OBJECTIVE: Public transport (PT) users often accumulate more physical activity (PA) than private motor vehicle users and financial incentives may increase PT use. Responding to rising petrol prices, from 28 March to 1 May 2022, the Tasmanian government made public bus use fare-free. This exploratory study examined the perceived impact of fare-free buses on bus use and PA.
METHODS: Tasmanian adults who had used the fare-free buses (N = 548) completed an online survey (4 May-14 June 2022). Quantitative data were analysed using descriptive and inferential methods and responses to open-ended questions categorised.
RESULTS: Over the fare-free period, 46% of participants reported more bus use-average weekly bus trips increased from 3.0 to 4.0 (p < 0.001). Most (81%) participants, including 36% (n = 33/93) who were not previous bus users, planned continued bus use despite financial cost. Total PA was reported higher (36%), the same (60%) and lower (4%) than usual during the fare-free period. Higher total PA was more common amongst those reporting increased bus use (n = 186/240; 78%). Responses to open-ended questions revealed: bus use-related PA gain was through walking to/from bus stops, more frequently attending PA settings (e.g., the gym) and unexpected walking due to bus service limitations; household-level cost savings, improved travel opportunities and better social/mental health were additional fare-free benefits.
UNASSIGNED: Fare-free buses were commonly perceived to increase bus use and PA. Intervention studies would determine if PA and financially incentivised PT have a causal relationship. Individual- and societal-level health economic analysis of free PT is warranted.

UNASSIGNED: The German Incentives for Physical Activity in Cardiac Patients trial is a three-arm, randomised controlled trial for secondary prevention of coronary heart disease (CHD). Guidance for developing complex interventions recommends pre-trial health economic modelling. The aim of this study is to model the long-term cost-effectiveness of the incentive-based physical activity interventions in a population with CHD.
UNASSIGNED: A decision-analytical Markov model was developed from a health services provider perspective, following a cohort aged 65 years with a previous myocardial infarction for 25 years. Monetary and social incentives were compared relative to no incentive. Intervention effects associated with physical activity were used to determine the costs, quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness and cost-utility ratios. The probability of cost-effectiveness was calculated through sensitivity analyses.
UNASSIGNED: The incremental QALYs gained from the monetary and social incentives, relative to control, were respectively estimated at 0.01 (95% CI 0.00 to 0.01) and 0.04 (95% CI 0.02 to 0.05). Implementation of the monetary and social incentive interventions increased the costs by €874 (95% CI €744 to €1047) and €909 (95% CI €537 to €1625). Incremental cost-utility ratios were €25 912 (95% CI €15 056 to €50 210) and €118 958 (95% CI €82 930 to €196 121) per QALY gained for the social and monetary incentive intervention, respectively. With a willingness-to-pay threshold set at €43 000/QALY, equivalent to the per-capita gross domestic product in Germany, the probability that the social and monetary incentive intervention would be seen as cost-effective was 95% and 0%, respectively.
UNASSIGNED: Exercise-based secondary prevention using inventive schemes may offer a cost-effective strategy to reduce the burden of CHD.

BACKGROUND: Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person\'s life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC.
OBJECTIVE: This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting.
METHODS: A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years.
RESULTS: Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained.
CONCLUSIONS: The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population.
BACKGROUND: ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.
UNASSIGNED: RR2-10.1186/S12888-019-2037-3.

BACKGROUND: As nearly two-thirds of women presenting at their first antenatal visit are either overweight or obese in urban South Africa, the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and non-communicable diseases. This protocol describes the planned economic evaluation of an individually randomised controlled trial of a complex continuum of care intervention targeting women and children in Soweto, South Africa (Bukhali trial).
METHODS: The economic evaluation of the Bukhali trial will be conducted as a within-trial analysis from both provider and societal perspectives. Incremental costs and health outcomes of the continuum of care intervention will be compared with standard care. The economic impact on implementing agencies (programme costs), healthcare providers, participants and their households will be estimated. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of child adiposity at age years averted. Additionally, ICERs will also be reported in terms of cost per quality-adjusted life year gained. If Bukhali demonstrates effectiveness, we will employ a decision analytical model to examine the cost-effectiveness of the intervention over a child\'s lifetime. A Markov model will be used to estimate long-term health benefits, healthcare costs and cost-effectiveness. Probabilistic sensitivity analyses will be conducted to explore uncertainty and ensure robust results. An analysis will be conducted to assess the equity impact of the intervention, by comparing intervention impact within quintiles of socioeconomic status.
BACKGROUND: The Bukhali trial economic evaluation has ethical approval from the Human Ethics Research Committee of the University of the Witwatersrand, Johannesburg, South Africa (M240162). The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.
BACKGROUND: Pan African Clinical Trials Registry (PACTR201903750173871; https://pactr.samrc.ac.za).

