Brussels, 27 September 2016

www.equipt.eu

FINAL CONFERENCE (EQUIPT): COUNTING THE NET BENEFIT OF INVESTING IN EVIDENCE-BASED TOBACCO CONTROL IN EUROPE

BRUSSELS, 27 SEPTEMBER 2016 2- EQUIPT Dear Delegates, Welcome to the EQUIPT Final Project Conference, Counting the Net Benefit of Final Project Investing in Evidence-based Tobacco Control in Europe. Conference Thanks to several innovations in recent decades - such as rigorous taxation, smokefree legislation and the implementation of cost-effective stop-smoking interventions- smoking prevalence has declined over time. However, the rate at which smoking prevalence is falling is stagnating and prevalence remains high in certain sub-groups WELCOME in the population. We know from the available evidence that coordinated, high impact and comprehensive approaches are the most effective ways to reduce smoking initiation, prevalence and intensity. However, policy makers and public health procurers still lack the data and financial justification to make the case for investment in tackling the scourge of tobacco. They need options that resonate to real practice and are cost-effective too.

To fill this important gap in evidence, the EQUIPT project has brought together eleven institutions from seven European member states with multi-disciplinary expertise to provide policy makers and wider stakeholders with bespoke information about the economic and wider returns that investing in evidence-based tobacco control including smoking cessation agendas can generate.

On behalf of the full EQUIPT project team, it is my pleasure to present you with the results of three years of intense and passionate work on return on investment of tobacco control policies, which is now to be consulted on the EQUIPT project website www.equipt.eu along with explanatory material on its use.

Thank you to all partners and stakeholders for making EQUIPT a reality.

On behalf of the EQUIPT Consortium, welcome to Brussels!

Dr Subhash Pokhrel, EQUIPT Project Coordinator and WP4 co-chair Director, Division of Health Sciences, Brunel University London, UK

-3 EQUIPT How to join the conference The EQUIPT project team is pleased to welcome you to the final project Final Project conference in Brussels on September 27, 2016, from 9.00 -16.30.

Conference From Brussels National Airport (Zaventem) you can reach the conference venue by taxi, train (to Brussels Central Station or Brussels South Station) or by bus line 12 or 21 to Place Luxembourg. agenda From Brussels Central Station (Gare Centrale/Brussel Cen- and traal) you can reach the conference venue by taxi or bus (71 to Porte de practical Namur). details From Brussels South Station (Brussels Midi/Brussel Zuid) you can reach the conference venue by metro line 2 or 6 to the stop Louise.

For any urgent questions please do not hesitate to contact us: Dominick Nguyen: [email protected] or +32 470 96 56 69 Andrea Glahn: [email protected] or +32 487 84 66 04

Accommodation and Conference Venue,

Hotel: AQUA Hotel Rue de Stassart 43- 1050 Ixelles Tel +32 2 213 01 01 - [email protected] www.aqua-hotel-brussels.com

If you have required so, reservation has been booked for you at the AQUA Hotel by the ENSP team.

**Meet us in the lobby of AQUA Hotel on 27 September at 8:40 to walk together to the venue.

Venue: NH Collection Hotel, Grand Sablon Rue Bodenbroek 2/4 - 1000 Brussels Tel +32 2 518 1100 http://www.nh-hotels.com/hotel/nhcollection-brussels-grand-sablon/

The conference venue is located 10 minutes walk from the AQUA Hotel.

