The cost-effectiveness and return-on-investment of a combined social and physical environmental intervention in office employees

Abstract Background: Healthcare workers are at a higher risk of COVID-19 infection during care encounters compared to the general population. Personal Protective Equipment (PPE) have been shown to protect COVID-19 among healthcare workers, however, Kenya has faced PPE shortages that can adequately protect all healthcare workers. We, therefore, examined the health and economic consequences of investing in PPE for healthcare workers in Kenya. Methods: We conducted a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model following the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. We examined two outcomes: 1) the cost per healthcare worker death averted, and 2) the cost per healthcare worker COVID-19 case averted. We performed a multivariate sensitivity analysis using 10,000 Monte Carlo simulations. Results: Kenya would need to invest $3.12 million to adequately protect healthcare workers against COVID-19. This investment would avert 416 and 30,041 healthcare worker deaths and COVID-19 cases respectively. Additionally, such an investment would result in a societal ROI of $170.64 million – equivalent to an 11.04 times return. Conclusion: Despite other nationwide COVID-19 prevention measures such as social distancing, over 70% of healthcare workers will still be infected if the availability of PPE remains scarce. As part of the COVID-19 response strategy, the government should consider adequate investment in PPE for all healthcare workers in the country as it provides a large return on investment and it is value for money.

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Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054811 ◽

2019 ◽

pp. tobaccocontrol-2018-054811

Author(s):

Marlon P Mundt ◽

Timothy B Baker ◽

Megan E Piper ◽

Stevens S Smith ◽

David L Fraser ◽

...

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Incremental Cost ◽

Low Income ◽

Financial Incentives ◽

Return On Investment ◽

Incremental Cost Effectiveness Ratio ◽

Control Group ◽

Cost Effectiveness Ratio ◽

The Cost

BackgroundLow-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels of financial incentives to maximise return on investment (ROI) for engaging low-income Medicaid recipients who smoke to take calls from a tobacco quit line.MethodsParticipants (N=1900) were recruited from May 2013 to June 2015 through quit line-based (n=980), clinic-based (n=444) or community-based referrals (n=476) into the Wisconsin Medicaid Quit Line Incentive project. Incentive (n=948) and control group participants (n=952) received $30 versus $0 per call, respectively, for taking up to five Wisconsin Tobacco Quit Line (WTQL) calls. Cost-effectiveness analyses estimated the incremental cost-effectiveness ratio for alternative financial incentives for engagement with WTQL calls. Probabilistic sensitivity analysis was employed to determine an optimal strategy for financial incentives to minimise the cost per individual who quit smoking.ResultsUsing fixed payments, the incremental cost-effectiveness ratio of $2316 per smoker who quit in the randomised trial decreased to $2150 per smoker who quit when the incentives were modelled at $20 per each of five WTQL calls taken. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four WTQL calls were set at $20, and the financial payment for the fifth WTQL call was set at $70.ConclusionsModelling suggests that financial incentives in the amount of $20 per call for taking the first four quit line calls and $70 for taking a fifth quit line call maximise ROI to engage low-income smokers with evidence-based smoking cessation treatment.

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