Cost-effectiveness analysis of face-to-face smoking cessation interventions by professionals

Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions: 1) Telephone Counseling (TC), 2) Minimal counseling by a general practitioner (H-MIS), 3) Minimal counseling by a general practitioner combined with Nicotine Replacement Therapy (H-MIS+NRT), 4) Intensive Counseling combined with Nicotine Replacement Therapy (IC+NRT) and 5) Intensive Counseling combined with Bupropion (IC+Bupr), in terms of costs per quitter, costs per life-year gained and costs per quality-adjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared to current practice. Base-case scenarios assumed that one of the five interventions was implemented for a period of either 1 year, 10 years or 75 years and reached 25% of the smokers. A computer simulation model, the RIVM Chronic Disease Model, was used to project future gains in life-years and Quality Adjusted Life Years (QALYs), and savings of health care costs from a decrease in the incidence of smoking-related diseases. Regardless of the duration for which the intervention was implemented, our time horizon was 75 years, i.e. costs and effects were studied over a period of 75 years. Intervention costs were computed based on bottom up estimates of resource use and costs per unit of resource use. Cost calculations of smoking cessation interventions were carried out from a health care perspective, i.e. total direct medical costs were calculated based on estimates of real resource use. Effectiveness in terms of cessation rates was obtained from Cochrane meta-analyses. For the base-case scenarios, future costs and effects were discounted at an annual percentage of 4%. Incremental cost-effectiveness ratios were calculated as: (additional intervention costs minus the savings from a reduced incidence of smoking related diseases) / (gain in health outcomes). A series of one-way sensitivity analyses were performed to assess the robustness of the cost-effectiveness ratios with regard to variations in cessation rates, intervention costs, discount rates, time horizon, and the percentage of smokers reached by the intervention. Results: Base-case estimates for costs per quitter ranged from Euro 443 for H-MIS to Euro 2800 for IC+NRT. Compared to current practice H-MIS is a dominant intervention regardless of the duration of implementation. This means that H-MIS not onl

Cost-effectiveness of face-to-face smoking cessation interventions: A dynamic modeling study

Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. Results: Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were highe

Age-related differences in muscular capacity among workers

Purpose: To quantify the age-related changes in muscular capacity in a working population, and to investigate whether these changes are dependent on sports participation. Methods: Data were used from the longitudinal study on musculoskeletal disorders, absenteeism, stress and health (n = 1,800). At baseline, isokinetic lifting strength and static muscle endurance were assessed, and endurance measurements were repeated after 3 years of follow-up. Sports participation was assessed using a questionnaire. Results: Cross-sectionally, static endurance of the neck/shoulder muscles was highest among older workers, but decreased longitudinally among all age groups. Younger workers who participated in sports 3 h per week or more had the best performance, but older workers who participated between 0 and 3 h per week had better performance than those who participated in sports more frequently. The conclusions are that there were age-related differences on muscular capacity. Younger workers who participated in sports frequently had the best muscular capacity. For aging workers, moderate sports participation seems to be effective in keeping them suitable for the relatively growing work demands

A systematic review of the relation between physical capacity and future low back and neck/shoulder pain

The results of longitudinal studies reporting on the relation between physical capacity and the risk of musculoskeletal disorders have never been reviewed in a systematic way. The objective of the present systematic review is to investigate if there is evidence that low muscle strength, low muscle endurance, or reduced spinal mobility are predictors of future low back or neck/shoulder pain. Abstracts found by electronic databases were checked on several inclusion criteria. Two reviewers separately evaluated the quality of the studies. Based on the quality and the consistency of the results of the included studies, three levels of evidence were constructed. The results of 26 prospective cohort studies were summarized, of which 24 reported on the longitudinal relationship between physical capacity measures and the risk of low back pain and only three studies reported on the longitudinal relationship between physical capacity measures and the risk of neck/shoulder pain. We found strong evidence that there is no relationship between trunk muscle endurance and the risk of low back pain. Furthermore, due to inconsistent results in multiple studies, we found inconclusive evidence for a relationship between trunk muscle strength, or mobility of the lumbar spine and the risk of low back pain. Finally, due to a limited number of studies, we found inconclusive evidence for a relationship between physical capacity measures and the risk of neck/shoulder pain. Due to heterogeneity, the results of this systematic review have to be interpreted with caution. © 2006 International Association for the Study of Pain

Fysieke belasting en belastbaarheid uit evenwicht

Body@Work Seminar "Werken aan bewegen en gezondheid", 8 november 2007, Vrije Universiteit Amsterdam

The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: an experiment

The aim of the study was to investigate the effectiveness of a resistance-training program on muscle strength of the back and neck/shoulder muscles, relative physical workload, muscle fatigue and musculoskeletal discomfort during a simulated assembly and lifting task. Twenty-two workers were randomized over an 8-week resistance-training group, and a control group. Isokinetic muscle strength was assessed using the Cybex dynamometer, muscle fatigue was measured using EMG, and perceived discomfort was measured using a 10-point scale. At the follow-up, we found no effect of the resistance-training program on isokinetic muscle strength of the back and shoulder muscles. Furthermore, we did not find any effect on EMG data, nor on musculoskeletal discomfort during the simulated work tasks. However, trained workers performed the lifting tasks for a longer time before reporting considerable discomfort than those in the control group. © 2008 Elsevier Ltd. All rights reserved