scholarly journals Estimating the Population Health Impact of Recently Introduced Modified Risk Tobacco Products: A Comparison of Different Approaches

2020 ◽  
Author(s):  
Peter N Lee ◽  
David Abrams ◽  
Annette Bachand ◽  
Gizelle Baker ◽  
Ryan Black ◽  
...  
Keyword(s):  
Population Health ◽  
Transition Probabilities ◽  
Model Development ◽  
Health Impact ◽  
Epidemiological Studies ◽  
Tobacco Product ◽  
Smoking Habits ◽  
Frequency Of Use ◽  
Life Years ◽  
Beneficial Impact

Abstract Introduction Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP). Aims and Methods We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018. Results Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the “null scenario” or joint smoking and MRTP habits in an “alternative scenario”. The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized. Conclusions Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction. Implications There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.

scholarly journals Estimated public health gains from German smokers switching to risk-reduced alternatives: Results from population health impact modelling

2020 ◽  
Author(s):  
Romana Rytsar ◽  
Smilja Djurdjevic ◽  
Alexander K Nussbaum ◽  
Ashok Kaul ◽  
Emanuel Bennewitz ◽  
...  
Keyword(s):  
Public Health ◽  
Cigarette Smoking ◽  
Population Health ◽  
Transition Probabilities ◽  
Health Impact ◽  
Life Years ◽  
Life Years Lost ◽  
Age Range ◽  
The Impact ◽  
Reduced Risk

Abstract Background Smoking is associated with cancer and cardiorespiratory disease mortality. Reducing smoking prevalence reduces deaths and life-years lost. Here, we estimate the impact of introducing heat-not-burn products and e-cigarettes in Germany from 1995 to 2015 on mortality from lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and stroke in men and women aged 30–79 years. Methods We used the previously described population health impact model. Modelling starts with individuals of a given sex and age range with a defined cigarette smoking distribution. They are then followed under a “Null Scenario”, where reduced-risk products are never introduced, and one of seven “Alternative Scenarios”, where they are. Transition probabilities allow tobacco product use to change annually, and the individual product histories then allow estimation of risks, relative to never users, for each year and Scenario, which are then used to estimate reductions in deaths and life-years lost for each Alternative Scenario. Results In the Null Scenario, we estimated 852,357 deaths from cigarette smoking, with 8.61 million life-years lost. Had everyone quit in 1995, with no further use of the three products, these numbers would reduce by 216,650 and 2.88 million. The reductions would be 159,278 and 2.06 million with an immediate complete switch from cigarettes to heat-not-burn products, and 179,470 and 2.34 million with an immediate switch to 50% heat-not-burn products and 50% e-cigarettes. In four Scenarios with a more gradual switch, estimated decreases were 39,818–81,293 deaths and 0.50–1.05 million life-years, representing 17.5%-37.5% of the effect of cessation. These estimates assume switching to heat-not-burn products and e-cigarettes involves risk decreases of 80% and 95% of those from quitting. The decreases would have increased, had more diseases and a wider age range been considered, and also with a longer follow-up period, the decreases increasing markedly with time. Conclusions Various limitations are discussed, none affecting our conclusion that introducing these new products into Germany in 1995 could have substantially reduced mortality. Our results imply deaths from cigarette smoking could be substantially reduced, both by cessation and switching to reduced-risk products. Risk-proportionate public health campaigns and regulation might increase such switching.

scholarly journals Modelling the impact of a new tobacco product: review of Philip Morris International’s Population Health Impact Model as applied to the IQOS heated tobacco product

2018 ◽  
Vol 27 (Suppl 1) ◽  
pp. s82-s86 ◽  
Author(s):  
Wendy B Max ◽  
Hai-Yen Sung ◽  
James Lightwood ◽  
Yingning Wang ◽  
Tingting Yao
Keyword(s):  
Population Health ◽  
New Product ◽  
Health Impact ◽  
Tobacco Product ◽  
Dynamic State ◽  
Model Parameters ◽  
Impact Model ◽  
Tobacco Products ◽  
Philip Morris ◽  
The Impact

