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This study examines the content, including mention of benefits and harms of testing and treatment, and funding of disease awareness campaign websites recognized by major noncommercial institutions.
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Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Internet , Humanos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Estados Unidos , Disseminação de Informação/métodosRESUMO
This Viewpoint highlights ways in which behavioral economics could enhance Food Is Medicine programs in the US.
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Economia Comportamental , Humanos , Promoção da Saúde/economia , Promoção da Saúde/métodosRESUMO
BACKGROUND: Studies on breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. METHODS: This is a cost-benefit analysis of data generated from a randomized controlled trial that investigated whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data of 339 participants on sociodemographics, mother and infant health, infant nutrition, direct and indirect costs of the intervention were used to assess the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months as primary outcome. Secondary outcomes included overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models explored the effect of the intervention on the overall infant nutrition cost and mother-infant health costs. Similar regression models investigated the association between cost variables and infant nutrition types (exclusive breastfeeding, mixed feeding, artificial milk). Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05. RESULTS: The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient at one year (incremental net benefits of 374 USD; BCR = 2.44), and two years (incremental net benefits of 472 USD; BCR = 2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p = 0.045). Stratified analyses by the infant nutrition type revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05) but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p = 0.001), they were similar in infants on Mixed Feeding or Artificial Milk. CONCLUSIONS: Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
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Aleitamento Materno , Análise Custo-Benefício , Países em Desenvolvimento , Humanos , Aleitamento Materno/economia , Feminino , Lactente , Adulto , Líbano , Países em Desenvolvimento/economia , Recém-Nascido , Promoção da Saúde/economia , Promoção da Saúde/métodos , Mães , MasculinoRESUMO
BACKGROUND: Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. METHODS: A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. RESULTS: This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. CONCLUSIONS: RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.
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Testes Respiratórios , Análise Custo-Benefício , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Tailândia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Meios de Comunicação de Massa , Adulto Jovem , Política de Saúde , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/economia , Promoção da Saúde/economia , Promoção da Saúde/métodosAssuntos
Doenças Cardiovasculares , Exercício Físico , Promoção da Saúde , Humanos , Hábitos , Promoção da Saúde/economia , Jogos de Vídeo , Recompensa , Motivação , Objetivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologiaRESUMO
Introduction: Physical inactivity is a risk factor for obesity and non-communicable diseases. Despite myriad health and non-health benefits resulting from physical activity (PA), most individuals do not meet PA recommendations. Providing an incentive for meeting activity goals may increase activity levels. Classical economists argue that cash is the best incentive. Behavioral economists have posited that hedonic (pleasurable) incentives (e.g., massages, restaurant meals) may be superior to cash when incentives are offered over multiple time periods. To date, no studies have directly compared the effectiveness of cash versus hedonic incentives in promoting PA across multiple time periods. Methods: We conducted a two-arm, parallel, 4-month randomized controlled trial with healthy adults in Singapore where participants were randomized to either cash or hedonic incentives. Participants could earn up to SGD50 (≈USD37) in cash or hedonic incentives each month they met the study's step target of 10,000 steps daily on at least 20/25 days out of the first 28 days of a month. The primary objective was to compare the mean proportion of months that participants met the step target between the two arms. Results: By month 4, participants in the cash (N = 154) and hedonic incentive (N = 156) arms increased their mean daily steps by 870 (p < 0.001) and 1,000 steps (p < 0.001), respectively. The mean proportion of months the step target was achieved was 90.53 and 88.34 for participants in the cash and hedonic incentive arms respectively, but differences across arms were small and not statistically significant for this or any outcome assessed. Conclusion: Our findings suggest that both cash and hedonic incentives are effective at promoting physical activity but that neither strategy is clearly superior.Clinical trial registration: ClinicalTrials.gov, NCT04618757 registered on November 6, 2020.
