokhrel
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK.
| | - Stephen Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK
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Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. Integ Health J 2022. [DOI: 10.1136/ihj-2021-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.
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Pokhrel S, Pokhrel R, Pokhrel N, Khadka N, Pardhe B. T175 MPV as an indicator of vascular complication in poor control diabetic population. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pokhrel R, Pokhrel N, Pokhrel S, Chaudhary A, Khadka N. M217 Six sigma metric evaluations of routine biochemistry parameters and glycated hemoglobin in a fully automated clinical chemistry laboratory. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Agyemang K, Banstola A, Pokhrel S, Anokye N. Determinants of Physical Activity and Dietary Habits among Adults in Ghana: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19084671. [PMID: 35457539 PMCID: PMC9025416 DOI: 10.3390/ijerph19084671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
A critical understanding of the interrelationship between two behavioral decisions—participating in physical activity, and eating healthily—is lacking in Ghana. This study aimed to determine which factors affect each of the two behavioral decisions, jointly and separately, among adults aged 18 years or older in three metropolises (Kumasi, Accra, and Tamale) of Ghana. The data from the Ghana Obesity Survey 2021 were used. A bivariate probit model was fitted to estimate nonlinear models that indicate an individual’s joint decision to participate in physical activity and consume a healthy diet. A positive correlation (r = 0.085; p < 0.05) was found between these two decisions, indicating a relationship between these two behavioral decisions. The common correlates between these decisions were self-reported good health status, high income, and attitudes toward being overweight. Men were more likely to be physically active but less likely to eat well. Both religion and culture determined participation in physical activity, but not the consumption of a healthy diet. Marital status determined diet, but not physical activity. The new knowledge gained from this analysis around the nature and the extent of the interconnectedness between physical activity and diet is critical to devising targeted interventions for obesity prevention in Ghana.
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Pokhrel S, Gregory A, Mellor A. Perioperative care in cardiac surgery. BJA Educ 2021; 21:396-402. [PMID: 34567795 PMCID: PMC8446225 DOI: 10.1016/j.bjae.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- S. Pokhrel
- James Cook University Hospital, Middlesbrough, UK
| | | | - A. Mellor
- James Cook University Hospital, Middlesbrough, UK
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Chapgain RH, Adhikari S, Pandey A, Sharma S, Pokhrel S, Devkota N, Shrestha NJ, Upadhaya D, Acharay J, Dharel M. Knowledge and Practices of Child Protection among the School Health Nurses of Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:460-466. [PMID: 36259189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Child protection is burning issues in developing countries including Nepal. Child protection is one of the key works of the school health nurses. Objective To find out about the existing knowledge and practices of child protection among the school health nurses. Method This descriptive cross-sectional study was conducted among 130 school health nurses working in different schools throughout Nepal. The participants were selected using purposive sampling technique and were invited to participate via various online networks. Self-administered questionnaire was used to collect data. Duration of data collection was 20 December 2020 to 10 February 2021. Descriptive statistics was used to analyze and interpret the data. Result Among the 130 Participants, 88.5% belonged to less than 29 years age group and 67.7% had Proficiency Certificate Level in Nursing education. None of them has received training related to child protection recognition and response and 90.8% had work experience of less than 5 years. Eighty percent and 96.9% participants had knowledge regarding the meaning of child right and child abuse respectively. But 45.4% had knowledge on meaning of child neglect; 53.1% and 72.3% had the knowledge of physical abuse and noncontact sexual abuse respectively. Majority (86.9%) of the participants reported as relatives were the abuser and 63.8% replied as home is the common place for abuse. Similarly, 85.4% had received the information regarding child protection via television radio and newspaper. Only 36.1% has already been involved in child protection. The participants who went to local government (Palika), police and Non-government Organizations for coordination for child right issues were 9(19.1%), 7(14.8%) and 8(17.0%) respectively. Conclusion Most of the school health nurses are young without having experience of childhood abuse and received any child protection training before joining the job. They have good knowledge of child right, physical, sexual abuse except child neglect and existing legal arrangements. There is gap in knowledge and practice.
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Affiliation(s)
- R H Chapgain
- Kanti Children's Hospital, Kathmandu, Nepal. National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - S Adhikari
- KantiChildren's Hospital, Kathmandu, Nepal
| | - A Pandey
- Birgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Birgunj, Parsa, Nepal
| | - S Sharma
- Scheer Memorial Hospital, Banepa, Nepal
| | - S Pokhrel
- KantiChildren's Hospital, Kathmandu, Nepal
| | - N Devkota
- KantiChildren's Hospital, Kathmandu, Nepal
| | - N J Shrestha
- KantiChildren's Hospital, Kathmandu, Nepal. National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - D Upadhaya
- Cumbria Partnership NHS Foundation Trust, UK
| | - J Acharay
- Alder Hey Children's Hospital, NHS Foundation Trust, UK
| | - M Dharel
- National Child Right Council, Kathmandu, Nepal
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Walker N, Smith B, Barnes J, Verbiest M, Parag V, Pokhrel S, Wharakura M, Lees T, Cubillos Gutierrez H, Jones B, Bullen C. Cytisine versus varenicline for smoking cessation in New Zealand indigenous Māori: a randomized controlled trial. Addiction 2021; 116:2847-2858. [PMID: 33761149 PMCID: PMC8519028 DOI: 10.1111/add.15489] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/13/2020] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
AIM To determine whether cytisine was at least as effective as varenicline in supporting smoking abstinence for ≥ 6 months in New Zealand indigenous Māori or whānau (extended-family) of Māori, given the high smoking prevalence in this population. DESIGN Pragmatic, open-label, randomized, community-based non-inferiority trial. SETTING Bay of Plenty, Tokoroa and Lakes District Health Board regions of New Zealand. PARTICIPANTS Adult daily smokers who identified as Māori or whānau of Māori, were motivated to quit in the next 2 weeks, were aged ≥ 18 years and were eligible for subsidized varenicline. Recruitment used multi-media advertising. INTERVENTIONS A total of 679 people were randomly assigned (1 : 1) to receive a prescription for 12 weeks of cytisine or varenicline, plus low-intensity cessation behavioural support from the prescribing doctor and community stop-smoking services or a research assistant. Day 5 of treatment was the designated quit date. MEASUREMENTS The primary outcome was carbon monoxide-verified continuous abstinence at 6 months, analysed as intention-to-treat (with multiple imputation for missing data). Secondary outcomes measured at 1, 3, 6 and 12 months post-quit date included: self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance and acceptability, nicotine withdrawal/urge to smoke and health-care utilization/health-related quality of life. FINDINGS Verified continuous abstinence rates at 6 months post-quit date were 12.1% (41 of 337) for cytisine versus 7.9% (27 of 342) for varenicline [risk difference 4.29%, 95% confidence interval (CI) = -0.22 to 8.79; relative risk 1.55; 95% CI = 0.97-2.46]. Sensitivity analyses confirmed that the findings were robust. Self-reported adverse events over 6 months occurred significantly more frequently in the varenicline group (cytisine: 313 events in 111 participants; varenicline: 509 events in 138 participants, incidence rate ratio 0.56, 95% CI = 0.49-0.65, P < 0.001) compared with the cytisine group. Common adverse events were headache, nausea and difficulty sleeping. CONCLUSION A randomized controlled trial found that cytisine was at least as effective as varenicline at supporting smoking abstinence in New Zealand indigenous Māori or whānau (extended-family) of Māori, with significantly fewer adverse events.