ObjectivesWe review the Population Health Impact Model (PHIM) developed by Philip Morris International and used in its application to the US Food and Drug Administration (FDA) to market its heated tobacco product (HTP), IQOS, as a modified-risk tobacco product (MRTP). We assess the model against FDA guidelines for MRTP applications and consider more general criteria for evaluating reduced-risk tobacco products.MethodsIn assessing the PHIM against FDA guidelines, we consider two key components of the model: the assumptions implicit in the model (outcomes included, relative harm of the new product vs cigarettes, tobacco-related diseases considered, whether dual or polyuse of the new product is modelled, and what other tobacco products are included) and data used to estimate and validate model parameters (transition rates between non-smoking, cigarette-only smoking, dual use of cigarettes and MRTP, and MRTP-only use; and starting tobacco use prevalence).ResultsThe PHIM is a dynamic state transition model which models the impact of cigarette and MRTP use on mortality from four tobacco-attributable diseases. The PHIM excludes morbidity, underestimates mortality, excludes tobacco products other than cigarettes, does not include FDA-recommended impacts on non-users and underestimates the impact on other population groups.ConclusionThe PHIM underestimates the health impact of HTP products and cannot be used to justify an MRTP claim. An assessment of the impact of a potential MRTP on population health should include a comprehensive measure of health impacts, consideration of all groups impacted, and documented and justifiable assumptions regarding model parameters.

scholarly journals Quantitative Health Impact Assessment Methodology for Societal Initiatives: A Scoping Review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L M Reumers ◽  
M P M Bekker ◽  
M W J Jansen ◽  
H B M Hilderink ◽  
D Ruwaard
Keyword(s):  
Impact Assessment ◽  
Scoping Review ◽  
Method Development ◽  
Health Impact Assessment ◽  
Transition Probabilities ◽  
Health Effect ◽  
Health Impact ◽  
Life Years ◽  
Wide Range ◽  
Literature Selection

Abstract Background Promoting health rather than treating disease is gaining popularity and promotion initiatives are increasingly situated in the societal domain. In this scoping review, the literature on quantitative health impact assessment (HIA) practice and methodology is explored in order to provide an overview of methods that have been used or proposed for estimating societal initiatives’ health outcomes. Methods Systematic searches were done in PubMed and Web of Science in order to identify relevant literature. A set of selection criteria ensured that studies held useful quantitative HIA methodology and a societal approach. Reference lists of all selected studies were then examined for other studies. After literature selection, quantifiable features of interest were recorded and general observations on the composition of the current literature were made. Results The literature selection process yielded 54 included studies, most of which focus on lifestyle-related determinants. Of different health outcome measurements, deaths (averted) was most frequently used, followed by life years and quality- and disability-adjusted life years. Equity is frequently mentioned, but not often estimated. Most studies made estimates based on simulation models, notably with Monte Carlo, Markov and system dynamics models (simulation period mean 46 years; median 50 years). Inputs for the models such as relative risks, transition probabilities and price elasticities were taken from census and register data, survey data, evidence from previous (scientific) studies and outcomes from stakeholder sessions. Conclusions HIA holds a wide range of practices with some overlap. Different methods’ strengths and weaknesses partly depend on the phenomenon of interest. Some policy types have standard approaches, but there is no one universal optimal method and therefore having a grasp of multiple methods is useful. Furthermore, estimating health effect distributions could make an important addition to HIA. Key messages Quantitative HIA can be conducted using various methodological bases and most studies use some form of simulation modelling. Different simulation methods are distinct, but do show some overlap. Quantitative HIA topics often relate to individual behaviour (micro-level proximal determinants). There is room for HIA method development for determinants with indirect connections to the individual.