4- EQUIPT Time Programme Lead Presenter

9.00 Registration/Coffee ENSP Final Project 9:30

Conference 9.30 Opening of the Conference MEP Karin Kadenbach 9.45

9.45 Introduction to the EQUIPT Project Dr Subhash Pokhrel programme 10.15

10.15 Stakeholder engagement in Professor Silvia Evers 11.15 EQUIPT (2 papers) 27 September 2016 NH Sablon Stakeholders’ views to inform the de- Prof. Silvia Evers velopment of EQUIPTMOD: methods Collection, and key findings Rue Bodenbroek 2-4, Stakeholder engagement for re- Prof. Annette Boaz 1000 Brussels search impact: the SEEIMPACT study

11.15 Coffee break 11.30

11.30 EQUIPT tool to support deci- 13.15 sions (4 papers)

EQUIPTMOD: methods and possibi- Prof. Doug Coyle lities for the economic model within the EQUIPT ROI tool

Effectiveness and reach estimates for Prof. Robert West modelling return on investment from tobacco cessation interventions

Treatment and intervention costs for Dr Marta Trapero-Bertran modelling return on investment from tobacco cessation interventions

Country application of the EQUIPT Maximillian Präger, model: The case of Germany Prof. Reiner Leidl

13.15 Lunch 14.15

14.15 Transferability of EQUIPT to 16.00 CEE and beyond (3 papers)

What opportunities can EQUIPT offer Prof. Zoltán Kaló to CEE and wider European countries?

Adapting EQUIPT tool to other coun- Dr Bertalan Nemeth tries: parameter needs and analysis

EQUIPT experience for better tobac- Andrea Crossfield co control

16.00 Conclusions Cornel Radu-Loghin, 16.30 ENSP

-5 EQUIPT MEP Karin Kadenbach Karin Kadenbach (born 19 April 1958 in Vienna) is an Aus- Final Project trian social democratic politician. She is a member of the Eu- ropean Parliament since 2009. Within the Parliament, she is a Conference member of the Committee on Environment, Public Health and Food Safety, the Committee on Agriculture and Rural Develop- ment as well as the Committee on Budgetary Control. Additio- nally, Karin Kadenbach became Vice-President of the Animal Welfare Intergroup in July 2015. Furthermore Karin Kadenbach is Vice-President Presenters of the Delegation for relations with Japan and substitute member in the Delegation for relations with the Korean Peninsula. Prior to joining the European Parliament in 2009, Ms. Kadenbach served for sixteen years as a municipal councilor in her municipality Großmugl and was a member of the Lower Austrian Regional Assembly for seven years. From 2007 to 2008, she was a regional minister holding the port- folio «health and nature protection» in the Lower Austrian Regional Assembly. After graduating in Advertising and Marketing (university course) at Vienna University of Economics and Business, she worked at J. W. Thompson advertising agency. Karin Kadenbach lives in Großmugl and Brussels and is a mother of five children.

DR Subhash Pokhrel EQUIPT Project Coordinator and WP4 co-chair

Dr Subash Pokhrel is Divisional Director for Health Sciences at Brunel University London. He led the development of the NICE Return on Investment (ROI) tool in the UK. He is featured in the 2013 (Feb) issue of International Innovation on his lea- dership to successfully pool together international expertise to conduct ROI research in tobacco control. He has a PhD in health economics (summa cum laude) from Heidelberg Univer- sity, Germany and has published extensively in international peer-reviewed journals, covering a wide range of health systems and healthcare services. His publication profile covers several public health areas including tobacco use, physical activity, breastfeeding, government welfare programmes and alcohol misuse.

PROF. Silvia Evers EQUIPT WP1 chair and country-lead

Silvia Evers is Professor of Public Health Technology Assessment at Maastricht University, the Netherlands in the Department of Health Services Research of the Faculty of Health, Medicine and Life Science. Next to that, she is working at the Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation. At the Maastricht University, she is programme leader of the programme ‘Creating value-based health care’ and profile coordinator of the HTA-trace of the Health Sciences Research Master at Caphri, Research School of Public Health and Primary Care. Currently, she has been the cosupervisor of more than 20 Ph.D. students and more than 100 Bachelor and Master Students. She has co-authored up to 200 (peer-reviewed) publications (Google’s H-index 33). Her chief current research efforts are directed towards the methodology of economic evaluation of (preventive) interventions, meta-analysis, transferability and quality of life analysis. She has a special interest in the application of these methods, looking at innovative interventions in the field of public health. She is editor of the International Journal of Integrated Care (see www.ijic.org), the Journal of Mental Health Policy and Economics, and associate editor of BMC Health Services Research.