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Exercício Físico , Motivação , Humanos , Feminino , Masculino , Singapura , Adulto , Pessoa de Meia-Idade , Promoção da Saúde/métodos , Promoção da Saúde/economia , RecompensaRESUMO
INTRODUCTION: This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts. METHODS: Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024. RESULTS: Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54. CONCLUSIONS: The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.
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Vacinas contra COVID-19 , COVID-19 , Análise Custo-Benefício , Humanos , COVID-19/prevenção & controle , COVID-19/economia , COVID-19/epidemiologia , Estados Unidos/epidemiologia , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/administração & dosagem , United States Dept. of Health and Human Services , Promoção da Saúde/economia , Promoção da Saúde/métodos , SARS-CoV-2 , Vacinação/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricosRESUMO
OBJECTIVE: In the United States, adult dental benefits are optional in the state-managed, public insurance program, Medicaid. States also have the option to adapt their Medicaid program via waivers which pair healthy behaviour incentives (HBI) with cost-sharing. These waivers have proven ineffective, but the empirical evidence has ignored differences between states. This study aims to evaluate the impact of four state's HBI Medicaid waiver on dental visits among low-income adult population subject to incentives and cost-sharing requirements by the HBI waiver. METHODS: Analysing biannual data from the Behavioural Risk Factor Surveillance System's Oral Health module (2008-2018) with a Difference-in-Differences design, this study estimated the effect of a Healthy Behaviour Incentive waiver on the probability of visiting the dentist in the past year. The three states that implemented an HBI Waiver (Indiana, Michigan and Wisconsin) were analysed separately. Secondary outcomes included being uninsured and having all teeth extracted. Matrix Completion methods accounted for dynamic treatment and tested for non-common trends. Inference was based on randomization inference tests. RESULTS: Only in Michigan was an HBI waiver consistently associated with a significant increase in the probability of a dental visit (Est. = 5.6%-points, p = .01). There was little convincing evidence that HBI waivers were associated with being uninsured or having all teeth extracted. CONCLUSIONS: Between 2010 and 2019, many states have implemented an HBI waiver, each with a different approach to incentivizing dental visits. These implementation differences may explain the heterogeneous effects by state. More work is needed to evaluate how Medicaid waivers impact health outcomes in low-income populations.
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Medicaid , Pobreza , Humanos , Estados Unidos , Adulto , Feminino , Masculino , Motivação , Comportamentos Relacionados com a Saúde , Pessoa de Meia-Idade , Sistema de Vigilância de Fator de Risco Comportamental , Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Michigan , WisconsinRESUMO
INTRODUCTION: Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS: The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS: A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS: Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.
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Alimento Processado , Pobreza , Impostos , Humanos , Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Dieta Saudável/economia , Dieta Saudável/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Pobreza/estatística & dados numéricos , Bebidas Adoçadas com Açúcar/economia , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Impostos/economia , Estados UnidosRESUMO
INTRODUCTION: This systematic economic review examined the cost-benefit and cost-effectiveness of park, trail, and greenway infrastructure interventions to increase physical activity or infrastructure use. METHODS: The search period covered the date of inception of publications databases through February 2022. Inclusion was limited to studies that reported cost-benefit or cost-effectiveness outcomes and were based in the U.S. and other high-income countries. Analyses were conducted from March 2022 through December 2022. All monetary values reported are in 2021 U.S. dollars. RESULTS: The search yielded 1 study based in the U.S. and 7 based in other high-income countries, with 1 reporting cost-effectiveness and 7 reporting cost-benefit outcomes. The cost-effectiveness study based in the United Kingdom reported $23,254 per disability-adjusted life year averted. The median benefit-to-cost ratio was 3.1 (interquartile interval=2.9-3.9) on the basis of 7 studies. DISCUSSION: The evidence shows that economic benefits exceed the intervention cost of park, trail, and greenway infrastructure. Given large differences in the size of infrastructure, intervention costs and economic benefits varied substantially across studies. There was insufficient number of studies to determine the cost-effectiveness of these interventions.
