Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings

2017 ◽  
Vol 27 (e2) ◽  
pp. e167-e170 ◽  
Author(s):  
Christine L Cleghorn ◽  
Tony Blakely ◽  
Giorgi Kvizhinadze ◽  
Frederieke S van der Deen ◽  
Nhung Nghiem ◽  
...  
Keyword(s):  
Time Horizon ◽  
Health Gain ◽  
Cost Savings ◽  
Age Group ◽  
Tobacco Taxes ◽  
Health Gains ◽  
Life Years ◽  
Tobacco Tax ◽  
Working Age ◽  
The Impact

ObjectiveThe health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon.MethodsAs per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%.ResultsFor this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20–65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20–65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60–64 and 65–69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011–2020.ConclusionsThe majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20–65 years). There remains a need for more work on the associated productivity benefits of such health gains.

Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame

2017 ◽  
Vol 27 (3) ◽  
pp. 278-286 ◽  
Author(s):  
Frederieke S van der Deen ◽  
Nick Wilson ◽  
Christine L Cleghorn ◽  
Giorgi Kvizhinadze ◽  
Linda J Cobiac ◽  
...  
Keyword(s):  
Smoking Prevalence ◽  
Health Gain ◽  
Cost Savings ◽  
Uncertainty Interval ◽  
Health Gains ◽  
Life Years ◽  
Tobacco Tax ◽  
Population Forecasting ◽  
Modelling Studies ◽  
Tobacco Endgame

ObjectiveThere is growing international interest in advancing ‘the tobacco endgame’. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3.MethodsTwo models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs.ResultsAll selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population’s lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG).ConclusionsImplementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best.

scholarly journals Estimating the Financial Impact of Gene Therapy*

2020 ◽  
Author(s):  
Chi Heem Wong ◽  
Dexin Li ◽  
Nina Wang ◽  
Jonathan Gruber ◽  
Rena Conti ◽  
...  
Keyword(s):  
Gene Therapy ◽  
Time Horizon ◽  
Financial Impact ◽  
Age Group ◽  
Patient Access ◽  
Quality Adjusted Life Years ◽  
Gene Therapies ◽  
Life Years ◽  
Expected Benefits ◽  
Quality Adjusted Life

AbstractWe assess the potential financial impact of future gene therapies by identifying the 109 late-stage gene therapy clinical trials currently underway, estimating the prevalence and incidence of their corresponding diseases, developing novel mathematical models of the increase in quality-adjusted life years for each approved gene therapy, and simulating the launch prices and the expected spending of these therapies over a 15-year time horizon. The results of our simulation suggest that an expected total of 1.09 million patients will be treated by gene therapy from January 2020 to December 2034. The expected peak annual spending on these therapies is $25.3 billion, and the total spending from January 2020 to December 2034 is $306 billion. We decompose their annual estimated spending by treated age group as a proxy for U.S. insurance type, and consider the tradeoffs of various methods of payment for these therapies to ensure patient access to their expected benefits.

Abstract 057: Estimating the Benefits of the Proposed FDA Sodium Reformulation Policy on Cardiovascular Disease, Disparities and Economic Costs

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jonathan Pearson-Stuttard ◽  
Chris Kypridemos ◽  
Brendan Collins ◽  
Yue Huang ◽  
Piotr Bandosz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Sodium Reduction ◽  
Uncertainty Interval ◽  
Population Total ◽  
Health Gains ◽  
Life Years ◽  
The Us ◽  
Hispanic White