6- EQUIPT PROF. Annette Boaz Professor Annette Boaz is a social scientist who worked at the Final Project universities of Oxford, Warwick, Queen Mary, University of London and Kings College London before coming to the joint Conference Faculty of Health, Social Care and Education at Kingston Uni- versity and St George’s University of London in 2013. She has spent more than 20 years exploring the relationship between research policy and practice in the UK and internationally. She has conducted research for a range of funders including the UK Cabinet Office, the Presenters NIHR and the European Union. She also spent a year at the Department of Health working in the Policy Research Programme. She worked for a number of years in the UK Economic and Social Research Council (ESRC) funded Centre for Evidence Based Policy. She continues to conduct research in this field and is one of the ma- naging editors of the international journal Evidence & Policy. The journal has been building an international reputation, and although only 10 years old it has already achieved an ISI impact factor. She has an interest in implementation and improve- ment and has completed an evaluation of experienced based co-design of services in two health care pathways. She supports a number of national initiatives aimed at increasing capacity for research use including the National Institute for Health Research Knowledge Mobilization Fellowship scheme, the ESRC Impact Prize and the UK Implementation Network. Current projects include: The Health Foundation funded Patient and Family Centred Care (PFCC) in end of life care project.

PROF. Doug Coyle EQUIPT Lead modeller

Professor Doug Coyle is a visiting professor of health economics at Brunel University London and Professor and Interim Director for the School of Epidemiology, Public Health and Pre- ventive Medicine at University of Ottawa. He has been involved in numerous economic studies and has advised provincial and national governments with respect to cost effectiveness and reimbursement. Previously, he led the modelling of the NICE ROI tool developed by Brunel University. He is an expert in health economics evaluation methodologies, particularly in relation to the hand- ling of uncertainty and variability within models. He has authored more than 180 peerreviewed articles.

-7 PROF. Robert West EQUIPT EQUIPT Project Coordinator and WP4 co-chair

Final Project Robert West is Professor of Health Behaviour at University College London (UCL). He is one of the world’s leading smoking Conference cessation researchers, having been working in the field for 30 years and having published more than 300 scientific works on the subject. His research covers clinical and population-level interventions to promote smoking cessation as well as systematic reviews. Together with Martin Raw and Ann McNeill he wrote the blueprint for the Presenters UK stop smoking services and has worked with them on a major review of effective and affordable treatments to promote cessation that can be adopted globally. He advises the English Department of Health on smoking cessation and his research plays a key role in evaluating the effectiveness of its social marketing campaigns and policies. He has access to unique data sets from which to estimate real world effectiveness, including the Smoking Toolkit Study and individual level data from several hundred thousand smokers attending the English Stop Smoking Services. His analysis based on these datasets has led to key parameter values that have been included in the current version of the NICE ROI tool. He is also working with other member states, (e.g. the Czech Republic) to analyse comparative effectiveness data. He has been involved in evaluations of social marketing approaches to promoting stop-smoking treatment, both from the government and from pharmaceutical indus- tries. He is involved in annual surveys of health professionals delivering smoking cessation support.

DR Marta Trapero-Bertran EQUIPT WP2 co-lead and country-lead

Marta Trapero-Bertran is a senior researcher at University Pompeu Fabra and Universitat Internacional de Catalunya (UIC), specialized in economic evaluation. She holds a PhD in health economics from Brunel University, studying ways in which external effects are included in economic evaluation of public health interventions (such as those to prevent pregnant women from smoking). She led the modelling of the Tobacco Control Economic Toolkit, a decision-support tool first available to Local Authority level decision makers wanting to invest in tobacco control in the UK. She has worked in several health policy projects in Spain, the UK and Mozambique. She has several papers published in National and International academic journals with high Impact Factor and also books. She was president of the Association of Health Economics (AES) and founding member of the European Health Economics Association (Eu- HEA).