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Affiliation(s)
- Natalie Walker
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Barry Smith
- Lakes District Health BoardRotoruaNew Zealand
| | - Joanne Barnes
- School of Pharmacy, The University of AucklandAucklandNew Zealand
| | - Marjolein Verbiest
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
| | - Varsha Parag
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Mary‐Kaye Wharakura
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Tina Lees
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Huber Cubillos Gutierrez
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Brian Jones
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Christopher Bullen
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
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15
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Siddiqi K, Islam Z, Khan Z, Siddiqui F, Mishu M, Dogar O, Shah V, Khan J, Pokhrel S, Iqbal R, Bauld L, Sheikh A, Grugel J. Identification of Policy Priorities to Address the Burden of Smokeless Tobacco in Pakistan: A Multimethod Analysis. Nicotine Tob Res 2021; 22:2262-2265. [PMID: 31570940 PMCID: PMC7733056 DOI: 10.1093/ntr/ntz163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022]
Abstract
Introduction We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders’ views as to which of these identified priorities are most important. Methods In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders’ views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy priorities using a postevent survey. Results Among all tobacco users in Pakistan (n = 24 million), one-third of men and two-thirds of women consume ST. In 2017, its use led to an estimated 18 711 deaths due to cancer and ischemic heart disease. Compared to smoking, policies to control ST lag behind significantly. Priority areas for ST policies included: banning ST sale to and by minors, advocacy campaigns, introduction of licensing, levying taxes on ST, and standardizing ST packaging. A clear commitment to close cooperation between state actors and stakeholder groups is needed to create a climate of support and information for effective policy making. Conclusions Smokeless tobacco control in Pakistan should focus on four key policy instruments: legislation, education, fiscal policies, and quit support. More research into the effectiveness of such policies is also needed. Implications A number of opportunities to improve ST regulation in Pakistan were identified. Among these, immediate priorities include banning ST sale to and by minors, mobilizing advocacy campaign, introduction of licensing through the 1958 Tobacco Vendors Act, levying taxes on ST, and standardizing ST packaging.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Ziauddin Islam
- Tobacco Control Cell, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Masuma Mishu
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Vandana Shah
- Campaign for Tobacco Free Kids, Washington, DC 20005
| | - Javaid Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Subhash Pokhrel
- Department of Clinical Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Jean Grugel
- Department of Politics, University of York, York YO10 5DD, UK
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Abstract
BACKGROUND Promotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs). OBJECTIVE The objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations. DATA SOURCES A systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature. STUDY ELIGIBILITY CRITERIA Cost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria. STUDY APPRAISAL AND SYNTHESIS OF METHODS Screening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed. RESULTS The majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost-utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil. LIMITATIONS Meta-analysis was not performed due to heterogeneity of the studies. CONCLUSIONS AND RECOMMENDATIONS Economic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas. PROSPERO REGISTRATION NUMBER CRD42018099856.
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Affiliation(s)
- Priyanga Diloshini Ranasinghe
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
- Ministry of Health, Nutrition, Indegenous Medicine, Colombo 10, Sri Lanka
| | - Subhash Pokhrel
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
| | - Nana Kwame Anokye
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
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17
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Kane AD, Paterson J, Pokhrel S, Berry SK, Monkhouse D, Brand JW, Ingram M, Danjoux GR. Peri-operative COVID-19 infection in urgent elective surgery during a pandemic surge period: a retrospective observational cohort study. Anaesthesia 2020; 75:1596-1604. [PMID: 33090469 DOI: 10.1111/anae.15281] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID-19) pandemic is challenging and it is not clear how COVID-19 may impact peri-operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, we establish if implementation of a bespoke peri-operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID-19-associated complication profile. We present a single-centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID-19 surge in the UK between 29 March and 12 June 2020. Patients asymptomatic for COVID-19 were screened by oronasal swab and chest imaging (chest X-ray or computed tomography if aged ≥ 18 years), proceeding to surgery if negative. COVID-19 positive patients at screening were delayed. Postoperatively, patients transitioning to COVID-19 positive status by reverse transcriptase polymerase chain reaction testing were identified by an in-house tracking system and monitored for complications and death within 30 days of surgery. Out of 557 patients referred for surgery (230 (41.3%) women; median (IQR [range]) age 61 (48-72 [1-89])), 535 patients (96%) had COVID-19 screening, of which 13 were positive (2.4%, 95%CI 1.4-4.1%). Out of 512 patients subsequently undergoing surgery, 7 (1.4%) developed COVID-19 positive status (1.4%, 95%CI 0.7-2.8%) with one COVID-19-related death (0.2%, 95%CI 0.0-1.1%) within 30 days. Out of these seven patients, four developed pneumonia, of which two required invasive ventilation including one patient with acute respiratory distress syndrome. Low rates of COVID-19 infection and mortality in the elective surgical population can be achieved within a targeted care bundle. This should provide reassurance that elective surgery can continue, where possible, despite high community rates of COVID-19.
