OP11 Structural Uncertainty In Economic Modelling For Smoking Cessation

2017 ◽  
Vol 33 (S1) ◽  
pp. 6-7
Author(s):  
Becky Pennington ◽  
Alex Filby ◽  
Matthew Taylor ◽  
Lesley Owen
Keyword(s):  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Recurrent Events ◽  
Smoking Status ◽  
Discrete Event ◽  
Economic Models ◽  
Economic Modelling ◽  
Model Structure ◽  
Cohort Model ◽  
The Impact

INTRODUCTION:Guidance for developing economic models recommend that model structure is carefully considered, and assumptions varied in sensitivity analysis (1). Models in smoking cessation have typically used cohort-level approaches, although recently discrete event simulations (DESs) have been developed (2). DESs allow additional flexibility such as modelling changing risk over time, and recurrent events. Our aim was to explore the impact of varying model structure and assumptions on the cost-effectiveness of smoking cessation programs.METHODS:We built a cohort state-transition model which related mortality to smoking status and considered the prevalence (based on smoking status) of five comorbidities associated with smoking, each of which has an associated cost and quality of life decrement. We additionally built a patient-level DES, using the Discretely Integrated Condition Event framework (3). The DES used the same data as the cohort model, except considering incidence for comorbidities rather than prevalence. We considered a population of smokers aged 16 years old and an intervention costing GBP827 on which 27 percent of people quit, compared with no treatment. We produced results using the two models for comparable scenarios, and ran additional scenarios considering different assumptions.RESULTS:In the cohort model, the incremental cost-effectiveness ratio (ICER) for intervention versus no treatment was GBP4,000/quality-adjusted life year (QALY). In the DES, modelling mortality linked to smoker status produced an ICER of GBP1,000/QALY and modelling mortality linked to comorbidities produced an ICER of GBP6,000/QALY. In the DES with mortality linked to comorbidities, varying the relative risk of comorbidities with time since quitting gave an ICER of GBP3,000/QALY. Including relapse increased the ICER to GBP21,000/QALY.CONCLUSIONS:The ICER for the smoking cessation program changes when model assumptions are varied, although the choice of DES versus cohort model appears to make a relatively small difference. Inclusion of relapse substantially changes the ICER, demonstrating the importance of long-term effects in economic models.

scholarly journals Changes in carotid artery structure with smoking cessation

2019 ◽  
Vol 24 (6) ◽  
pp. 493-500 ◽  
Author(s):  
Carol Mitchell ◽  
Megan E Piper ◽  
Stevens S Smith ◽  
Claudia E Korcarz ◽  
Michael C Fiore ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Carotid Artery ◽  
Linear Models ◽  
Smoking Status ◽  
Secondary Analysis ◽  
Texture Features ◽  
Carotid Ultrasound ◽  
Longitudinal Effects ◽  
Status Interaction ◽  
The Impact

Carotid artery grayscale ultrasound echogenicity and texture features predict cardiovascular disease events. We evaluated the longitudinal effects of smoking cessation on four grayscale ultrasound measures. This was a secondary analysis of data from 188 age, sex, and body mass index (BMI)-matched smokers (94 eventual abstainers [EA], 94 continued smokers [CS]) from a smoking cessation trial that had carotid ultrasound examinations at baseline and after 3 years. General linear models that included time, smoking group (EA or CS), and a time*smoking interaction term were used to examine the impact of smoking abstinence on carotid artery grayscale marker values at year 3. Participants were mean (SD) 50.3 (11.4) years old (57% female, 86% white). The baseline grayscale median value (GSM) was inversely correlated with age, BMI, insulin resistance, and smoking pack-years ( r = −0.20 to –0.30, p < 0.007 for all). There was a significant time*smoking status interaction for predicting GSM at year 3: GSM decreased significantly in the EA group compared to the CS group (–3.63 [13.00] vs CS 0.39 [12.06] units; p = 0.029). BMI increased more in the EA than the CS group (2.42 [3.00] vs CS 0.35 [2.57] kg/m2; p < 0.001). After adjusting for changes in BMI, the time*smoking status interaction no longer was significant ( p = 0.138). From baseline to year 3, contrast increased similarly in both groups. Entropy and angular second moment did not change significantly in either group. Changes in carotid ultrasound echogenicity and grayscale texture features during a smoking cessation attempt are modest and mostly related to weight gain. Clinicaltrials.gov Identifier: NCT01553084

scholarly journals Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population

