Summary This study examined the long‐term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90‐minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long‐term follow‐up. Primary outcome was weight‐loss at follow‐up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7–6.9). From posttest to follow‐up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2–1.4). Weight regain from posttest to follow‐up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male‐only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop‐outs prevent generalization of the results. 

Long‐term effects of a lifestyle modification program for men with obesity delivered in German football clubs

The hockey fans in training intervention for men with overweight or obesity: a pragmatic cluster randomised trial

Evaluating the Factor Structure of the Preliminary Version of EuroQol Health and Well-Being Instrument in China: A Replication of the Confirmatory Factor Analysis

In this article, we summarise recent developments, identify gaps, and propose a research agenda for quantitative health impact assessment (HIA) of environmental exposures linked to urban transport and land use. This is based on a workshop of 30 experts, complemented by targeted literature identified by participants to illustrate the state of research and practice gaps. The practice of quantitative HIA in urban transport and land use interventions covers a diverse range of methods, models, and frameworks. The selection of an appropriate model depends upon the use case, i.e., the research question, resources and expertise, and application. The plurality of models can be a strength if differences are explicit and their implications are understood. A major gap in most assessments and frameworks is the lack of equity consideration. This should be integrated into all stages of the HIA, considering exposures, susceptibility, disease burden, capacity to benefit, household budgets, responsibility for harm, and participation in the process. Scenarios of environmental exposures in urban transport and land use interventions are often overly simple, while the scenario design process of spatial planning is often opaque. Researchers should specify the involvement of stakeholders and the data, evidence, or behavioural model used to construct the scenario. Recent developments in exposure assessment (remote sensing and modelling) have increased the capacity to conduct HIAs for small geographies at scale. At the same time, advances in simulation have enabled the representation of behaviours at high spatial and temporal resolution. The combination can enable person-centric measures accounting for location, activities, and behaviours, with HIA proceeding ahead of epidemiology. Most HIAs still use Comparative Risk Assessment. This is suitable for estimating the disease burdens of environmental exposures, but more advanced longitudinal methods are better suited for studying interventions. Beyond health outcomes, well-being must be incorporated. The monetisation of health outcomes through welfare economics remains contentious. Representation of uncertainty is increasingly acknowledged. Value of Information methods can inform where new data collection would most efficiently reduce final result uncertainty. In the context of the climate crisis and related environmental limits, methods are needed that consider adaptation alongside mitigation and prevention and test robustness to an increasingly unstable future.

pdf/quantitative-health-impact-assessment-of-environmental-bneh131364jr.pdf

Quantitative Health Impact Assessment of Environmental Exposures Linked to Urban Transport and Land Use in Europe: State of Research and Research Agenda

Objectives We sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training–New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand. Design A modelled cost-effectiveness analysis using efficacy data from RUFIT-NZ was conducted from the Aotearoa New Zealand healthcare perspective. Setting A Markov cohort model was constructed with a lifetime time horizon. The model simulated events of myocardial infarction (MI), stroke and type 2 diabetes mellitus (T2DM) occurring among a hypothetical cohort of 10 000 individuals receiving either the RUFIT-NZ intervention or no intervention. Efficacy data were based on the RUFIT-NZ trial, and the latest Global Burden of Disease study was used to extrapolate the impact of body weight reduction on clinical outcomes of T2DM, MI or stroke. Cost and utility data were drawn from the RUFIT-NZ trial and published sources. Primary outcome measures The incremental cost-effectiveness ratio (ICER). Results Over a lifetime time horizon, participants in the RUFIT-NZ intervention gained 0.02 (discounted) quality-adjusted life years (QALYs) at an additional cost of NZ$863, relative to no intervention. The estimated ICER was NZ$49 515 per QALY gained (discounted), which is above the arbitrary willingness-to-pay threshold of NZ$45 000 per QALY. Sensitivity analyses supported the robustness of these findings. Conclusions RUFIT-NZ was associated with a reduction in cardiovascular and endocrine events for overweight and obese males. However, based on conservative assumptions, RUFIT-NZ was unlikely to be cost-effective from a healthcare system perspective. Trial registration number ACTRN12619000069156. 

Long-term cost-effectiveness analysis of rugby fans in training–New Zealand: a body weight reduction programme for males

A healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed.To determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks.We conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30-65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks.Our final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained.RUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ.Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245-0645. 