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Affiliation(s)
- A D Kane
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - J Paterson
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - S Pokhrel
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - S K Berry
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - D Monkhouse
- Department of Intensive Care Medicine, James Cook University Hospital, Middlesbrough, UK
| | - J W Brand
- Department of Cardiothoracic Intensive Care Medicine and Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - M Ingram
- Department of Cardiothoracic Intensive Care Medicine and Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - G R Danjoux
- Department of Cardiothoracic Intensive Care Medicine and Anaesthesia, James Cook University Hospital, Middlesbrough, UK.,Hull York Medical School and School of Health and Social Science, Teesside University, Middlesbrough, UK
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18
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Codogno JS, Monteiro HL, Turi-Lynch BC, Fernandes RA, Pokhrel S, Anokye N. Sports Participation and Health Care Costs in Older Adults Aged 50 Years or Older. J Aging Phys Act 2020; 28:634-640. [PMID: 32053793 DOI: 10.1123/japa.2019-0219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 11/18/2022]
Abstract
The objective of the study was to analyze the relationship between sports participation and health care costs in older adults. The sample was composed of 556 participants (145 men and 411 women) who were followed from 2010 to 2014. The engagement in sports considered three different components (intensity, volume, and previous time). Health care costs were assessed annually through medical records. Structural equation modeling (longitudinal relationship between sport and costs) and analysis of variance for repeated measures (comparisons over time) were used. Health care costs increased significantly from 2010 to 2014 (analysis of variance; p value = .001). Higher baseline scores for intensity were related to lower health care costs (r = -.223, 95% confidence interval [-.404, -.042]). Similar results were found to volume (r = -.216, 95% confidence interval [-.396, -.036]) and time of engagement (r = -.218, 95% confidence interval [-.402, -.034]). In conclusion, higher sports participation is related to lower health care costs in older adults.
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Hanney SR, Kanya L, Pokhrel S, Jones TH, Boaz A. How to strengthen a health research system: WHO's review, whose literature and who is providing leadership? Health Res Policy Syst 2020; 18:72. [PMID: 32571364 PMCID: PMC7308111 DOI: 10.1186/s12961-020-00581-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. MAIN TEXT The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. CONCLUSIONS The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.
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Affiliation(s)
- Stephen R. Hanney
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Lucy Kanya
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Teresa H. Jones
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Annette Boaz
- Faculty of Health, Social Care and Education, a partnership between Kingston University and St George’s, University of London, London, United Kingdom
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20
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Vargas-Martínez AM, Trapero-Bertran M, Lima-Serrano M, Anokye N, Pokhrel S, Mora T. Measuring the effects on quality of life and alcohol consumption of a program to reduce binge drinking in Spanish adolescents. Drug Alcohol Depend 2019; 205:107597. [PMID: 31590139 DOI: 10.1016/j.drugalcdep.2019.107597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/06/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
AIM To present a comparison between the effects on health due to a reduction in binge drinking (BD) and health-related quality of life (HRQoL), as a result of ALERTA ALCOHOL, an intervention aimed at reducing BD in Spanish adolescents. METHODS A two-arm cluster randomized controlled trial was conducted with an intervention and a control group, randomized at the school level, following individuals over four months. The study population consisted of Andalusian adolescents aged 15 to 19 years who were enrolled in urban public high schools (n = 1247). Participants were assigned randomly to receive the intervention. The main outcomes studied were the number of occasions of BD in the last 30 days, which was directly obtained from the answers given by the adolescents, and HRQoL measured with the EQ-5D-5 L questionnaire. The model of estimation was the generalized estimating equations (GEE) approach. RESULTS The program showed a BD reduction at the 4-month follow-up, although it was not shown to significantly increase the HRQoL in adolescents who reduced the number of occasions of BD and had received the intervention. However, it was shown that those who would predictably reduce the number of occasions of BD controlled by several sociodemographic variables perceived a higher HRQoL, as did those who had a greater adherence to the program. CONCLUSIONS Higher adherence to a web-based computer-tailored intervention to prevent BD in adolescents has a positive effect on decreasing the number of occasions of BD in adolescents as well as on increasing participants' HRQoL, although this second effect is very small, which could be due to the short follow-up time. This fact is quite important and should be assessed extensively to corroborate the results and translate into health policy.
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Affiliation(s)
- Ana Magdalena Vargas-Martínez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain; Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marta Lima-Serrano
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
| | - Nana Anokye
- Health Economics Research Group (HERG), Brunel University, Uxbridge, London, UK.
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Brunel University, Uxbridge, London, UK.
| | - Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
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21
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Fairless L, Pokhrel S, Barham N. Patient perspectives of ‘one stop shop’ preassessment. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aveyard P, Lindson N, Tearne S, Adams R, Ahmed K, Alekna R, Banting M, Healy M, Khan S, Rai G, Wood C, Anderson EC, Ataya-Williams A, Attwood A, Easey K, Fluharty M, Freuler T, Hurse M, Khouja J, Lacey L, Munafò M, Lycett D, McEwen A, Coleman T, Dickinson A, Lewis S, Orton S, Perdue J, Randall C, Anderson R, Bisal N, Hajek P, Homsey C, McRobbie HJ, Myers-Smith K, Phillips A, Przulj D, Li J, Coyle D, Coyle K, Pokhrel S. Nicotine preloading for smoking cessation: the Preloading RCT. Health Technol Assess 2019; 22:1-84. [PMID: 30079863 DOI: 10.3310/hta22410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. OBJECTIVES To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. DESIGN Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. SETTING NHS smoking cessation clinics. PARTICIPANTS People seeking help to stop smoking. INTERVENTIONS Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. MAIN OUTCOME MEASURES The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. RESULTS In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. LIMITATIONS The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. CONCLUSIONS Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. TRIAL REGISTRATION Current Controlled Trials ISRCTN33031001. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Adams
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Khaled Ahmed
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rhona Alekna
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Miriam Banting
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mike Healy
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shahnaz Khan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Gurmail Rai
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Carmen Wood
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma C Anderson
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Angela Attwood
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Kayleigh Easey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Fluharty
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Therese Freuler
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Hurse
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Jasmine Khouja
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Lindsey Lacey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Marcus Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anne Dickinson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Johanna Perdue
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Randall
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rebecca Anderson
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natalie Bisal
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Celine Homsey
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Hayden J McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katherine Myers-Smith
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Phillips
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Doug Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Katherine Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Subhash Pokhrel
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
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Fernandes RA, Mantovani AM, Codogno JS, Turi-Lynch BC, Pokhrel S, Anokye N. The Relationship between Lifestyle and Costs Related to Medicine Use in Adults. Arq Bras Cardiol 2019; 112:749-755. [PMID: 30892384 PMCID: PMC6636366 DOI: 10.5935/abc.20190049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses. OBJECTIVE To examine the interrelationship between the costs of medicine use and lifestyle behaviors. METHODS A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05. RESULTS In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs. CONCLUSION Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact.