2019 ◽  
Vol 6 (1) ◽  
pp. e000395
Author(s):  
James Brown ◽  
Christianna Kyriacou ◽  
Elisha Pickett ◽  
Kelly Edwards ◽  
Hemal Joshi ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Smoking Status ◽  
Healthcare Services ◽  
Lifestyle Changes ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Smoking Cessation Services ◽  
Living With Hiv ◽  
Systematic Identification ◽  
The Impact

IntroductionPeople living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease.MethodsWe evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation.ResultsOverall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking.DiscussionThe simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.

Impact of a Bladder Cancer Diagnosis on Smoking Behavior

2012 ◽  
Vol 30 (15) ◽  
pp. 1871-1878 ◽  
Author(s):  
Jeffrey C. Bassett ◽  
John L. Gore ◽  
Amanda C. Chi ◽  
Lorna Kwan ◽  
William McCarthy ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Smoking Cessation ◽  
General Population ◽  
Tobacco Use ◽  
Cancer Diagnosis ◽  
Smoking Status ◽  
Simple Random Sample ◽  
Cancer Risk Factors ◽  
History Of ◽  
The Impact

Purpose Bladder cancer is the second most common tobacco-related malignancy. A new bladder cancer diagnosis may be an opportunity to imprint smoking cessation. Little is known about the impact of a diagnosis of bladder cancer on patterns of tobacco use and smoking cessation among patients with incident bladder cancer. Patients and Methods A simple random sample of noninvasive bladder cancer survivors diagnosed in 2006 was obtained from the California Cancer Registry. Respondents completed a survey on history of tobacco use, beliefs regarding bladder cancer risk factors, and physician influence on tobacco cessation. Respondents were compared by smoking status. Those respondents smoking at diagnosis were compared with general population controls obtained from the California Tobacco Survey to determine the impact of a diagnosis of bladder cancer on patterns of tobacco use. Results The response rate was 70% (344 of 492 eligible participants). Most respondents (74%) had a history of cigarette use. Seventeen percent of all respondents were smoking at diagnosis. Smokers with a new diagnosis of bladder cancer were almost five times as likely to quit smoking as smokers in the general population (48% v 10%, respectively; P < .001). The bladder cancer diagnosis and the advice of the urologist were the reasons cited most often for cessation. Respondents were more likely to endorse smoking as a risk factor for bladder cancer when the urologist was the source of their understanding. Conclusion The diagnosis of bladder cancer is an opportunity for smoking cessation. Urologists can play an integral role in affecting the patterns of tobacco use of those newly diagnosed.

scholarly journals Algorithm for resolving discrepancies between claims for smoking cessation pharmacotherapies during pregnancy and smoking status in delivery records: The impact on estimates of utilisation

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0202999 ◽  
Author(s):  
Lucinda Roper ◽  
Duong Thuy Tran ◽  
Kristjana Einarsdóttir ◽  
David B. Preen ◽  
Alys Havard
Keyword(s):  
Smoking Cessation ◽  
Smoking Status ◽  
The Impact

scholarly journals Impact of marginalization on tobacco use in individuals diagnosed with head and neck Cancer

2019 ◽  
Vol 48 (1) ◽  
Author(s):  
Grace Margaret Scott ◽  
Corliss Best ◽  
Kevin Fung ◽  
Michael Gupta ◽  
Doron D. Sommer ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Smoking Cessation ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Nicotine Dependence ◽  
Tobacco Use ◽  
Neck Cancer ◽  
Census Data ◽  
Smoking Status ◽  
The Impact

