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Finkelstein EA, Chodavadia PA, Strombotne K. A systematic review of the economic value proposition for commercially available nonsurgical weight-loss interventions. Obesity (Silver Spring) 2023. [PMID: 37231621 DOI: 10.1002/oby.23760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The study aim was to review the economic evaluation literature of commercially available and effective nonsurgical weight-loss interventions to investigate whether there is evidence to support claims of cost-effectiveness (i.e., good value for money) or cost savings (i.e., a positive return on investment). METHODS Relevant databases were systematically reviewed to identify economic evaluations of commercially available weight-loss products and services shown to result in clinically significant weight loss. Five weight-loss medications (orlistat, liraglutide, naltrexone-bupropion, semaglutide, and phentermine-topiramate), two meal replacement programs (Jenny Craig, Optifast), and one behavioral intervention (Weight Watchers [WW]) that met inclusion criteria were identified. After screening, 32 relevant comparisons of cost-effectiveness or cost savings across 20 studies were identified. RESULTS Ten of twenty pharmaceutical comparisons showed evidence of cost-effectiveness based on established thresholds. Four of twelve nonpharmaceutical comparisons provided evidence of cost-effectiveness, and five made claims of cost savings. However, methodological concerns cast doubt on the robustness of these claims. CONCLUSIONS Evidence of cost-effectiveness for commercially available, evidence-based, nonsurgical weight-loss interventions is mixed. There is no evidence for cost-saving weight-loss medications and only weak evidence for behavioral and weight-loss interventions. Results provide a call to action to generate more robust evidence of the economic value proposition for these interventions.
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Affiliation(s)
- Eric A Finkelstein
- Duke-NUS Medical School, Singapore
- Duke University Global Health Institute, Durham, North Carolina, USA
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Tenso K, Avila CJD, Garrido M, Lauver M, Reger MA, Legler A, Strombotne K. The use of crisis line services during the COVID-19 pandemic: Evidence from the veterans health administration. Gen Hosp Psychiatry 2023; 82:101-102. [PMID: 36858847 PMCID: PMC9916126 DOI: 10.1016/j.genhosppsych.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Kertu Tenso
- Partnered Evidence-based Policy Resource Center, Veterans Health Administration, Boston, MA, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Cecille Joan Dizon Avila
- Partnered Evidence-based Policy Resource Center, Veterans Health Administration, Boston, MA, USA,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Melissa Garrido
- Partnered Evidence-based Policy Resource Center, Veterans Health Administration, Boston, MA, USA,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - MaryGrace Lauver
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - Mark A. Reger
- Mental Health Service Line, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Aaron Legler
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Kiersten Strombotne
- Partnered Evidence-based Policy Resource Center, Veterans Health Administration, Boston, MA, USA,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
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Feyman Y, Avila CJ, Auty S, Mulugeta M, Strombotne K, Legler A, Griffith K. Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic. Health Serv Res 2022; 58:642-653. [PMID: 36478574 PMCID: PMC9878051 DOI: 10.1111/1475-6773.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.
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Affiliation(s)
- Yevgeniy Feyman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Cecille Joan Avila
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Samantha Auty
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha Mulugeta
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kiersten Strombotne
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Aaron Legler
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kevin Griffith
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Garrido MM, Jones DK, Woodruff A, Strombotne K, Palani S, Zahakos S, Adelberg M, Pizer SD, Frakt AB. Detecting fraud, waste, and abuse in substance use disorder treatment. Health Serv Res 2022; 57:997-1000. [PMID: 35932224 PMCID: PMC9441269 DOI: 10.1111/1475-6773.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Melissa M. Garrido
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
| | - David K. Jones
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Alexander Woodruff
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
- Present address:
Boston Medical Center, One Boston Medical Center PlBostonMassachusettsUSA
| | - Kiersten Strombotne
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
| | - Sivagaminathan Palani
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
| | - Sarah Zahakos
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Michael Adelberg
- Faegre Drinker Biddle & Reath LLPWashingtonDistrict of ColumbiaUSA
| | - Steven D. Pizer
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
| | - Austin B. Frakt
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
- Partnered Evidence‐Based Policy Resource CenterBoston VA Healthcare SystemBostonMassachusettsUSA
- Department of Health Policy & ManagementHarvard T.H. Chan School of Public HealthCambridgeMassachusettsUSA
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Strombotne K, Sindelar J, Buckell J. Who, me? Optimism bias about US teenagers' ability to quit vaping. Addiction 2021; 116:3180-3187. [PMID: 33891783 PMCID: PMC8492482 DOI: 10.1111/add.15525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 04/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The vaping rate among US teenagers has doubled in the last 2 years, which may be explained in part by teenagers' optimism that they would have relatively little trouble in quitting. The aim of this study was to estimate the extent to which teenagers exhibited optimism bias, what characteristics are associated with optimism bias and which factors are related to respondents' perceptions of how hard it would be for them to quit. DESIGN A national, on-line, cross-sectional survey in 2018 using quota sampling. SETTING United States. PARTICIPANTS Respondents were 1610 teenagers aged 14-18 years who had ever tried or heard of JUULs or e-cigarettes generally. MEASUREMENTS Optimism bias was defined as respondents' perceptions of their own difficulty quitting vaping compared with that of an average US person of their own age. Linear regression was used to examine associations between respondents' characteristics with both optimism bias and their own perceived difficulty quitting vaping. FINDINGS More than 60% of teenagers were optimistically biased about their ability to quit vaping. Smoking (b = -0.69, P < 0.01) and JUULing (b = -0.62, P < 0.01) were negatively associated with optimism bias but reduced-price school lunch eligibility (0.27, P = 0.02) and school satisfaction were positively associated (b = 0.05, P = 0.02). Smoking (b = 0.85, P < 0.01) was associated with an increased perception of the difficulty of quitting. That association was negative for black respondents (b = -0.81, P = 0.01) and those eligible for reduced-priced lunches (b = -0.48, P = 0.01), and positive for Hispanic respondents (b = 0.47, P = 0.04). CONCLUSIONS On average, US teenagers appear to show optimism bias about their ability to quit vaping, which decreases with smoking and vaping and increases with eligibility for reduced-price school lunches.
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Affiliation(s)
- Kiersten Strombotne
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA
| | - Jody Sindelar
- Jody Sindelar, Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA
| | - John Buckell
- John Buckell, Health Economics Research Center, Nuffield Department of Population Health and Health Behaviours, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Strombotne K, Buckell J, Sindelar JL. Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey. Tob Control 2021; 30:199-205. [PMID: 32300029 PMCID: PMC7572758 DOI: 10.1136/tobaccocontrol-2019-055394] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Use of JUULs and e-cigarettes is growing rapidly, particularly among adolescents. Research suggests that flavours may increase the appeal of these products, but little is known about how flavours influence perception. We examined whether youth perceptions about the health risks of JUULs and e-cigarettes vary with flavours. METHODS We conducted a national survey in 2018 of 1610 high-school students aged 14-18 who had ever heard of either JUULs or e-cigarettes. Respondents were asked to rate the lung cancer risk, the harm of second-hand vapour, potential for addiction and healthiness of differently flavoured JUUL and e-cigarette products. We investigated the relationship among flavour, risk perception and socio-demographic information. RESULTS We found that risk perceptions for both JUULs and e-cigarettes differ significantly by flavour type. Youths perceive fruit flavours to be less likely to lead to lung cancer (-0.909 (0.065)), have harmful second-hand vapour (-0.933 (0.060)) and be more addictive (1.104 (0.094)) relative to tobacco flavours. Candy, menthol/mint and alcohol flavours show similar patterns of risk association, although the magnitude is slightly smaller than for fruit flavours. CONCLUSIONS Youths believe that flavours are related to the health risks of both JUULs and e-cigarettes despite the fact that these differences in risk by flavour have not been scientifically or systematically established. A policy concern is that misperceptions based on flavour may result in increased vaping by youths. The findings from this study support the assertion that banning fruit, menthol or mint and sweet flavours could reduce the appeal of JUULs and e-cigarettes to youth, with concomitant health protections.