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Affiliation(s)
- Romulo Araujo Fernandes
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil.,Departmento de Educação Física - Faculdade de Ciências e Tecnologia - Universidade Estadual Paulista (UNESP), Presidente Prudente, SP - Brazil
| | - Alessandra Madia Mantovani
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil
| | - Jamile Sanches Codogno
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil.,Departmento de Educação Física - Faculdade de Ciências e Tecnologia - Universidade Estadual Paulista (UNESP), Presidente Prudente, SP - Brazil
| | - Bruna Camilo Turi-Lynch
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil
| | - Subhash Pokhrel
- Institute of Environment - Health and Societies - Brunel University - Uxbridge, London - United Kingdom
| | - Nana Anokye
- Institute of Environment - Health and Societies - Brunel University - Uxbridge, London - United Kingdom
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Walker N, Smith B, Barnes J, Verbiest M, Kurdziel T, Parag V, Pokhrel S, Bullen C. Cytisine versus varenicline for smoking cessation for Māori (the indigenous people of New Zealand) and their extended family: protocol for a randomized non-inferiority trial. Addiction 2019; 114:344-352. [PMID: 30276931 PMCID: PMC6587772 DOI: 10.1111/add.14449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/27/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Cytisine, a nicotinic acetylcholine receptor partial agonist (like varenicline) found in some plants, is a low-cost, effective smoking cessation medication that may appeal to Māori [the indigenous people of New Zealand (NZ)]. The RAUORA trial aims to determine the effectiveness, safety and cost-effectiveness of cytisine (Tabex® ) versus varenicline (Champix® ) for smoking cessation in Māori and the whānau (extended family) of Māori. DESIGN Pragmatic, community-based, open-label randomized non-inferiority trial. SETTING Lakes District Health Board region, NZ. PARTICIPANTS Daily smokers (n = 2140) who self-identify as Māori or whānau of Māori, and are: aged ≥ 18 years, motivated to quit smoking in the next 2 weeks, eligible for subsidized varenicline, able to provide verbal consent and have daily access to a mobile phone/internet. Recruitment uses multi-media advertising. INTERVENTION AND COMPARATOR Participants are randomized (1 : 1 ratio) to receive a prescription for 12 weeks of cytisine tablets [following the manufacturer's dosing regimen for 25 days, then one 1.5-mg tablet every 6 hours (two per day) until 12 weeks] or varenicline tablets (following the manufacturer's dosing regimen). Both groups receive brief stop-smoking advice from the prescribing doctor and withdrawal-orientated behavioural support via community-based stop-smoking counselling services (frequency, duration and mode of delivery tailored for participants) or a research assistant (six weekly 10-15-minute calls). Participants are advised to reduce their smoking over the first 4 days of treatment, with day 5 as their designated quit-date. MEASUREMENTS The primary outcome is carbon monoxide-verified continuous abstinence at 6 months post-quit date. Secondary outcomes at 1, 3, 6 and 12 months post-quit date include: self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance, treatment acceptability, nicotine withdrawal/urge to smoke and health-care utilization/health-related quality of life. COMMENTS This trial compares cytisine and varenicline when used by the indigenous people of NZ and their extended family for smoking cessation.
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Affiliation(s)
- Natalie Walker
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Barry Smith
- Lakes District Health BoardRotoruaNew Zealand
| | - Joanne Barnes
- School of PharmacyThe University of AucklandAucklandNew Zealand
| | - Marjolein Verbiest
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand,Tranzo Scientific Centre for Care and Welfare, School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
| | - Tomasz Kurdziel
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Varsha Parag
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Chris Bullen
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
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Ranasinghe PD, Pokhrel S, Anokye NK. The economics of physical activity in low-income and middle-income countries: protocol for a systematic review. BMJ Open 2019; 9:e022686. [PMID: 30659037 PMCID: PMC6340626 DOI: 10.1136/bmjopen-2018-022686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/09/2018] [Accepted: 11/23/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Evidence on the economic costs of physical inactivity and the cost-effectiveness of physical activity interventions in low-income and middle-income countries (LMICs) is sparse, and fragmented where they are available. This is the first review aimed to summarise available evidence on economics of physical activity in LMICs, identify potential target variables for policy, and identify and report gaps in the current knowledge on economics of physical activity in LMICs. METHODS AND ANALYSIS Peer-reviewed journal articles of observational, experimental, quasi-experimental and mixed-method studies on economics of physical activity in LMICs will be identified by a search of electronic databases; Scopus, Web of Science and SPORTDiscus. Websites of WHO, the National Institute for Health and Care Excellence international, World Bank and reference lists of included studies will be searched for relevant studies. The study selection process will be a two-stage approach; title and abstract screen for inclusion, followed by a review of selected full-text articles by two independent reviewers. Disagreements will be resolved by consensus and discussion with a third reviewer. Data will be extracted using standardised piloted data extraction forms. Risk of bias will be critically appraised using standard checklists based on study designs. Descriptive synthesis of data is planned. Where relevant, summaries of studies will be classified according to type of economic analysis, country or country category, population, intervention, comparator, outcome and study design. Meta-analysis will be performed where appropriate. This protocol for systematic review is prepared according to the Preferred Reporting Items for Systematic review and Meta-analysis for Protocols -2015 statement. ETHICS AND DISSEMINATION Ethical approval is not obtained as original data will not be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42018099856.
