To assess the relative cost-effectiveness of a high-intensity treatment (HIT) and a low-intensity treatment (LIT) for smoking cessation.
The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up (point prevalence) from a randomized controlled trial of 2 smoking cessation programs in Sweden. Future disease-related costs (in Swedish kronor [SEK] 2004; SEK7.35 = USD1) and health effects (in quality-adjusted life-years [QALYs]) were estimated via a Markov model comprising lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease including stroke with costs and QALYs discounted 3% annually.
HIT was more effective than LIT (23% vs. 16% quitters), but at a considerably higher intervention cost: SEK26,100 versus 9,100 per quitter. The model-estimated societal costs avoided did not balance the higher intervention costs, so the incremental cost-effectiveness ratio (ICER) amounted to SEK100,000 per QALY for HIT versus LIT. All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY. Compared with no intervention, LIT was cost saving, whereas HIT was estimated at SEK8,400 per QALY.
Compared with no smoking cessation program, it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs. The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden. Thus, if smoking cessation programs are judged in the same manner as other Swedish health care measures, the high-intensity program should be chosen before the low-cost program.
This study compared the cost efficiency of observation and inclinometer assessment of trunk and upper-arm inclination in a population of flight baggage handlers, as an illustration of a general procedure for addressing the trade-off between resource consumption and statistical performance in occupational epidemiology.
Trunk and upper-arm inclination with respect to the line of gravity were assessed for three days on each of 27 airport baggage handlers using simultaneous inclinometer and video recordings. Labor and equipment costs associated with data collection and processing were tracked throughout. Statistical performance was computed from the variance components within and between workers and bias (with inclinometer assumed to produce "correct" inclination angles). The behavior of the trade-off between cost and efficiency with changed sample size, as well as with changed logistics for data collection and processing, was investigated using simulations.
At similar total costs, time spent at trunk and arm inclination angles >60 ° as well as 90 (th)percentile arm inclination were estimated at higher precision using inclinometers, while median inclination and 90th percentile trunk inclination was determined more precisely using observation. This hierarchy remained when the study was reproduced in another population, while inclinometry was more cost-efficient than observation for all three posture variables in a scenario where data were already collected and only needed to be processed.
When statistical performance was measured only in terms of precision, inclinometers were more cost-efficient than observation for two out of three posture metrics investigated. Since observations were biased, inclinometers consistently outperformed observation when both bias and precision were included in statistical performance. This general model for assessing cost efficiency may be used for designing exposure assessment strategies with considerations not only of statistical but also cost criteria. The empirical data provide a specific basis for planning assessments of working postures in occupational groups.
RISE Research Institutes of Sweden, Scheelevägen 27, SE- 223 70 Lund, Sweden; Chalmers University of Technology, Department of Architecture and Civil Engineering, SE-412 96 Göteborg, Sweden. Electronic address: email@example.com.
To cope with present and future challenges, a growing number of water utilities in Sweden, Europe and elsewhere initiate various forms of inter-municipal cooperations creating a new regional level of drinking water governance. In order to reach viable decisions of alternative ways forward, there is an international consensus that sustainability needs to be addressed in water supply planning, design and decision-making. There are, however, few decision aids focusing on assessing the sustainability of inter-municipal cooperations and the inter-municipal policies and interventions that regional decision-makers are faced with. This paper presents a decision support model based on a combination of cost-benefit analysis and multi-criteria decision analysis for assessing the sustainability of regional water supply interventions, including formations of inter-municipal cooperations. The proposed decision support model integrates quantitative and semi-quantitative information on sustainability criteria. It provides a novel way of presenting monetized benefits and costs, capturing utilitarian aspects of alternative interventions, with non-monetized social and environmental effects, capturing aspects based in the deontological theories of moral ethics. The model is based on a probabilistic approach where uncertainties are defined by statistical probability distributions. A case study is used to exemplify and evaluate model application in decision situations regarding regionalization, (de)centralization, source water quality and redundancy. All evaluated alternatives were expected to contribute to a slightly improved social sustainability, whereas the results were more varying in the economic and environmental domains. A structured and transparent treatment of uncertainties facilitates a better understanding of the results as well as communication between decision-makers, stakeholders and the community.
The successful and systematic collection of demographic and lifestyle data is central in the process of any epidemiological study. The traditionally used methods such as face-to-face and telephone interviews as well as paper-questionnaires are increasingly failing to produce good qualitative results within financially feasible limits. Tools that are better suited for the present dynamic populations are needed and the Internet presents a powerful alternative for the collection of data with several intrinsic features still unexplored.
The role of economic analysis is not only to estimate the economic consequences of preventive programmes, their costs and benefits, but also to contribute to an understanding of individual and collective choice in allocating resources to prevention. A basic economic concept of relevance for prevention is investment. For investments, costs will always precede benefits in time. This means that the choice of discount rate is of great importance for the value of prevention. The identification and evaluation of costs for preventive programmes has its special problems. The 'opportunity cost' of time is important, both for a correct estimation of the social costs of preventive programmes and for an understanding of individual behaviour in relation to prevention. 'Willingness to pay' is the basic concept in the economic evaluation of benefits from prevention. The use of this concept in health care has been criticized, but it is preferable to indirect methods of benefit evaluation. However, for many preventive programmes, it is sufficient to study cost-effectiveness. The distributional consequences of different measures of effectiveness have to be recognized, as well as the role of prevention in reducing inequalities in health in general.