Abstract Background Considerable evidence now indicates that individuals living in underprivileged neighbourhoods have higher rates of mortality and morbidity independent of individual-level characteristics. This study explored the impact of geographical marginalization on smoking cessation in a population of individuals with a diagnosis of head and neck cancer. The aims of this study were twofold: (1) assess the prevalence of smoking cessation in those with a previous diagnosis of head and neck cancer, (2) analyze the determinants of smoking alongside area-based measures of socioeconomic status. Methods This was a cross-sectional study. We administered a self-reported nicotine dependence package to participants between the ages of 20–90 with a previous mucosal head and neck cancer diagnosis and with a history of tobacco use. Using the Canadian Marginalization (CAN-Marg) Index tool based on 2006 Canada Census data we compared the degree of marginalization to the smoking status. For those individuals who were currently smoking, nicotine dependence and readiness to quit were assessed. A summative score of marginalization was compared to smoking status of individuals. Results The results from this study indicate that the summative level of marginalization developed from the combined factors of residential instability, material deprivation, ethnic concentration and dependency may be important factors in smoking cessation. Conclusions This analysis of determinants of smoking alongside area-based measures of socioeconomic status may implicate the need for targeted population-based smoking cessation interventions.

scholarly journals Economic Modelling of the Delay in Passing the Petroleum Industry Bill in Nigeria and Its Impact on Deep Offshore Investments and Government Take Statistics

2020 ◽  
Author(s):  
Oghenerume Ogolo ◽  
Petrus Nzerem
Keyword(s):  
Petroleum Industry ◽  
Economic Models ◽  
Economic Modelling ◽  
Government Revenue ◽  
Production Sharing ◽  
The Government ◽  
Petroleum Sector ◽  
The Impact ◽  
Offshore Region

Abstract The petroleum industry bill (PIB) in Nigeria aims to reform the petroleum sector of the country and increase government revenue from petroleum investments. Despite the benefits the bill offers to the country, its passage has suffered several setbacks. This research therefore studied the impact of the delay in passing the bill on deep offshore investments. Economic models were built using the fiscal terms in PIB 2009 and 1993 production sharing contract (PSC) arrangement to evaluate the impact of the bill. The model with the 1993 PSC fiscal terms was adjusted to capture the delay in passing the bill. The bill was assumed to be passed on a yearly basis for 10 years (2010 to 2019). The impact of the delay in passing the bill based on the reserve portfolio of firms in the deep offshore region of the country was also evaluated. The delay in passing the PIB reduced the government take. It was seen that for the non-passage of the bill, the government lost about $1227.2 MM. When the bill was passed in 2019, the government had been losing about $11.843 MM on a yearly basis due to the delay in passing the bill.

scholarly journals The Need for Theory in Actuarial Economic Models

1999 ◽  
Vol 5 (2) ◽  
pp. 377-395 ◽  
Author(s):  
P.P. Huber ◽  
R.J. Verrall
Keyword(s):  
Financial Economics ◽  
Theoretical Approach ◽  
Economic Models ◽  
Theoretical Framework ◽  
Empirical Approach ◽  
Specific Reference ◽  
Economic Modelling ◽  
Empirical Testing ◽  
The Uk ◽  
The Impact

ABSTRACTThis paper addresses the fundamental issues in the construction and use of actuarial economic models, with specific reference to those described in the UK literature. Two approaches are considered: an empirical approach and a theoretical approach using financial economics. Although empirical testing is essential, the difficulties associated with it should not be underestimated. A theoretical framework can be used to limit the impact of these difficulties. However, economic modelling is further complicated by the lack of a reliable and comprehensive theoretical framework. This suggests that economic models are always likely to be inaccurate and consequently actuarial judgement is likely to be indispensable.

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