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Análise Custo-Benefício , Exercício Físico , Parques Recreativos , Humanos , Parques Recreativos/economia , Planejamento Ambiental/economia , Promoção da Saúde/economia , Promoção da Saúde/métodos , Estados UnidosRESUMO
OBJECTIVES: Corporate health programs (CHPs) aim to improve employees' health through health promotion strategies at the workplace. Physical activity (PA) plays a crucial role in primary prevention, leading many companies to implement PA-based CHPs. However, there is limited examination in the scientific literature on whether PA-based CHPs (PA-CHPs) lead to economic benefits. This systematic review aimed to summarize the available literature on the economic aspects of PA-CHPs. METHODS: A systematic review was conducted to identify studies focused on PA-CHPs targeting healthy sedentary workers and reporting at least one economic outcome, such as return on investment (ROI), costs, or sick leave. RESULTS: Of 1036 studies identified by our search strategy, 11 studies involving 60 020 participants met the inclusion criteria. The mean (±SD) cost per capita for PA-CHPs was estimated as 359 (±238) (95% CI, 357-361). In 75% of the studies, the net savings generated by PA-CHPs in 12 months were reported, with an average of 1095 (±865) (95% CI, 496-1690). ROI was assessed in 50% of the included studies, with an average of 3.6 (±1.41) (95% CI, 2.19-5.01). CONCLUSIONS: In addition to promoting a healthy lifestyle, PA-CHPs have the potential to generate significant economic returns. However, the heterogeneity among the existing studies highlights the need for standardization and accurate reporting of costs in future research.
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Análise Custo-Benefício , Exercício Físico , Promoção da Saúde , Humanos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Saúde Ocupacional , Local de Trabalho , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/métodos , Avaliação de Programas e Projetos de Saúde , Comportamento SedentárioRESUMO
Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.
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Promoção da Saúde , Promoção da Saúde/economia , Humanos , Análise Custo-Benefício , Serviços de Saúde Comunitária/economiaRESUMO
OBJETIVO: Evaluar sistemáticamente literatura sobre uso y efectividad los empujoncitos basados en la Economía del Comportamiento (EC). MÉTODOS: Se realizaron búsquedas en PubMed, Web of Science, Lilacs y SciELO; estudios publicados en inglés, portugués y español entre 2017-2021 que examinaran aspectos de la EC; la calidad se evaluó con la Effective Public Health Practice Project. RESULTADOS: Se examinaron 81 estudios, cumpliendo los criterios 17. La mayoría se realizaron en Estados Unidos, publicados entre 2019-2021, con calidad fuerte (n = 12) y moderada (n = 5); con una diversidad de intervenciones practicadas y diferencias en los métodos de implementación. Demostrando la efectividad de las estrategias basadas en la EC en la salud de los sujetos de estudio. CONCLUSIONES: En materia de toma de decisiones, el comportamiento es un proceso complejo que requiere de análisis constante desde la EC, la que representa un enfoque pormetedor para apoyar intervenciones en materia de salud pública más efectivas.
OBJECTIVE: To systematically evaluate the literature on the use and effectiveness of nudges based on Behavioral Economics (BE). METHODS: PubMed, Web of Science, Lilacs, and SciELO were searched; studies published in English, Portuguese, and Spanish between 2017-2021 that examined aspects of BE; quality was assessed using the Effective Public Health Practice Project. RESULTS: 81 studies were examined, 17 meeting the criteria. Most were conducted in the United States and published between 2019-2021, with strong (n = 12) and moderate (n = 5) quality, with a diversity of interventions practiced and differences in implementation methods. The selected studies demonstrated the effectiveness of strategies based on BE in the study subjects' health. CONCLUSIONS: In decision-making, behavior is a complex process requiring constant analysis from the BE, and BE is a promising approach to support more effective public health interventions.
