Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Aims: To evaluate costs, effects and cost effectiveness of increased reach of specific smoking cessation interventions in Germany. Design: A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A healthcare perspective (extended to include out-of-pocket payments) with lifetime horizon was considered. A probabilistic analysis was used to assess uncertainty around predicted estimates. Setting: Germany. Participants: Cohort of current smoking population (18+ years) in Germany. Interventions: Interventions included group-based behavioral support, financial incentive programs and varenicline. For Prospective Scenario 1 the reach of group-based behavioral support, financial incentive program and varenicline was increased by 1% of yearly quit attempts (=57,915 quit attempts), while Prospective Scenario 2 represented a higher reach mirroring the levels observed in England. Measurements: EQUIPTMOD considered reach, intervention cost, number of quitters, QALYs gained, cost effectiveness and return on investment. Findings: The highest returns through reduction in smoking-related healthcare costs were seen for the financial incentive program (€2.71 per €1 invested), followed by that of group-based behavioral support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, Prospective Scenario 1 led to 15,034 QALYs gained and €27 million cost-savings, compared with Current Investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5,000, the probability of being cost effective is around 75% for Prospective Scenario 1. Conclusions Increasing the reach of group-based behavioral support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policy makers that improves the population’s health outcomes and that may be considered cost-effective

Quinoa Phenotyping Methodologies: An International Consensus

Quinoa is a crop originating in the Andes but grown more widely and with the genetic potential for significant further expansion. Due to the phenotypic plasticity of quinoa, varieties need to be assessed across years and multiple locations. To improve comparability among field trials across the globe and to facilitate collaborations, components of the trials need to be kept consistent, including the type and methods of data collected. Here, an internationally open-access framework for phenotyping a wide range of quinoa features is proposed to facilitate the systematic agronomic, physiological and genetic characterization of quinoa for crop adaptation and improvement. Mature plant phenotyping is a central aspect of this paper, including detailed descriptions and the provision of phenotyping cards to facilitate consistency in data collection. High-throughput methods for multi-temporal phenotyping based on remote sensing technologies are described. Tools for higher throughput post-harvest phenotyping of seeds are presented. A guideline for approaching quinoa field trials including the collection of environmental data and designing layouts with statistical robustness is suggested. To move towards developing resources for quinoa in line with major cereal crops, a database was created. The Quinoa Germinate Platform will serve as a central repository of data for quinoa researchers globally

Using data from online geocoding services for the assessment of environmental obesogenic factors: A feasibility study.

BackgroundThe increasing prevalence of obesity is a major public health problem in many countries. Built environment factors are known to be associated with obesity, which is an important risk factor for type 2 diabetes. Online geocoding services could be used to identify regions with a high concentration of obesogenic factors. The aim of our study was to examine the feasibility of integrating information from online geocoding services for the assessment of obesogenic environments.MethodsWe identified environmental factors associated with obesity from the literature and translated these factors into variables from the online geocoding services Google Maps and OpenStreetMap (OSM). We tested whether spatial data points can be downloaded from these services and processed and visualized on maps. True- and false-positive values, false-negative values, sensitivities and positive predictive values of the processed data were determined using search engines and in-field inspections within four pilot areas in Bavaria, Germany.ResultsSeveral environmental factors could be identified from the literature that were either positively or negatively correlated with weight outcomes in previous studies. The diversity of query variables was higher in OSM compared with Google Maps. In each pilot area, query results from Google showed a higher absolute number of true-positive hits and of false-positive hits, but a lower number of false-negative hits during the validation process. The positive predictive value of database hits was higher in OSM and ranged between 81 and 100% compared with a range of 63-89% for Google Maps. In contrast, sensitivities were higher in Google Maps (between 59 and 98%) than in OSM (between 20 and 64%).ConclusionsIt was possible to operationalize obesogenic factors identified from the literature with data and variables available from geocoding services. The validity of Google Maps and OSM was reasonable. The assessment of environmental obesogenic factors via geocoding services could potentially be applied in diabetes surveillance

The expansion of natural gas infrastructure puts energy transitions at risk

Whether additional natural gas infrastructure is needed or would be detrimental to achieving climate protection goals is currently highly controversial. Here we combine five perspectives to argue why expansion of the natural gas infrastructure hinders a renewable energy future and is no bridge technology. We highlight that natural gas is a fossil fuel with a significantly underestimated climate impact that hinders decarbonization through carbon lock-in and stranded assets. We propose five ways to avoid common shortcomings for countries that are developing strategies for greenhouse gas reduction: manage methane emissions of the entire natural gas value chain, revise assumptions of scenario analyses with new research insights on greenhouse gas emissions related to natural gas, replace the ‘bridge’ narrative with unambiguous decarbonization criteria, avoid additional natural gas lock-ins and methane leakage, and take climate-related risks in energy infrastructure planning seriously

Estimating costs for modelling return on investment from smoking cessation interventions

Introduction Aim and objective: Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model (EQUIPTMOD). Methods Focused search of administrative and published data on dult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking related costs, child population (0-15 years) was also included. A standardized checklist was developed in order to ensure consistency in methods of data collection. Costs of treating smoking attributable diseases; productivity losses due to smoking attributable absenteeism; and costs of implementing smoking cessation interventions were measured. Results Annual costs (per case) of treating smoking attributable lung cancer were between €5,074 (Hungary) and €52,106 (Germany); coronary heart disease between €1,521 (Spain) and €3,955 (Netherlands); chronic obstructive pulmonary disease between €1,280 (England) and €4,199 (Spain); stroke between €1,829 (Hungary) and €14,880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioral support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); €27 (Spain). Conclusions Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across the five study countries. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions. Funding We have received funding from the European Community's Seventh Framework Programme (The EQUIPT Project; grant agreement 602270). The funders had no influence in the conduction of this study or the drafting of this manuscript