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Affiliation(s)
- Kiersten Strombotne
- Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - John Buckell
- Health Economics Research Centre, University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, UK
| | - Jody L Sindelar
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
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Strombotne K, Connolly H. LONGITUDINAL RELATIONSHIPS OF ADOLESCENT OBESITY AND CHRONIC CONDITIONS IN LATER-LIFE: EVIDENCE FROM PTTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Strombotne
- American Institutes for Research, Washington, District of Columbia, United States
| | - H Connolly
- American Institutes for Research, Washington, DC, USA
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Strombotne K, Horner E, Walters E, Lapham SJ. NON-CREDIBLE ADOLESCENT SURVEY RESPONSES AND LATER-IN-LIFE ALZHEIMER’S DISEASE AND RELATED DISORDERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Strombotne
- American Institutes for Research, Washington, District of Columbia, United States
| | - E Horner
- American Institutes for Research, Washington, DC, USA
| | - E Walters
- Research Consultant, Los Angeles, CA, USA
| | - S J Lapham
- American Institutes for Research, Washington, DC, USA
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Horner E, Strombotne K, Huang A, J Lapham S. INVESTIGATING THE EARLY LIFE DETERMINANTS OF ADRD USING THE PT-MEDICARE STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Horner
- American Institutes for Research, Washington, District of Columbia, United States
| | - K Strombotne
- American Institutes for Research, Washington, DC, USA
| | - A Huang
- American Institutes for Research, Washington, DC, USA
| | - S J Lapham
- American Institutes for Research, Washington, DC, USA
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Finkelstein EA, Li W, Melo G, Strombotne K, Zhen C. Identifying the effect of shelf nutrition labels on consumer purchases: results of a natural experiment and consumer survey. Am J Clin Nutr 2018; 107:647-651. [PMID: 29635504 DOI: 10.1093/ajcn/nqy014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/15/2018] [Indexed: 11/14/2022] Open
Abstract
Background NuVal, developed by NuVal, LLC, is a shelf nutrition label that rates the nutritional quality of foods on a scale of 1 (worst) to 100 (best). Objective The objective of this study was to explore the impact of the NuVal labels on food-purchasing patterns. Design In 2014, NuVal updated its nutrient profiling system, which changed the NuVal score on many foods. We took advantage of this "natural experiment" to assess the extent to which a change in the NuVal score influenced purchases of yogurts, a category with a wide range of more and less healthy alternatives. We supplemented these data with a survey of consumers in stores using NuVal labels to obtain their experience with the labels and the extent to which they state that the labels influence their purchases. Results Results suggested that a 1-point increase in the NuVal score is associated with a 0.49% increase in sales. Because only 8% of survey respondents reported using NuVal to influence dairy purchases, the impact of a change in the score among users may be >10 times the average effect. Conclusion Results suggest that front-of-package nutrition labels are likely to influence purchasing patterns. This trial was registered at www.clinicaltrials.gov as NCT03390075.
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Affiliation(s)
| | - Wenying Li
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA
| | - Grace Melo
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA
| | | | - Chen Zhen
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA
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Horner EM, Strombotne K, Huang A, Lapham S. Investigating the Early Life Determinants of Type-II Diabetes Using a Project Talent-Medicare Linked Data-set. SSM Popul Health 2018; 4:189-196. [PMID: 29854904 PMCID: PMC5976829 DOI: 10.1016/j.ssmph.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/25/2017] [Accepted: 01/23/2018] [Indexed: 12/23/2022] Open
Abstract
The increasing prevalence of Type II Diabetes (T2D) presents a serious health and financial public crisis. Our study examines the hypothesis that adolescents' perceptions of economic insecurity, along with absolute and relative socioeconomic status (SES), can contribute to T2D prevalence later in life. Project Talent (PT) Survey data, collected on high school students in 1960, have been linked to Medicare records from 2012, presenting a unique opportunity to examine measures gathered in adolescence and T2D prevalence later-in-life among a large, national, and diverse sample (n=88,849). Our results provide compelling evidence that real, perceived, and relative SES in adolescence have persistent impacts on later-in-life diabetes risk, even when controlling for possible confounders such as cognitive ability, conscientiousness, and early-adulthood educational attainment.
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