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Humanos , Saúde Pública , Economia Comportamental , Promoção da Saúde/economia , Promoção da Saúde/métodos , Comportamentos Relacionados com a Saúde , Tomada de DecisõesRESUMO
OBJECTIVE: To systematically evaluate the literature on the use and effectiveness of nudges based on Behavioral Economics (BE). METHODS: PubMed, Web of Science, Lilacs, and SciELO were searched; studies published in English, Portuguese, and Spanish between 2017-2021 that examined aspects of BE; quality was assessed using the Effective Public Health Practice Project. RESULTS: 81 studies were examined, 17 meeting the criteria. Most were conducted in the United States and published between 2019-2021, with strong (n = 12) and moderate (n = 5) quality, with a diversity of interventions practiced and differences in implementation methods. The selected studies demonstrated the effectiveness of strategies based on BE in the study subjects' health. CONCLUSIONS: In decision-making, behavior is a complex process requiring constant analysis from the BE, and BE is a promising approach to support more effective public health interventions.
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Economia Comportamental , Promoção da Saúde , Saúde Pública , Humanos , Promoção da Saúde/métodos , Promoção da Saúde/economia , Comportamentos Relacionados com a Saúde , Tomada de DecisõesAssuntos
Promoção da Saúde , Cuidado Pré-Natal , Reembolso de Incentivo , Abandono do Hábito de Fumar , Feminino , Humanos , Gravidez , Comportamentos Relacionados com a Saúde , Fumar/efeitos adversos , Fumar/economia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Reembolso de Incentivo/economia , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodos , Motivação , Promoção da Saúde/economia , Promoção da Saúde/métodos , Apoio Financeiro , RecompensaRESUMO
BACKGROUND: Internationally, government policies mandating schools to provide students with opportunities to participate in physical activity are poorly implemented. The multi-component Physically Active Children in Education (PACE) intervention effectively assists schools to implement one such policy. We evaluated the value of investment by health service providers tasked with intervention delivery, and explored where adaptations might be targeted to reduce program costs for scale-up. METHODS: A prospective trial-based economic evaluation of an implementation intervention in 61 primary schools in New South Wales (NSW), Australia. Schools were randomised to the PACE intervention or a wait-list control. PACE strategies included centralised technical assistance, ongoing consultation, principal's mandated change, identifying and preparing in-school champions, educational outreach visits, and provision of educational materials and equipment. Effectiveness was measured as the mean weekly minutes of physical activity implemented by classroom teachers, recorded in a daily log book at baseline and 12-month follow-up. Delivery costs (reported in $AUD, 2018) were evaluated from a public finance perspective. Cost data were used to calculate: total intervention cost, cost per strategy and incremental cost (overall across all schools and as an average per school). Incremental cost-effectiveness ratios (ICERs) were calculated as the incremental cost of delivering PACE divided by the estimated intervention effect. RESULTS: PACE cost the health service provider a total of $35,692 (95% uncertainty interval [UI] $32,411, $38,331) to deliver; an average cost per school of $1151 (95%UI $1046, $1236). Training in-school champions was the largest contributor: $19,437 total; $627 ($0 to $648) average per school. Educational outreach was the second largest contributor: $4992 total; $161 ($0 to $528) average per school. The ICER was $29 (95%UI $17, $64) for every additional minute of weekly physical activity implemented per school. CONCLUSION: PACE is a potentially cost-effective intervention for increasing schools implementation of a policy mandate. The investment required by the health service provider makes use of existing funding and infrastructure; the additional cost to assist schools to implement the policy is likely not that much. PACE strategies may be adapted to substantially improve delivery costs. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12617001265369; Prospectively registered 1st September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373520.