PP39 Budget Projections And Health Impact Of PD-1/PD-L1 Inhibitors

2019 ◽  
Vol 35 (S1) ◽  
pp. 44-45
Author(s):  
Alexander Roediger ◽  
Julie van Bavel ◽  
James Pellissier ◽  
Stefano Lucherini ◽  
Neil Davies ◽  
...  
Keyword(s):  
Impact Analysis ◽  
Budget Impact ◽  
Treatment Options ◽  
Model Development ◽  
Standard Of Care ◽  
Health Impact ◽  
Budget Impact Analysis ◽  
Rapid Expansion ◽  
Projection Model ◽  
Life Years

IntroductionThe rapid expansion of immuno-oncology treatment options has led to concerns around their long-term affordability. Evidence on the potential budget and health impact of these new treatment options is required to inform public health policy and ensure adequate allocation of budget for the future.MethodsThe Health Impact Projection model was developed to compare the economic impact and health outcomes observed with and without PD-1/PD-L1 inhibitors using traditional budget impact analysis. Seven types of high-incidence cancers were included: melanoma, first- and second-level non-small cell lung, bladder, head and neck, renal cell carcinoma, and triple negative breast. Inputs were based on publicly available data and literature, and over 10 key experts (oncologists, health economists) were involved in the model development. The model draws on five-year budget impact analysis.ResultsUsing the experience of Belgium, Slovenia, Switzerland, and Italy, the model estimates budget and health impact of the PD-1/PD-L1 inhibitor class. It shows that for 2018-2022, the class will provide additional life years and avoid high-grade adverse events (AEs) with a manageable budget impact per year compared to the standard of care. The model also enables policy-makers to assess the adequacy of their budget for the near future and explore the implications of different policy decisions. Results for Belgium show that over the five-year period the PD-1/PD-L1 inhibitors will save 10,635 additional life years, avoid 7,597 AEs and have a budget impact of approximately EUR 260 million. Results for Slovenia show 1,468 additional life years gained and 869 AEs avoided with a budget impact of approximately EUR 116 million; for Switzerland, 6,775 life years gained, 6,953 AEs avoided, and EUR 106 million budget impact; and for Italy, 5,019 life years gained, 2,040 AEs avoided, and EUR 627 million budget impact.ConclusionsAlthough limitations exist, the model informs planning by helping quantify the potential impact of immune-oncology treatments on health and budget in different scenarios.

scholarly journals A Computational Model for Assessing the Population Health Impact of Introducing a Modified Risk Claim on an Existing Smokeless Tobacco Product

2019 ◽  
Vol 16 (7) ◽  
pp. 1264 ◽  
Author(s):  
Raheema Muhammad-Kah ◽  
Yezdi Pithawalla ◽  
Edward Boone ◽  
Lai Wei ◽  
Michael Jones ◽  
...  
Keyword(s):  
Smokeless Tobacco ◽  
Computational Models ◽  
Transition Probabilities ◽  
Health Impact ◽  
Tobacco Product ◽  
Sensitivity Analyses ◽  
Relative Risk Ratio ◽  
Base Case ◽  
Net Benefit ◽  
Premature Deaths

Computational models are valuable tools for predicting the population effects prior to Food and Drug Administration (FDA) authorization of a modified risk claim on a tobacco product. We have developed and validated a population model using best modeling practices. Our model consists of a Markov compartmental model based on cohorts starting at a defined age and followed up to a specific age accounting for 29 tobacco-use states based on a cohort members transition pathway. The Markov model is coupled with statistical mortality models and excess relative risk ratio estimates to determine survival probabilities from use of smokeless tobacco. Our model estimates the difference in premature deaths prevented by comparing Base Case (“world-as-is”) and Modified Case (the most likely outcome given that a modified risk claim is authorized) scenarios. Nationally representative transition probabilities were used for the Base Case. Probabilities of key transitions for the Modified Case were estimated based on a behavioral intentions study in users and nonusers. Our model predicts an estimated 93,000 premature deaths would be avoided over a 60-year period upon authorization of a modified risk claim. Our sensitivity analyses using various reasonable ranges of input parameters do not indicate any scenario under which the net benefit could be offset entirely.

scholarly journals Modeling the Population Health Impact of Introducing a Modified Risk Tobacco Product into the U.S. Market