Background: Sodium consumption is a leading modifiable risk factor for CVD mortality and morbidity in the US. In 2016, the US Food and Drug Administration (FDA), following recent effective examples in several other countries, proposed voluntary sodium targets for industry to reduce sodium in processed foods. Aim: We aimed to estimate the potential CVD, equity and economic impacts of implementing this policy. Methods: We used the validated US IMPACT Food Policy microsimulation model to estimate the CVD cases averted, quality-adjusted life-years (QALYs) gained and cost-effectiveness from 2017-2036 of the FDA sodium reformulation policy in US adults (30+ years). Model inputs included national demographics and sodium intakes from NHANES, FDA short- and long-term sodium reformulation targets, sodium effects on blood pressure and of blood pressure on CVD from meta-analyses, government costs to administer and monitor the policy and industry reformulation costs, and validated healthcare and productivity costs. We modelled 3 scenarios: a) Optimal, 100% compliance of 10-year reformulation targets b) Modest, 50% compliance of 10-year reformulation targets c) Pessimistic, 100% compliance of 2-year reformulation targets with no further progress Costs were inflated to 2017 US dollars and outputs were discounted annually by 3%. We took a societal perspective for this analysis. Rigorous probabilistic sensitivity analyses were conducted. Results: The optimal scenario achieving the 10-year sodium reduction targets could prevent ~ 450,000 CVD cases (95% Uncertainty Interval: 240,000-740,000), gain 2.1 million QALYs (1.7m-2.4m), and produce $41billion ($14bn-$81bn) cost-savings from 2017-2036. The modest and pessimistic scenarios were also cost-saving, with both health gains and savings about one half and one quarter, respectively, of the optimal scenario. Relative disparities between non-Hispanic white and non-Hispanic black populations would be reduced in all scenarios. The pessimistic scenario yielded the largest reduction in absolute disparities (70,000 CVD cases (33,000-120,000) prevented in non-Hispanic blacks vs. 13,000 (0-54,000) in non-Hispanic whites). The optimal scenario would prevent approximately 4.6% (130,000 cases (65,0000-220,000)) of all CVD cases in non-Hispanic blacks compared to 1.5% (220,000 cases (120,000-360,000)) in non-Hispanic whites. Despite a smaller population, total net savings would be over 50% larger in non-Hispanic blacks than non-Hispanic whites ($19bn vs $12bn) in the optimal scenario. Conclusions: Implementing and even partly achieving the FDA sodium reduction targets could generate substantial health gains and net cost savings. Crucially, this policy could also reduce CVD disparities between non-Hispanic black and non-Hispanic white populations.

scholarly journals The Public Health Gains Had Cigarette Companies Chosen to Sell Very Low Nicotine Cigarettes

2020 ◽  
Author(s):  
David T Levy ◽  
K Michael Cummings ◽  
Bryan W Heckman ◽  
Yameng Li ◽  
Zhe Yuan ◽  
...  
Keyword(s):  
Public Health ◽  
Expert Elicitation ◽  
The Public ◽  
Nicotine Content ◽  
Premature Deaths ◽  
Health Gains ◽  
Life Years ◽  
Life Years Lost ◽  
Technical Capability ◽  
The Impact

Abstract Introduction The U.S. Food and Drug Administration (FDA) has proposed lowering the nicotine content of cigarettes to a minimally addictive level to increase smoking cessation and reduce initiation. This study has two aims: (1) to determine when cigarette manufacturers had the technical capability to reduce cigarette nicotine content and (2) to estimate the lost public health benefits of implementing a standard in 1965, 1975, or 1985. Methods To determine the technical capability of cigarette companies, we reviewed public patents and internal cigarette company business records using the Truth Tobacco Industry Documents. To evaluate the impact of a very low nicotine content cigarette (VLNC) standard on smoking attributable deaths (SADs) and life-years lost (LYLs), we applied a validated (CISNET) model that uses past smoking data, along with estimates of the potential impact of VLNCs derived from expert elicitation. Results Cigarette manufacturers recognized that cigarettes were deadly and addictive before 1964. Manufacturers have had the technical capability to lower cigarette nicotine content for decades. Our model projected that a standard implemented in 1965 could have averted 21 million SADs (54% reduction) and 272 million LYLs (64% reduction) from 1965 to 2064, a standard implemented in 1975 could have averted 18.9 million SADs and 245.4 million LYLs from 1975 to 2074, and a standard implemented in 1985 could have averted 16.3 million SADs and 211.5 million LYLs from 1985 to 2084. Conclusions Millions of premature deaths could have been averted if companies had only sold VLNCs decades ago. FDA should act immediately to implement a VLNC standard. Implications Prior research has shown that a mandated reduction in the nicotine content of cigarettes could reduce the prevalence of smoking and improve public health. Here we report that cigarette manufacturers have had the ability to voluntarily implement such a standard for decades. We use a well-validated model to demonstrate that millions of smoking attributable deaths and life-years lost would have been averted if the industry had implemented such a standard.

Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country

2019 ◽  
Vol 26 (4) ◽  
pp. 302-309 ◽  
Author(s):  
Matt Boyd ◽  
Giorgi Kvizhinadze ◽  
Adeline Kho ◽  
Graham Wilson ◽  
Nick Wilson
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Cataract Surgery ◽  
Health Gain ◽  
Cost Effective ◽  
Falls Prevention ◽  
Age Group ◽  
System Perspective ◽  
Life Years ◽  
Incident Cases

AimTo estimate the health gain, health system costs and cost-effectiveness of cataract surgery when expedited as a falls prevention strategy (reducing the waiting time for surgery by 12 months) and as a routine procedure.MethodsAn established injurious falls model designed for the New Zealand (NZ) population (aged 65+ years) was adapted. Key parameters relating to cataracts were sourced from the literature and the NZ Ministry of Health. A health system perspective with discounting at 3% was used.ResultsExpedited cataract surgery for 1 year of incident cases was found to generate a total 240 quality-adjusted life years (QALYs) (95% uncertainty interval (UI) 161 to 360) at net health system costs of NZ$2.43 million (95% UI 2.02 to 2.82 million) over the remaining lifetimes of the surgery group. This intervention was cost-effective by widely accepted standards with an incremental cost-effectiveness ratio (ICER) of NZ$10 600 (US$7540) (95% UI NZ$6030 to NZ$15 700) per QALY gained. The level of cost-effectiveness did not vary greatly by sex, ethnicity and previous fall history, but was higher for the 65–69 age group compared with the oldest age group of 85–89 years (NZ$7000 vs NZ$14 200 per QALY gained). Comparing cataract surgery with no surgery, the ICER was even more favourable at NZ$4380 (95% UI 2410 to 7210) per QALY. Considering only the benefits for vision improvement and excluding the benefits of falls prevention, it was still favourable at NZ$9870 per QALY.ConclusionsExpedited cataract surgery appears very cost-effective. Routine cataract surgery is itself very cost-effective, and its value appears largely driven by the falls prevention benefits.

scholarly journals Health benefits and economic advantages associated with increased utilization of a smoking cessation program

2020 ◽  
Author(s):  
Santanu K Datta ◽  
Paul A Dennis ◽  
James M Davis
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Best Practice ◽  
Cost Savings ◽  
Companion Paper ◽  
Smoking Cessation Program ◽  
Life Years ◽  
Practice Advisory ◽  
Patient Health ◽  
The Impact

Rationale, aim & objective: The goal of this study was to examine the health and economic impacts related to increased utilization of the Duke Smoking Cessation Program resulting from the addition of two relatively new referral methods – Best Practice Advisory and Population Outreach. Materials & methods: In a companion paper ‘Comparison of Referral Methods into a Smoking Cessation Program’, we report results from a retrospective, observational, comparative effectiveness study comparing the impact of three referral methods – Traditional Referral, Best Practice Advisory and Population Outreach on utilization of the Duke Smoking Cessation Program. In this paper we take the next step in this comparative assessment by developing a Markov model to estimate the improvement in health and economic outcomes when two referral methods – Best Practice Advisory and Population Outreach – are added to Traditional Referral. Data used in this analysis were collected from Duke Primary Care and Disadvantaged Care clinics over a 1-year period (1 October 2017–30 September 2018). Results: The addition of two new referral methods – Best Practice Advisory and Population Outreach – to Traditional Referral increased the utilization of the Duke Smoking Cessation Program in Primary Care clinics from 129 to 329 smokers and in Disadvantaged Care clinics from 206 to 401 smokers. The addition of these referral methods was estimated to result in 967 life-years gained, 408 discounted quality-adjusted life-years saved and total discounted lifetime direct healthcare cost savings of US$46,376,285. Conclusion: Health systems may achieve increased patient health and decreased healthcare costs by adding Best Practice Advisory and Population Outreach strategies to refer patients to smoking cessation services.