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Exercício Físico , Promoção da Saúde , Políticas , Instituições Acadêmicas , Criança , Análise Custo-Benefício , Promoção da Saúde/economia , Humanos , New South Wales , Estudos ProspectivosRESUMO
OBJECTIVE: Few studies have reported the cost and cost-effectiveness of workplace interventions to reduce sedentary time. The purpose of this study was to complete an economic evaluation of a multilevel intervention to reduce sitting time and increase light-intensity physical activity (LPA) among employees. METHODS: We conducted a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a 12-month multilevel intervention with (STAND+) and without (MOVE+) a sit-stand workstation, across 24 worksites (N=630 employee participants) enrolled in a cluster randomized clinical trial. We estimated the intervention costs using activity-based costing strategy. The intervention costs were further expressed as per person and per worksite. CEA was conducted using an incremental cost-effectiveness ratio (ICER) metric, expressed as costs for additional unit of sitting time (minute/day), LPA (minutes/day), cardiometabolic risk score, and quality-adjusted life years (QALY) increased/decreased at 12 months. We assessed the cost analysis and CEA from the organizational (ie, employer) perspective with a one-year time horizon. RESULTS: Total intervention costs were $134 and $72 per person, and $3939 and $1650 per worksite for the STAND+ (N worksites = 12; N employees = 354) and MOVE+ (N worksites = 12; N employees = 276) interventions, respectively. The ICER was $1 (95% CI $0.8-1.4) for each additional minute reduction of workplace sitting time (standardized to 8-hour workday); and $4656 per QALY gained at 12 months. There was a modest and non-significant change of loss of work productivity improvement (-0.03 hours, 95% CI -4.16-4.09 hours), which was associated with a $0.34 return for every $1 invested. CONCLUSIONS: The multi-level intervention with sit-stand workstations has the potential to be widely implemented to reduce workplace sitting time. Future research into work productivity outcomes in terms of cost-benefits for employers is warranted.
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Doenças Cardiovasculares , Promoção da Saúde , Local de Trabalho , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Promoção da Saúde/economia , Humanos , Estudos Retrospectivos , Comportamento SedentárioRESUMO
During the COVID-19 pandemic, media accounts emerged describing faith-based organizations (FBOs) working alongside health departments to support the COVID-19 response. In May 2021, the Department of Health and Human Services, Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) sent an electronic survey to the 59 ASTHO member jurisdictions and four major US cities to assess state and territorial engagement with FBOs. Findings suggest that public health officials in many jurisdictions were able to work effectively with FBOs during the COVID-19 pandemic to provide essential education and mitigation tools to diverse communities. (Am J Public Health. 2022;112(3):397-400. https://doi.org/10.2105/AJPH.2021.306620).
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Vacinas contra COVID-19/administração & dosagem , COVID-19/etnologia , COVID-19/prevenção & controle , Organizações Religiosas/organização & administração , Promoção da Saúde/organização & administração , Relações Comunidade-Instituição , Organizações Religiosas/economia , Equidade em Saúde , Promoção da Saúde/economia , Humanos , Pandemias , Administração em Saúde Pública , SARS-CoV-2 , Governo Estadual , Estados Unidos/epidemiologia , Hesitação Vacinal/etnologiaRESUMO
OBJECTIVES: Lifestyle interventions during pregnancy improve maternal and infant outcomes. We aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types with standard care. METHODS: A decision tree model was constructed to compare lifestyle intervention effects from a novel meta-analysis. The target population was women with singleton pregnancies and births at more than 20 weeks' gestation. Interventions were categorized as diet, diet with physical activity, physical activity, and mixed (lacking structured diet and, or, physical activity components). The outcome of interest was cost per case prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth) expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public healthcare perspective. Scenario analyses were included for all structured interventions combined and by adding neonatal intensive care unit costs. Costs were estimated from published data and consultations with experts and updated to 2019 values. Discounting was not applied owing to the short time horizon. RESULTS: Physical activity interventions reduced adverse maternal events by 4.2% in the intervention group compared with standard care and could be cost saving. Diet and diet with physical activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020), respectively. Mixed interventions did not reduce events and were dominated by standard care. In scenario analysis, all structured interventions combined and all interventions when including neonatal intensive care unit costs (except mixed) may be cost saving. Probabilistic sensitivity analysis showed that for physical activity and all structured interventions combined, the probability of being cost saving was 58% and 41%, respectively. CONCLUSIONS: Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide.