A systematic review of whole disease models for informing healthcare resource allocation decisions.

BACKGROUND: Whole disease models (WDM) are large-scale, system-level models which can evaluate multiple decision questions across an entire care pathway. Whilst this type of model can offer several advantages as a platform for undertaking economic analyses, the availability and quality of existing WDMs is unknown. OBJECTIVES: This systematic review aimed to identify existing WDMs to explore which disease areas they cover, to critically assess the quality of these models and provide recommendations for future research. METHODS: An electronic search was performed on multiple databases (MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database) on 23rd July 2023. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) appraisal checklist for economic evaluations. Model characteristics were descriptively summarised. RESULTS: Forty-four WDMs were identified, of which thirty-two were developed after 2010. The main disease areas covered by existing WDMs are heart disease, cancer, acquired immune deficiency syndrome and metabolic disease. The quality of included WDMs is generally low. Common limitations included failure to consider the harms and costs of adverse events (AEs) of interventions, lack of probabilistic sensitivity analysis (PSA) and poor reporting. CONCLUSIONS: There has been an increase in the number of WDMs since 2010. However, their quality is generally low which means they may require significant modification before they could be re-used, such as modelling AEs of interventions and incorporation of PSA. Sufficient details of the WDMs need to be reported to allow future reuse/adaptation.

The effects of exercise and nicotine replacement therapy on smoking rates in women.

PURPOSE: To examine the individual effects of supervised and intensive exercise as well as the combined effects of exercise and nicotine replacement therapy (NRT) on (a) smoking cessation and reduction rates and (b) psychological and physiological processes during withdrawal. METHODS: One-hundred and forty-two inactive female smokers were randomised into the following four groups: exercise+nicotine patch; exercise+no nicotine patch; cognitive behavior therapy (CBT)+nicotine patch and CBT+no nicotine patch. Smoking abstinence (verified by saliva cotinine and expired carbon monoxide), cessation self-efficacy, and physical fitness and body weight were assessed at baseline (week 1), quit date (week 6), program termination (week 12), and 3- and 12-month follow-up. RESULTS: There were significant differences in a 7-day point prevalence but not continuous abstinence rates between treatment groups across targeted end points. Consistently higher cessation rates were seen when NRT was added to both treatment programs. Compared with CBT participants, exercise participants had significantly increased functional exercise capacity and had gained significantly less weight during program end points but these differences did not hold at a 12-month follow-up. Compared with exercise participants, CBT participants felt greater cessation efficacy and reported greater knowledge, coping and support resources across all end points. CONCLUSIONS: Exercise combined with NRT facilitates smoking cessation, improves functional exercise capacity, and delays weight gain in women smokers. We recommend that physicians and health care professionals recommend exercise and NRT together for highly motivated women interested in quitting smoking.