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Affiliation(s)
- Priyanga Diloshini Ranasinghe
- Department of Health, Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
- Division of Health Sciences, Department of Clinical Sciences, Collage of Health and Life Sciences, Brunel University, London, UK
| | - Subhash Pokhrel
- Health Economics Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Nana Kwame Anokye
- Health Economics Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
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Stewart G, Anokye NK, Pokhrel S. Quantifying the contribution of utility cycling to population levels of physical activity: an analysis of the Active People Survey. J Public Health (Oxf) 2018; 38:644-652. [PMID: 28158729 PMCID: PMC6088795 DOI: 10.1093/pubmed/fdv182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Glenn Stewart
- Health Economics Research Group (HERG), Institute for Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex UB83PH, UK
| | - Nana Kwame Anokye
- Health Economics Research Group (HERG), Institute for Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex UB83PH, UK
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute for Environment, Health and Societies, Brunel University London, Uxbridge, Middlesex UB83PH, UK
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Naatz H, Hoffmann R, Hartwig A, La Mantia F, Pokhrel S, Mädler L. Verfahren zur Bestimmung des Flachbandpotenzials von Nanopartikeln in porösen Elektroden. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- H. Naatz
- Universität Bremen; Mechanische Verfahrenstechnik; Badgasteiner Straße 1 28359 Bremen Deutschland
- Leibniz-Institut für Werkstofforientierte Technologien; Badgasteiner Straße 3 28359 Bremen Deutschland
| | - R. Hoffmann
- Universität Bremen; Biologie/Chemie; Leobener Straße 3 28359 Bremen Deutschland
- Fraunhofer-Institut für Fertigungstechnik und Angewandte Materialforschung; Wiener Straße 12 28359 Bremen Deutschland
| | - A. Hartwig
- Universität Bremen; Biologie/Chemie; Leobener Straße 3 28359 Bremen Deutschland
- Fraunhofer-Institut für Fertigungstechnik und Angewandte Materialforschung; Wiener Straße 12 28359 Bremen Deutschland
| | - F. La Mantia
- Universität Bremen; Energiesysteme; Bibliothekstraße 1 28359 Bremen Deutschland
| | - S. Pokhrel
- Universität Bremen; Mechanische Verfahrenstechnik; Badgasteiner Straße 1 28359 Bremen Deutschland
- Leibniz-Institut für Werkstofforientierte Technologien; Badgasteiner Straße 3 28359 Bremen Deutschland
| | - L. Mädler
- Universität Bremen; Mechanische Verfahrenstechnik; Badgasteiner Straße 1 28359 Bremen Deutschland
- Leibniz-Institut für Werkstofforientierte Technologien; Badgasteiner Straße 3 28359 Bremen Deutschland
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Singh J, Pokhrel S, Longworth L. Can Social Care Needs and Well-Being Be Explained by the EQ-5D? Analysis of the Health Survey for England. Value Health 2018; 21:830-838. [PMID: 30005755 DOI: 10.1016/j.jval.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 10/25/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The recent shift to an integrated approach to health and social care aims to provide cohesive support to those who are in need of care, but raises a challenge for resource allocation decision making, in particular for comparison of diverse benefits from different types of care across the two sectors. OBJECTIVE To investigate the relationship of social care needs and well-being with a generic health status measure using multivariate regression. METHODS We empirically compared responses to health and well-being measures and social care needs from a cross-sectional data set of the general population (the Health Survey for England). Multivariate regression analyses were conducted to examine whether social care needs measured by the Barthel index can be explained by health status as captured by the EuroQol five-dimensional questionnaire (EQ-5D) and two well-being measures-the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and the General Health Questionnaire (GHQ-12). RESULTS Our study found that poor overall scores for EuroQol visual analogue scale, EQ-5D index, GHQ-12, and WEMWBS indicated a need for social care. Investigation of the dimensions found that the EQ-5D dimensions self-care and pain/discomfort were statistically significantly associated with the need for social care. Two dimensions of the WEMWBS ("been feeling useful" and "had energy to spare") were statistically significantly associated with the Barthel index, but none of the GHQ-12 dimensions were. CONCLUSIONS The results show that the need for social care, which is dependent on the ability to perform personal day-to-day activities, is more closely related to the EQ-5D dimensions than the well-being measures WEMWBS and GHQ-12.
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Affiliation(s)
- Jeshika Singh
- PHMR Ltd.-Health Economics, Pricing and Reimbursement, London, UK; Health Economics Research Group, Department of Clinical Sciences, Brunel University London, London, UK.
| | - Subhash Pokhrel
- Health Economics Research Group, Department of Clinical Sciences, Brunel University London, London, UK
| | - Louise Longworth
- PHMR Ltd.-Health Economics, Pricing and Reimbursement, London, UK
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Trapero-Bertran M, Muñoz C, Coyle K, Coyle D, Lester-George A, Leidl R, Bertalan N, Cheung KL, Pokhrel S, Lopez-Nicolás A. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trapero-Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak-Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S, EQUIPT Study Group OBOT. Estimating costs for modelling return on investment from smoking cessation interventions. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Németh B, Kulchaitanaroaj P, Lester‐George A, Huic M, Coyle K, Coyle D, Pokhrel S, Kaló Z. A utility of model input uncertainty analysis in transferring tobacco control-related economic evidence to countries with scarce resources: results from the EQUIPT study. Addiction 2018; 113 Suppl 1:42-51. [PMID: 29377316 PMCID: PMC6033140 DOI: 10.1111/add.14092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/31/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
AIMS To inform the transferability of tobacco control-related economic evidence to resource-poor countries. METHODS We ran a univariate sensitivity analysis on a return on investment (ROI) model, the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), to identify key input values to which the ROI estimates were sensitive. The EQUIPTMOD used a Markov-based state transition model to estimate the ROI of several tobacco control interventions in five European countries (England, Germany, Spain, Hungary and the Netherlands). Base case ROI estimates were obtained through average values of model inputs (throughout the five countries), which were then replaced one at a time with country-specific values. Tornado diagrams were used to evaluate the significance of sensitivity, defined as a ≥ 10% difference in ROI estimates from the base case estimates. RESULTS The ROI estimates were sensitive to 18 (of 46) input values. Examples of model inputs to which ROI estimates were sensitive included: smoking rate, costs of smoking-related diseases (e.g. lung cancer) and general population attributes. CONCLUSION Countries that have limited research time and other resources can adapt EQUIPTMOD to their own settings by choosing to collect data on a small number of model inputs. EQUIPTMOD can therefore facilitate transfer of tobacco control related economic evidence to new jurisdictions.
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Affiliation(s)
| | - Puttarin Kulchaitanaroaj
- Health Economics Research Group, Institute of Environment, Health and SocietyBrunel University LondonUK,Department of Pharmacy Practice and Science, College of PharmacyUniversity of IowaIowa CityIAUSA
| | | | - Mirjana Huic
- Agency for Quality and Accreditation in Health Care and Social WelfareZagrebCroatia
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietyBrunel University LondonUK
| | - Doug Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietyBrunel University LondonUK,School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietyBrunel University LondonUK
| | - Zoltán Kaló
- Syreon Research InstituteBudapestHungary,Department of Health Policy and Health EconomicsEötvös Loránd UniversityBudapestHungary
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Trapero‐Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak‐Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S. Estimates of costs for modelling return on investment from smoking cessation interventions. Addiction 2018; 113 Suppl 1:32-41. [PMID: 29532538 PMCID: PMC6033022 DOI: 10.1111/add.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 11/02/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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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
| | - 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
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Puttarin Kulchaitanaroaj
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
- Department of Epidemiology and Community Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Maximilian Präger
- 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
| | - Judit Józwiak‐Hagymásy
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei Long Cheung
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Mickael Hiligsmann
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
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Affiliation(s)
- Subhash Pokhrel
- Health Economics Research Group, Brunel University London, London, UK
| | - Robert West
- Institute of Epidemiology and Health, University College London, London, UK
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West R, Coyle K, Owen L, Coyle D, Pokhrel S. Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction 2018; 113 Suppl 1:19-31. [PMID: 28833834 PMCID: PMC6032933 DOI: 10.1111/add.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Estimating 'return on investment' (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. METHODS Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. FINDINGS Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster-acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone applications and e-cigarettes. CONCLUSIONS Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Kathryn Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
| | - Lesley Owen
- Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
| | - Doug Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
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Coyle K, Coyle D, Lester‐George A, West R, Nemeth B, Hiligsmann M, Trapero‐Bertran M, Leidl R, Pokhrel S. Development and application of an economic model (EQUIPTMOD) to assess the impact of smoking cessation. Addiction 2018; 113 Suppl 1:7-18. [PMID: 28833765 PMCID: PMC6033161 DOI: 10.1111/add.14001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/27/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision-makers need tools to assess the Return on Investment (ROI)/cost-effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. METHODS EQUIPTMOD uses a Markov model to estimate life-time costs, quality-adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country-specific rates. RESULTS For illustration, over a life-time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease-related health care costs than if the smoker ceased smoking in the next 12 months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. CONCLUSIONS EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.
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Affiliation(s)
- Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
| | - Doug Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
- School of Epidemiology, Public Health and Preventative MedicineUniversity of OttawaOttawaONCanada
| | | | - Robert West
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | | | - Mickael Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI)Maastricht UniversityMaastrichtthe Netherlands
| | - 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
| | - 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
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
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Anraad C, Cheung K, Hiligsmann M, Coyle K, Coyle D, Owen L, West R, de Vries H, Evers SM, Pokhrel S. Assessment of cost-effective changes to the current and potential provision of smoking cessation services: an analysis based on the EQUIPTMOD. Addiction 2018; 113 Suppl 1:96-105. [PMID: 29430762 PMCID: PMC6033165 DOI: 10.1111/add.14093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/31/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Increasing the reach of smoking cessation services and/or including new but effective medications to the current provision may provide significant health and economic benefits; the scale of such benefits is currently unknown. The aim of this study was to estimate the cost-effectiveness from a health-care perspective of viable national level changes in smoking cessation provision in the Netherlands and England. METHODS A Markov-based state transition model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)] was used to estimate costs and benefits [expressed in quality-adjusted life years (QALY)] of changing the current provision of smoking cessation programmes in the Netherlands and England. The changes included: (a) increasing the reach of top-level services to increase potential quitters (e.g. brief physician advice); (b) increasing the reach of behavioural support (group-based therapy and SMS text-messaging support) to increase the success rates; (c) including a new but effective medication (cytisine); and (d) all changes implemented together (combined change). The costs and QALYs generated by those changes over 2, 5, 10 years and a life-time were compared with that of the current practice in each country. Results were expressed as incremental net benefit (INB) and incremental cost-effectiveness ratio (ICER). A sequential analysis from a life-time perspective was conducted to identify the optimal change. RESULTS The combined change was dominant (cost-saving) over all alternative changes and over the current practice, in both countries. The combined change would generate an incremental net benefit of €11.47 (2 years) to €56.16 (life-time) per smoker in the Netherlands and €9.96 (2 years) to €60.72 (life-time) per smoker in England. The current practice was dominated by all alternative changes. CONCLUSION Current provision of smoking cessation services in the Netherlands and England can benefit economically from the inclusion of cytisine and increasing the reach of brief physician advice, text-messaging support and group-based therapy.
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Affiliation(s)
- Charlotte Anraad
- Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Kei‐Long Cheung
- Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
| | - Doug Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
- School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
| | - Lesley Owen
- Centre for Guidelines, National Institute for Health and Care ExcellenceLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Hein de Vries
- Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Silvia M. Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
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Huber MB, Präger M, Coyle K, Coyle D, Lester‐George A, Trapero‐Bertran M, Nemeth B, Cheung KL, Stark R, Vogl M, Pokhrel S, Leidl R. Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:52-64. [PMID: 29243347 PMCID: PMC6033002 DOI: 10.1111/add.14062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany. DESIGN A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. SETTING Germany. PARTICIPANTS Cohort of current smoking population (18+ years) in Germany. INTERVENTIONS Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. MEASUREMENTS EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment. FINDINGS The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1. CONCLUSIONS Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.