Cost-effectiveness of a two-gene urine biomarker assay in MRI strategies for the initial detection of prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 91-91 ◽  
Author(s):  
Tim Govers ◽  
Matthew J. Resnick ◽  
Geert Trooskens ◽  
Wim Van Criekinge ◽  
Jack A. Schalken
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Health Gain ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Life Years ◽  
Clinically Significant ◽  
Using Data ◽  
Systematic Biopsy

91 Background: MRI is increasingly used in men with a suspicion for prostate cancer (PCa) to target abnormal areas next to systematic biopsy. Although, MRI increases the detection of clinically significant PCa compared to systematic biopsy alone, overdiagnosis and overtreatment of insignificant disease still exists. The 2-gene mRNA PCR urine test combined with traditional risk factors SelectMDx (MDxhealth Irvine Ca) predicts clinically significant PCa, and can be used to reduce overdiagnosis and overtreatment. We assessed the cost-effectiveness of SelectMDx in a population of U.S. men who in the current situation undergo initial MRI and biopsies. Methods: We developed a decision-analytic model to simulate the downstream outcomes in the current MRI strategy, i.e. systematic biopsy plus targeted biopsy in case of a positive MRI. SelectMDx was assessed in two different diagnostic pathways: 1) before MRI to select patients for MRI and biopsy, 2) after a negative MRI to select patients for systematic biopsy. Outcomes were quality-adjusted life years (QALYs) and costs. Model parameters were informed by literature. Two scenarios regarding the mortality of missed PCa were used, using SPCG trial data and using data from the PIVOT trial. Results: Using SelectMDx before MRI (1) resulted in a health gain of 0.003 and 0.030 QALY per patient compared to the current MRI strategy, using the SPCG and PIVOT data, respectively. Cost savings were $1590 per patient and about $496 million for the yearly population of men at risk in the U.S. (n = 311,879). SelectMDx after negative MRI (2) resulted in a health gain of 0.008 and 0,011 QALY per patient using the SPCG and PIVOT data.. Cost savings were $436 per patient and about $136 million for the yearly population. Conclusions: The use of SelectMDx to guide prostate biopsy decision-making can improve health outcomes and lower costs. Cost savings were highest when SelectMDx was used before MRI to select patients for MRI and biopsy. With respect to health gain, the use of SelectMDx after negative MRI was most beneficial when assuming higher mortality for missed PCa (SPCG). When the mortality was assumed to be lower (PIVOT) SelectMDx should be used before MRI to result in the highest health gain.

Taxing times? Smoker response to tax increases

2014 ◽  
Vol 7 (1) ◽  
pp. 36-48 ◽  
Author(s):  
Nathan Cowie ◽  
Marewa Glover ◽  
Dudley Gentles
Keyword(s):  
New Zealand ◽  
Low Income ◽  
Effective Means ◽  
Content Type ◽  
Deprived Neighbourhoods ◽  
Tobacco Taxes ◽  
Price Increases ◽  
Tobacco Tax ◽  
Adaptive Behaviours ◽  
The Impact

Purpose – Taxing tobacco is one of the most effective means to reduce smoking but concerns about the impact on poor smokers are a barrier. New Zealand resumed increasing tobacco taxes in April 2010. The paper hypothesised smokers would attempt to stop smoking and/or adapt, changing their smoking behaviours in response to price increases. The paper aims to discuss these issues. Design/methodology/approach – The authors conducted a door knock survey of smokers and recent ex-smokers who were home when visited. Participants (n=428) were from socioeconomically deprived neighbourhoods of Auckland with large proportions of Māori and Pacific Island people. Findings – Many smokers (66 per cent) attempted to quit an average of 3 times. More than 40 per cent stopped for at least 24 hours without intending to quit altogether, monthly or more. Consumption reduced among 40 per cent of participants, by an average 7.1 cigarettes daily. More than a fifth of participants switched to cheaper brands. Switching from factory made cigarettes to roll your own tobacco (6 per cent) or vice versa (5 per cent) was uncommon. Research limitations/implications – The method resulted in a low response rate. Tobacco tax is associated with reduced consumption and high levels of frequent quit attempts in socioeconomically deprived communities therefore our study supports tax increases as a means of reducing smoking. Originality/value – This is the first paper to investigate the effect of large recent New Zealand tobacco tax increases on low-income smokers’ adaptive behaviours.

