Health and economic consequences of applying the United States' PM2.5 automobile emission standards to other nations: a case study of France and Italy.

OBJECTIVES: The US has among the world's strictest automobile emission standards, but it is now loosening them. It is unclear where a nation should draw the line between the associated cost burden imposed by regulations and the broader societal benefits associated with having cleaner air. Our study examines the health benefits and cost-effectiveness of introducing stricter vehicle emission standards in France and Italy. STUDY DESIGN: Quasi-experimental study. METHODS: We used cost-effectiveness modeling to measure the incremental quality-adjusted life years (QALYs) and cost (Euros) of adopting more stringent US vehicle emission standards for PM2.5 in France and Italy. RESULTS: Adopting Obama era US vehicle emission standards would likely save money and lives for both the French and Italian populations. In France, adopting US emission standards would save €1000 and increase QALYs by 0.04 per capita. In Italy, the stricter standards would save €3000 and increase QALYs by 0.31. The results remain robust in both the sensitivity analysis and probabilistic Monte Carlo simulation model. CONCLUSIONS: Adopting more stringent emission standards in France and Italy would save money and lives.

The cost-effectiveness of limiting federal housing vouchers to use in low-poverty neighborhoods in the United States.

OBJECTIVE: Residents of low-income neighborhoods are exposed to relatively higher rates of crime, fewer opportunities to exercise, poorer schools, and few opportunities to eat healthy foods than residents of middle-class neighborhoods. Policies that influence neighborhood context could therefore serve as health interventions. We seek to inform the policy debate over the wisdom of spending health dollars on non-health sectors of the economy by defining the opportunity cost of doing so. STUDY DESIGN: Cost-effectiveness analysis with Markov model and Monte Carlo simulation. METHODS: We assess the long-term health and economic benefits of Moving to Opportunity-type housing vouchers vs traditional public housing. Our Markov model draws heavily from decades of follow-up data from a large randomized-controlled trial, from which we make projections about health outcomes and costs. RESULTS: Restricted housing vouchers cost less over the lifetime of recipients than traditional vouchers ($186,629 [95% credible interval: $148,856-$229,235] vs $194,077 [$153,831-$240,904]), while improving health and longevity (19.39 quality-adjusted life years [15.83-21.35] vs 19.16 [15.65-21.03]). Over 99% of the model simulations favored restricted housing vouchers over traditional public housing or non-restrictive vouchers. CONCLUSIONS: Restrictive vouchers appear to improve population health, save money, and save lives.

Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis.

BACKGROUND: The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma. RESULTS: A total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16-0.38, p<0.0001) and 28% (95% CI: 0.09-0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL. CONCLUSION: ACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.