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Affiliation(s)
- Manuel B. Huber
- 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)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Maximilian Präger
- 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)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
- School of Epidemiology, Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Marta Trapero‐Bertran
- Centre for Research on Economics an Health (CRES) Universitat Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | | | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Renee Stark
- 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)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Matthias Vogl
- 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)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Reiner Leidl
- 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)Institute of Health Economics and Health Care ManagementNeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Németh B, Józwiak‐Hagymásy J, Kovács G, Kovács A, Demjén T, Huber MB, Cheung K, Coyle K, Lester‐George A, Pokhrel S, Vokó Z. Cost-effectiveness of possible future smoking cessation strategies in Hungary: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:76-86. [PMID: 29368363 PMCID: PMC6032939 DOI: 10.1111/add.14089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
AIMS To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. METHODS The EQUIPTMOD, a Markov-based economic model, was used to assess the cost-effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group-based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life-time costs and quality-adjusted life years (QALYs) were calculated from a health-care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost-effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. RESULTS Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health-care cost-savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost-savings increased to €14.1598 per smoker. Doubling the reach of existing group-based behavioural support therapies and proactive telephone support resulted in health-care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. CONCLUSIONS According to the EQUIPTMOD modelling tool, it would be cost-effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group-based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term.
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Affiliation(s)
| | | | - Gábor Kovács
- Korányi National Institute of Tuberculosis and PulmonologyBudapestHungary
- Smoking Cessation Support CenterBudapestHungary
| | - Attila Kovács
- National Public Health and Medical Officer ServiceBudapestHungary
| | - Tibor Demjén
- National Institute for Health Development—Focal Point for Tobacco ControlBudapestHungary
| | - Manuel B. Huber
- 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
| | - Kei‐Long Cheung
- CAPHRI School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | | | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Zoltán Vokó
- Syreon Research InstituteBudapestHungary
- Department of Health Policy and Health EconomicsEötvös Loránd UniversityBudapestHungary
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Cheung K, Wijnen BFM, Hiligsmann M, Coyle K, Coyle D, Pokhrel S, de Vries H, Präger M, Evers SMAA. Is it cost-effective to provide internet-based interventions to complement the current provision of smoking cessation services in the Netherlands? An analysis based on the EQUIPTMOD. Addiction 2018; 113 Suppl 1:87-95. [PMID: 29243351 PMCID: PMC6032907 DOI: 10.1111/add.14069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The cost-effectiveness of internet-based smoking cessation interventions is difficult to determine when they are provided as a complement to current smoking cessation services. The aim of this study was to evaluate the cost-effectiveness of such an alternate package compared with existing smoking cessation services alone (current package). METHODS A literature search was conducted to identify internet-based smoking cessation interventions in the Netherlands. A meta-analysis was then performed to determine the pooled effectiveness of a (web-based) computer-tailored intervention. The mean cost of implementing internet based interventions was calculated using available information, while intervention reach was sourced from an English study. We used EQUIPTMOD, a Markov-based state-transition model, to calculate the incremental cost-effectiveness ratios [expressed as cost per quality-adjusted life years (QALYs) gained] for different time horizons to assess the value of providing internet-based interventions to complement the current package.). Deterministic sensitivity analyses tested the uncertainty around intervention costs per smoker, relative risks, and the intervention reach. RESULTS Internet-based interventions had an estimated pooled relative risk of 1.40; average costs per smoker of €2.71; and a reach of 0.41% of all smokers. The alternate package (i.e. provision of internet-based intervention to the current package) was dominant (cost-saving) compared with the current package alone (0.14 QALY gained per 1000 smokers; reduced health-care costs of €602.91 per 1000 smokers for the life-time horizon). The alternate package remained dominant in all sensitivity analyses. CONCLUSION Providing internet-based smoking cessation interventions to complement the current provision of smoking cessation services could be a cost-saving policy option in the Netherlands.
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Affiliation(s)
- Kei‐Long Cheung
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Ben F. M. Wijnen
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
- Department of Research and DevelopmentEpilepsy Center KempenhaegheHeezethe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Kathryn Coyle
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Hein de Vries
- Department of Health PromotionCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Maximilian Präger
- 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
| | - Silvia M. A. A. Evers
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
- Trimbos Institute, National Institute of Mental Health and AddictionUtrechtthe Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kulchaitanaroaj P, Kaló Z, West R, Cheung KL, Evers S, Vokó Z, Hiligsmann M, de Vries H, Owen L, Trapero-Bertran M, Leidl R, Pokhrel S. Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study. BMC Health Serv Res 2018; 18:115. [PMID: 29444679 PMCID: PMC5813331 DOI: 10.1186/s12913-018-2923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.
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Affiliation(s)
- Puttarin Kulchaitanaroaj
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Robert West
- Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, Birmingham, UK
| | - Kei Long Cheung
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Mickael Hiligsmann
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Marta Trapero-Bertran
- Centre for Research in Economics and Health, University Pompeu Fabra, Barcelona, Spain
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Cheung K, Evers S, De Vries H, Levy P, Pokhrel S, Jones T, Danner M, Wentlandt J, Knufinke L, Mayer S, Hiligsmann M. Most important barriers and facilitators of HTA usage in decision-making in Europe. Expert Rev Pharmacoecon Outcomes Res 2018; 18:297-304. [DOI: 10.1080/14737167.2018.1421459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K.L. Cheung
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - S.M.A.A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - H. De Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - P. Levy
- Department of Economics, Paris Dauphine University, Paris, France
| | - S. Pokhrel
- Health Economics Research Group, Brunel University, London, UK
| | - T. Jones
- Health Economics Research Group, Brunel University, London, UK
| | - M. Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - J. Wentlandt
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - L. Knufinke
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - S. Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - M. Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Meads C, Glover M, Dimmock P, Pokhrel S. Parafricta Bootees and Undergarments to Reduce Skin Breakdown in People with or at Risk of Pressure Ulcers: A NICE Medical Technologies Guidance. Appl Health Econ Health Policy 2016; 14:635-646. [PMID: 27116358 DOI: 10.1007/s40258-016-0245-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As part of the development of the National Institute for Health and Care Excellence (NICE) Medical Technologies Guidance on Parafricta Bootees and Undergarments to reduce skin breakdown in people with, or at risk of, pressure ulcers, the manufacturer (APA Parafricta Ltd) submitted clinical and economic evidence, which was critically appraised by an External Assessment Centre (EAC) and subsequently used by the Medical Technologies Advisory Committee (MTAC) to develop recommendations for further research. The University of Birmingham and Brunel University, acting as a consortium, were commissioned to act as the EAC, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance. Very little comparative evidence was submitted to demonstrate the effectiveness of Parafricta Bootees or Undergarments. The sponsor submitted a simple cost analysis to estimate the costs of using Parafricta in addition to current practice-in comparison with current practice alone-in hospital and community settings separately. The analysis took a National Health Service (NHS) perspective. The basis of the analysis was a previously published comparative study, which showed no statistical difference in average lengths of stay between patients who wore Parafricta Undergarments and Bootees, and those who did not. The economic model incorporated the costs of Parafricta but assumed shorter lengths of stay with Parafricta. The sponsor concluded that Parafricta was cost saving relative to the comparators. The EAC made amendments to the sponsor's analysis to correct for errors and to reflect alternative assumptions. Parafricta remained cost saving in most analyses, and the savings per prevalent case ranged from £757 in the hospital model to £3455 in the community model. All analyses were severely limited by the available data on effectiveness-in particular, a lack of good-quality comparative studies.
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Affiliation(s)
- Catherine Meads
- Health Economics Research Group (HERG), Brunel University, Uxbridge, UB8 3PH, UK.
| | - Matthew Glover
- Health Economics Research Group (HERG), Brunel University, Uxbridge, UB8 3PH, UK
| | - Paul Dimmock
- Medical Technologies Evaluation Programme (MTEP), National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Brunel University, Uxbridge, UB8 3PH, UK
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Croudace T, Brazier J, Gutacker N, Street A, Robotham D, Waterman S, Rose D, Satkunanathan S, Wykes T, Nasr N, Enderby P, Carlton J, Rowen D, Elliott J, Brazier J, Stevens K, Basarir H, Labeit A, Murphy M, Hollinghurst S, Salisbury C, Marley D, Wilson J, Barrat A, Roy B, Rombach I, Burke Ó, Jenkinson C, Gray A, Rivero-Arias O, Porter I, Gangannagaripalli J, Bramwell C, Valderas JM, Holch P, Davidson S, Routledge J, Henry A, Franks K, Gilbert A, Absolom K, Velikova G, Porter I, Valderas JM, Boehnke JR, Trigg A, Howells R, Singh J, Pokhrel S, Longworth L, Potter C, Hunter C, Kelly L, Gibbons E, Forder J, Coulter A, Fitzpatrick R, Peters M. Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Sheffield 2016: advances in patient reported outcomes research. Health Qual Life Outcomes 2016. [PMCID: PMC5073844 DOI: 10.1186/s12955-016-0540-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ) Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and longitudinal parameter shifts in epidemiological data: measurement invariance and response shifts in cohort and survey data describing the UK’s Quality of Life Jan R. Boehnke O12 Patient-reported outcomes within health technology decision making: current status and implications for future policy Andrew Trigg, Ruth Howells O13 Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England dataset Jeshika Singh, Subhash Pokhrel, Louise Longworth O14 Where patients and policy meet: exploring individual-level use of the Long-Term Conditions Questionnaire (LTCQ) Caroline Potter, Cheryl Hunter, Laura Kelly, Elizabeth Gibbons, Julian Forder, Angela Coulter, Ray Fitzpatrick, Michele Peters
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Tämm K, Sikk L, Burk J, Rallo R, Pokhrel S, Mädler L, Scott-Fordsmand JJ, Burk P, Tamm T. Parametrization of nanoparticles: development of full-particle nanodescriptors. Nanoscale 2016; 8:16243-16250. [PMID: 27714136 DOI: 10.1039/c6nr04376c] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While metal oxide nanoparticles (NPs) are one of the most commonly used nanomaterials, the theoretical models used to analyze and predict their behavior have been mostly based on just the chemical composition or the extrapolation from small metal oxide clusters' calculations. In this study, a set of novel, theoretical full-particle descriptors for modeling, grouping or read-across of metal oxide NP properties and biological activity was developed based on the force-field calculation of the potential energies of whole NPs. The capability of these nanodescriptors to group the nanomaterials acoording to their biological activity was demonstrated by Principal Component Analysis (PCA). The grouping provided by the PCA approach was found to be in good accordance with the algal growth inhibition data of well characterized nanoparticles, synthesized and measured inside the consortia of the EU 7FP framework MODERN project.
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Affiliation(s)
- K Tämm
- Institute of Chemistry, University of Tartu, Ravila 14a, Tartu 50411, Estonia.
| | - L Sikk
- Institute of Chemistry, University of Tartu, Ravila 14a, Tartu 50411, Estonia.
| | - J Burk
- Institute of Chemistry, University of Tartu, Ravila 14a, Tartu 50411, Estonia.
| | - R Rallo
- Departament d'Enginyeria Informatica i Matematiques, Universitat Rovira i Virgili, Av. Paisos Catalans 26, Tarragona 43007, Spain
| | - S Pokhrel
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, Germany
| | - L Mädler
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, Germany
| | - J J Scott-Fordsmand
- Aarhus University, Dept Bioscience, Vejlsøvej 25, PO Box 314, 8600 Silkeborg, Denmark
| | - P Burk
- Institute of Chemistry, University of Tartu, Ravila 14a, Tartu 50411, Estonia.
| | - T Tamm
- Institute of Technology, University of Tartu, Nooruse 1, Tartu 50411, Estonia
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Izaguirre E, Pokhrel S, Hedrick S, Knewtson T. TU-H-CAMPUS-TeP2-03: High Sensitivity and High Resolution Fiber Based Micro-Detector for Sub-Millimeter Preclinical Dosimetry. Med Phys 2016. [DOI: 10.1118/1.4957691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Knewtson T, Pokhrel S, Loyalka S, Izaguirre E. SU-F-T-559: High-Resolution Scintillating Fiber Array for In-Vivo Real-Time SRS and SBRT Patient QA. Med Phys 2016. [DOI: 10.1118/1.4956744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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