Healthcare ◽  
2018 ◽  
Vol 6 (2) ◽  
pp. 47 ◽  
Author(s):  
Smilja Djurdjevic ◽  
Peter Lee ◽  
Rolf Weitkunat ◽  
Zheng Sponsiello-Wang ◽  
Frank Lüdicke ◽  
...  
Keyword(s):  
Population Health ◽  
Health Impact ◽  
Tobacco Product ◽  
The U.S

scholarly journals Inequalities in population health loss by multiple deprivation: COVID-19 and pre-pandemic all-cause disability-adjusted life years (DALYs) in Scotland

2021 ◽  
Author(s):  
Grant Mark Andrew Wyper ◽  
Eilidh Fletcher ◽  
Ian Grant ◽  
Oliver Harding ◽  
Maria Teresa de Haro Moro ◽  
...  
Keyword(s):  
Population Health ◽  
Health Inequalities ◽  
Burden Of Disease ◽  
Health Impact ◽  
Disability Adjusted Life Years ◽  
Multiple Deprivation ◽  
Health Loss ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Index Of Inequality

Background: COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. These were scaled against pre-pandemic inequalities in DALYs combined across all causes, derived from the Scottish Burden of Disease (SBoD) study.Methods: National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Overall, and inequalities in, COVID-19 DALYs were scaled against pre-pandemic estimates of inequalities across all causes from the SBoD study.Results: Marked inequalities were observed across several measures. The SII was 2,048–2,289 COVID-19 DALYs per 100,000 population. The RII was 1.16, meaning that the rate in the most deprived areas was around 58% higher than the mean population rate, with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7–20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes.Conclusion: The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health.

scholarly journals Modeling the Population Health Impacts of Heated Tobacco Products in Japan

2021 ◽  
Vol 7 (3) ◽  
pp. 221-231
Author(s):  
Oscar M. Camacho ◽  
Andrew Hill ◽  
Stacy Fiebelkorn ◽  
Joshua D. Jones ◽  
Krishna Prasad ◽  
...  
Keyword(s):  
Population Health ◽  
Health Benefit ◽  
Health Impact ◽  
Baseline Scenario ◽  
Case Scenario ◽  
Cross Sectional ◽  
Worst Case ◽  
Tobacco Products ◽  
Life Years ◽  
And Migration

Objective: We evaluated the potential population health impact of launching heated tobacco products (HTP) in Japan. Method: We use a modeling approach to project the effects of HTP use in overall mortality up to 2100 and compare those projections against a baseline scenario based on smoking rates pre-HTP launch, ie, smoking only. The model was informed using data from publicly available sources and the literature, including population size, yearly deaths, and smoking prevalence with the initial year of 2004, and births and migration from 2004 to 2065. Transitions between products were estimated from cross-sectional population surveys in Japan. Result: In a worst-case scenario, population health gains would be seen with HTPs risk about 50% lower risk than smoking. Assuming equal risk for dual use and smoking, HTP risk would need to be at least 10% lower than smoking to achieve a population health benefit by 2100. Potential reduction in life-years lost with the introduction of HTPs was 13 million by 2100 compared with smoking only. Conclusions: In credible scenarios, substantial population harm reduction will follow the introduction of HTPs in Japan.

scholarly journals Reducing the Burden of Disease Through Tobacco Taxes in Mongolia: A Health Impact Analysis Using a Dynamic Public Health Model

2021 ◽  
Author(s):  
Ariuntuya Tuvdendorj ◽  
Stefan R A Konings ◽  
Bolormaa Purevdorj ◽  
Erik Buskens ◽  
Talitha L Feenstra
Keyword(s):  
Population Health ◽  
Burden Of Disease ◽  
Smoking Prevalence ◽  
Health Impact ◽  
Baseline Scenario ◽  
Potential Health ◽  
Life Years ◽  
Tobacco Tax ◽  
Smoking Behaviors ◽  
Tobacco Taxation

Abstract Background/Objectives Smoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia’s health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia. Methods The dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia’s National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors. Results Over a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period. Discussion Prevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health. Implications Tobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.

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