scholarly journals The potential of real-time analytics to improve care for mechanically ventilated patients in the intensive care unit: an early economic evaluation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lytske Bakker ◽  
Katerina Vaporidi ◽  
Jos Aarts ◽  
William Redekop
Keyword(s):  
Intensive Care ◽  
Cost Effectiveness ◽  
Real Time ◽  
Cost Savings ◽  
Cost Effective ◽  
Potential Cost ◽  
Lifetime Horizon ◽  
Scenario Analyses ◽  
Life Years ◽  
The Impact

Abstract Background Mechanical ventilation services are an important driver of the high costs of intensive care. An optimal interaction between a patient and a ventilator is therefore paramount. Suboptimal interaction is present when patients repeatedly demand, but do not receive, breathing support from a mechanical ventilator (> 30 times in 3 min), also known as an ineffective effort event (IEEV). IEEVs are associated with increased hospital mortality prolonged intensive care stay, and prolonged time on ventilation and thus development of real-time analytics that identify IEEVs is essential. To assist decision-making about further development we estimate the potential cost-effectiveness of real-time analytics that identify ineffective effort events. Methods We developed a cost-effectiveness model combining a decision tree and Markov model for long-term outcomes with data on current care from a Greek hospital and literature. A lifetime horizon and a healthcare payer perspective were used. Uncertainty about the results was assessed using sensitivity and scenario analyses to examine the impact of varying parameters like the intensive care costs per day and the effectiveness of treatment of IEEVs. Results Use of the analytics could lead to reduced mortality (3% absolute reduction), increased quality adjusted life years (0.21 per patient) and cost-savings (€264 per patient) compared to current care. Moreover, cost-savings for hospitals and health improvements can be incurred even if the treatment’s effectiveness is reduced from 30 to 10%. The estimated savings increase to €1,155 per patient in countries where costs of an intensive care day are high (e.g. the Netherlands). There is considerable headroom for development and the analytics generate savings when the price of the analytics per bed per year is below €7,307. Furthermore, even when the treatment’s effectiveness is 10%, the probability that the analytics are cost-effective exceeds 90%. Conclusions Implementing real-time analytics to identify ineffective effort events can lead to health and financial benefits. Therefore, it will be worthwhile to continue assessment of the effectiveness of the analytics in clinical practice and validate our findings. Eventually, their adoption in settings where costs of an intensive care day are high and ineffective efforts are frequent could yield a high return on investment.

scholarly journals Assessing the impact of smoking on the health and productivity of the working-age Indonesian population using modelling

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041832
Author(s):  
Regina P U Satyana ◽  
Regina E Uli ◽  
Dianna Magliano ◽  
Ella Zomer ◽  
Danny Liew ◽  
...  
Keyword(s):  
Control Strategies ◽  
Productivity Loss ◽  
Life Quality ◽  
Years Of Life Lost ◽  
Full Time ◽  
Indonesian Population ◽  
Annual Discount Rate ◽  
Life Years ◽  
Working Age ◽  
The Impact

ObjectivesTo estimate the impact of smoking in the working-age Indonesian population in terms of costs, years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs) lost.MethodsLife table modelling of Indonesian smokers aged 15–54 years, followed up until 55 years (retirement age). Contemporary data on demographics, all-cause mortality, population attributable fractions and prevalence of smoking were derived from the Institute for Health Metrics and Evaluation. The quality of life and reduction in productivity due to smoking were derived from published sources. The analysis was repeated but with the assumption that the cohorts were non-smokers. The differences in results represented the losses incurred due to smoking. Gross domestic product (GDP) per equivalent full-time worker (US$11 765) was used for estimation of the cost of each PALY, and an annual discount rate of 3.0% was applied to all costs and outcomes.ResultsThe prevalences of smoking among Indonesian working-age men and women were 67.2% and 2.16%, respectively. This study estimated that smoking caused 846 123 excess deaths, 2.9 million years of life lost (0.40%), 41.6 million QALYs lost (5.9%) and 15.6 million PALYs lost (2.3%). The total cost of productivity loss due to smoking amounted to US$183.7 billion among the working-age population followed up until retirement. Healthcare cost was predicted to be US$1.8 trillion. Over a 1-year time horizon, US$10.2 billion was lost in GDP and 117 billion was lost in healthcare costs.ConclusionSmoking imposes significant health and economic burden in Indonesia. The findings stress the importance of developing effective tobacco control strategies at the macro and micro levels, which would benefit the country both in terms of health and wealth.

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