BACKGROUND: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations.
OBJECTIVE: This study will examine how product features are associated with the prices of devices sold in web-based vape shops.
METHODS: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices.
RESULTS: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers.
CONCLUSIONS: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.

UNASSIGNED: This study aimed to obtain insights from epilepsy specialists on the use of Patient-Reported Outcome (PRO) measures and how they can affect the management of people with epilepsy and healthcare resource utilization.
UNASSIGNED: The heads of two referral units for people with epilepsy at one tertiary care hospital were invited to respond to a structured survey.
UNASSIGNED: Paper-based questionnaires and face-to-face interviews were the main modalities used to measure the quality of life of people with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), the Adverse Event Profile (adult centre), the Generalized Anxiety Disorder-7, Short-Form Health Survey 36, PSY-Flex, SAFA and Child Behavior Checklist (paediatric centre) were the most used scales. There was consensus about the favourable impact of PRO upon patient management, disease management and measurement of the success of a treatment. Both respondents considered the PRO as important as other main indicators like efficacy and tolerability of the treatment. Lack of time, personnel and economic resources was identified as a barrier on the use of PRO. The PRO could reduce the number of visits, exams and treatments, and increase the time spent on each patient and the number of neuropsychological, psychological and rehabilitation services. The standardized use of PRO was considered useful and the increase in human resources was considered a priority to achieve this goal.
UNASSIGNED: Despite the heterogeneity in the actual collection of PRO, there was a uniform perception about their role to optimize the care of people with epilepsy.

BACKGROUND: Several prevalence-based cost-of-illness (COI) studies have been conducted to estimate the economic burden of alcohol consumption borne by a particular society in a given year. Yet there are few studies examining the economic costs incurred by an individual drinker over his/her lifetime. Thus, this study aims to estimate the costs incurred by an individual drinker\'s alcohol consumption over his or her lifetime in Thailand.
METHODS: An incidence-based COI approach will be employed. To project individuals\' associated costs over a lifetime, a Markov modelling technique will be used. The following six alcohol-related diseases/conditions will be considered in the model: hypertension, haemorrhagic stroke, liver cirrhosis, liver cancer, alcohol use disorders and road injury. The analysis will cover both direct (ie, direct healthcare cost, costs of property damage due to road traffic accidents) and indirect costs (ie, productivity loss due to premature mortality and hospital-related absenteeism). The human capital approach will be adopted to estimate the cost of productivity loss. All costs will be presented in Thai baht, 2022.
BACKGROUND: The Institutional Review Board of Mahidol University, Faculty of Dentistry/Faculty of Pharmacy has confirmed that no ethical approval is required (COE.No.MU-DT/PY-IRB 2021/010.0605). Dissemination of the study findings will be carried out through peer-reviewed publications, conferences and engagement with policy-makers and public health stakeholders.

BACKGROUND: Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate).
METHODS: This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant.
RESULTS: Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€.
CONCLUSIONS: Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents.
BACKGROUND: clinicaltrials.gov, NCT02677272.

BACKGROUND: Digital health and telemedicine are potentially important strategies to decrease health care\'s environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine.
OBJECTIVE: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants.
METHODS: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States.
RESULTS: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons.
CONCLUSIONS: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector\'s carbon footprint.

The purpose of this study is to explore the impact of GDP per capita income (GDPPCI), unemployment, higher education (HE), and economic growth (EG) on migration in Sri Lanka. Numerous global and local studies have explored the influence of macroeconomic and socioeconomic factors on migration. In the Sri Lankan context, fewer studies have probed the impact of GDPPCI, unemployment, HE, and EG on migration, particularly concerning brain drain and domestic labour market pressure. An applied research methodology was adopted, utilising annual data from 1986 to 2022. The statistical data were sourced from reports by the Sri Lanka Bureau of Foreign Employment (SLBFE), the Central Bank of Sri Lanka (CBSL), Labor Force Survey Data from the Department of Census and Statistics (LFSDCS), and University Grants Commissions (UGC). This study utilised the Vector Error Correlation model (VECM), Vector Auto-regression (VAR), and Granger Causality test through STATA. The empirical findings of the VAR model highlighted that GDPPCI and EG negatively impact migration, whereas unemployment and HE positively affect migration. The study\'s implications demonstrated that GDPPCI, unemployment, HE, and EG were the primary factors influencing the country\'s migration decisions. These findings will hopefully inform and guide the Sri Lankan government and policymakers for more effective decision-making.