/pdf/rugby-fans-in-training-new-zealand-rufit-nz-a-randomized-8jvgffek.pdf

Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs

The EQ Health and Wellbeing (EQ-HWB) is a novel measure that conceptually overlaps with the 5-level EQ-5D (EQ-5D-5L) while capturing broader dimensions of health and well-being. This study aimed to explore the extent to which the EQ-HWB and EQ-5D-5L capture overlapping or complementary constructs and to explore the discriminative ability of the EQ-HWB Short version (EQ-HWB-S) as a multiattribute utility instrument in the Australian setting.A secondary analysis of data from a nationally representative cross-sectional survey of 2002 Australian adults was performed. The survey included socioeconomic questions and health characteristics and the EQ-HWB and EQ-5D-5L instruments. Convergent and known-group validity were evaluated through Spearman rank correlation and multivariable regression analyses, respectively. An exploratory factor analysis was also performed to explore the underlying constructs of the 2 measures.Correlation coefficients varied from moderate to strong (rs ≥ 0.40) between the EQ-5D-5L and the corresponding EQ-HWB dimensions (all P < .001). Based on the exploratory factor analysis, both instruments measure similar underlying constructs, with the EQ-HWB capturing broader aspects of well-being. The known-group analysis demonstrated the relative discriminative ability of the EQ-HWB-S in capturing broader aspects of health and well-being.The EQ-HWB was at least moderately correlated with the EQ-5D-5L in overlapping domains/dimensions and demonstrated greater sensitivity in participants with mental health problems versus the EQ-5D-5L. Our findings support future research exploring the value of the EQ-HWB-S as a multiattribute utility instrument for the general Australian population. 

Exploring the comparability between EQ-5D and the EQ-HWB in the general Australian population.

ABSTRACT Introduction No recent full-text-based systematic review has been published to examine economic evidence around acute myeloid leukemia (AML) or chronic lymphocytic leukemia (CLL) treatment. We aimed to perform a systematic review in this area. Areas covered This review entailed searches in three main databases for economic evaluations of treatment in AML or CLL. After title and abstract screening, two reviewers examined all the citations in full text. Any disagreement between the two reviewers was resolved through discussion with the third reviewer. We used predesigned tools for data extraction, including study characteristics, primary results and conclusions. The quality of included studies was assessed. Expert opinion The majority of the studies adopted the modeling approach to estimate the long-term cost-effectiveness of the treatment from the healthcare system payer’s perspective. Most studies concluded that the evaluated treatment interventions for untreated or refractory AML or CLL were cost-effective across various jurisdictions. The EQ-5D, followed by time trade-off and standard-gamble, was the most commonly used outcome measure to derive the utility weights associated with each health state. Clear justifications for the choice of modeling technique are recommended for future studies. Collecting the health-related quality of life outcome using a common instrument over the clinical trial could aid the comparability among economic studies.

A systematic review of economic evaluations for the pharmaceutical treatment of chronic lymphocytic leukemia and acute myeloid leukemia

An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a novel method for exploring the interaction between sociodemographic characteristics that affect health outcomes. This study explores the interaction between geographic remoteness and socioeconomic status on health outcomes in Australia from an intersectional perspective.Data from a cross-sectional survey were matched with data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. To explore the effect of health-related quality of life on life expectancy, quality-adjusted life expectancy (QALE) was estimated through applying utility values derived from the EQ-5D-5L to life table data from the Australian Bureau of Statistics. The effect of geographic remoteness on QALE was quantified using multivariable linear regression. An intersectional MAIHDA was performed to explore differences in mean QALE across strata formed by intersections of age, sex, and Socioeconomic Indexes for Areas score.Based on multivariable linear modeling, QALE declined significantly with increasing remoteness (inner regional, -1.0 years [undiscounted]; remote/very remote, -3.3 years [undiscounted]) (P < .001). In contrast, life expectancy was only significantly different between participants in remote/very remote areas and major cities (β-coefficient, -2.4; 95% CI -4.4 to -0.4; P = .016). No intersectional interaction effects between strata on QALE were found in the MAIHDA.QALE has considerable value as a metric for exploring disparities in health outcomes. Given that no intersectional interactions were identified, our findings support broad interventions that target the underlying social determinants of health appropriately reduce disparities versus interventions targeting intersectional interactions. 

An Intersectional Approach to Quantifying the Impact of Geographic Remoteness and Health Disparities on Quality-Adjusted Life Expectancy: Application to Australia.

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Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs

Exploring the comparability between EQ-5D and the EQ-HWB in the general Australian population.

A systematic review of economic evaluations for the pharmaceutical treatment of chronic lymphocytic leukemia and acute myeloid leukemia

An Intersectional Approach to Quantifying the Impact of Geographic Remoteness and Health Disparities on Quality-Adjusted Life Expectancy: Application to Australia.