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6. Financial incentives to stop smoking: Potential financial consequences of different reward schedules.

Author

Valentelyte, Gintare, Sheridan, Aishling, Kavanagh, Paul, Doyle, Frank, and Sorensen, Jan

Subjects
TOBACCO, MONETARY incentives, SMOKING cessation, STAKEHOLDERS
Abstract

Introduction: Financial incentives to stop smoking (FISS) programs have been implemented internationally to encourage people who smoke to quit smoking. However, such programs require that the financial reward structure and its resulting effects on smoking quit rates are considered. We analyzed a number of scenarios for FISS reward schedules for current smoking individuals in Ireland, with a view to identify the potential implications in terms of financial consequences and expected effects. Methods: Using national QuitManager services data 2021–2023, we defined smoking quit rates for smokers currently using the national Health Services Executive stop smoking services in Ireland. Smoking quit rates at 4, 12 and 52 weeks were defined, and additionally defined by sex, age and education level. Using scenarios assuming different FISS reward sizes, structures and targeted population sub-groups, we estimated the number of additional quitters, budget impact, and incremental costeffectiveness ratio. Results: A FISS program, if implemented for a cohort of 3500 smokers can result in a budget impact ranging €250000 – €870000. The cost-effectiveness trade-off between different payment schedules and the expected effect size suggested that FISS are cost-effective even at a moderate effect size. A FISS program implemented to approximately 20000 smokers nationally would cost between €2.0 million and €4.8 million, subject to the chosen reward schedule. Across social groups, FISS is more cost-effective for females, individuals in the youngest age group, and individuals with a medium level of education. Conclusions: This analysis highlights the importance of considering different FISS schedules and potential quit effects, when designing such programs. We highlight that FISS programs should be targeted at certain social groups to achieve highest long-term smoking cessation rates. We also identified important challenges that decision-makers face when designing the reward structure of FISS programs. The acceptability or otherwise of the FISS structures may differ among stakeholders and should be explored. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals

Author

Rajesh, Joel, Valentelyte, Gintare, McNamara, Deborah A., and Sorensen, Jan

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Logistic regression, Surgical procedures, Pandemic, medicine, Humans, In patient, Pandemics, Retrospective Studies, Hospitals, Public, SARS-CoV-2, business.industry, COVID-19, General Medicine, Hospital admission, medicine.disease, Comorbidity, Operative, Patient flow, Emergency medicine, Emergency surgical procedure, Length of stay, Original Article, business, Abdominal surgery
Abstract

Background The SARS-CoV-2 pandemic caused severe disruption to scheduled surgery in Ireland but its impact on emergency abdominal surgery (EAS) is unknown. Aims The primary objective was to identify changes in volume, length of stay (LOS), and survival outcomes following EAS during the pandemic. A secondary objective was to evaluate differences in EAS patient flow including admission source, ITU utilisation, discharge destination, and readmission rates. Methods Using a national administrative dataset, demographic, comorbidity, and patient flow data on 5611 patients admitted for EAS between 2018 and 2020 were extracted. Pre-pandemic and pandemic timeframes were compared using graphic and regression analyses, and bivariate logistic regression, adjusting for demographics and case-mix. Results There was a 19.9% decrease in EAS during the 2020 COVID-19 pandemic with no difference in comorbidity, nor in the commonest procedures. Most patients (92.4%) were admitted from home. In-hospital post-operative mortality was unchanged (7.6%). Patients over 80 comprised 16.3% of EAS pre-COVID, but 17.9% during COVID. Average total LOS reduced significantly by 4.9 days and 3.5 days during COVID-19 waves 1 (29 Feb 2020–30 June 2020) and 2 (1 July 2020–30 Nov 2020), respectively. During wave 1, pre-operative LOS reduced (1 day) and ICU LOS was significantly shorter (0.8 days), but similar change was not observed during wave 2. Conclusions Significant improvements in patient flow following admission for EAS during the pandemic were observed. These changes were not associated with greater mortality nor increased readmission rates and offer important insights into optimal delivery of EAS services.

Published
2021

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