8- EQUIPT Maximillian Präger Maximillian Präger is a research associate at Helmholtz Final Project Zentrum Munich. He is working in the Health Care Manage- ment research group led by Professor Leidl. He did his Bache- Conference lor’s degree in Economics and his Master’s degree in Public Health at Ludwig-Maximilians-University, Munich. His main working areas involve decision analytic modelling, survival analysis and statistical programming. He is responsible for parameter collection, stakeholder interviews and model validation for the German Presenters version of the EQUIPT model.

PROF. Reiner Leidl EQUIPT WP2 co-chair and country-lead

Reiner Leidl is Professor at the Munich School of Manage- ment. He holds a PhD in Economics and a chair in Health Economics and Health Care Management at Ludwig-Maximi- lians-University, Munich. He also is Director of the Institute of Health Economics and Health Care Management at Helmholtz Zentrum München and co-ordinator of the LMU Munich Center of Health Sciences. In 2014/2015, he chaired the German Association of Health Economics. He has published in high-ranking health economics journals, including Pharmacoeconomics, Health Economics, European Journal of Health Economics, Medical Decision Making, and Value in Health.

PROF. Zoltán Kaló EQUIPT WP3 chair and country-lead

Zoltàn Kalo is the founder and leader of Syreon Research Ins- titute. He is a full Professor of Health Economics and Head of the Institute of Economics at Eötvös Loránd University (ELTE) in Budapest. He is the co-director of a master program in Health Policy, Planning and Financing. He has 20 years of international experience in academia and industry, specializing in health systems design, HTA implementation, health economics and outcomes research, economic modelling, patient access and pricing policies of healthcare technologies. He serves as a policy advisor to public decision-makers and global health care corporations. He was a Director of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) between 2012-2014, and the Chair of ISPOR Central and Eastern European Network Executive Committee between 2013-2015.

-9 EQUIPT DR Bertalan Nemeth Dr Betalan Nemeth is graduated from the Corvinus University Final Project of Budapest (MSc in Quantitative economics and Operation research) and the Eötvös Loránd University (Pharmaceutical Conference economics and drug policies). Between 2010 and 2015 he has been a health economist at the Hungarian HTA office. Since August 2015 Bertalan has been a Senior Health Eco- nomist at Syreon Research Institute where he is involved in various projects in the fields of modelling for economic evaluation in health, health Presenters technology assessment, health statistics and reviewing. Bertalan is the President-Elect of the Hungarian Health Economics Association (ISPOR Hungary Chapter), has been a participant in the international EUnetHTA project, the ISPOR HTA Roundtable – EUROPE and he is currently a member of the Scientific Committee of the annual IME_META Conference. Bertalan was also a co-chair of the Workshop Review Com- mittee of the ISPOR 18th Annual European Congress.

Andrea Crossfield EQUIPT WP4 co-lead

Andrea Crossfield is Chief Executive of Healthier Futures (for- merly Tobacco Free Futures) in the UK. Previous roles have included Department of Health Regional Tobacco Policy Ma- nager for the North West and Programme Director for Smoke- Free Liverpool. While at SmokeFree Liverpool, Andrea was involved in leading Liverpool’s local smokefree legislation in 2004 and implementing comprehensive approaches to tobacco control at community level. Her background is in local government. Tobacco Free Futures, Fresh and Smokefree South West commissioned the Tobacco Control Eco- nomic Toolkit, a decision-support tool first available to Local Authority level decision makers wanting to invest in tobacco control in the UK and Andrea later supported its adaptation into the NICE Tobacco ROI tool. She is actively involved in a range of national partnerships – including the Smokefree Action Coalition and Alcohol Health Alliance – and has a keen interest in public health advocacy and its role in securing evidenced based comprehensive approaches to tackling public health agendas such as that advocated by the WHO FCTC.

Cornel Radu-Loghin EQUIPT WP5

Cornel Radu-Loghin is the Secretary General of ENSP since May 2015. Previously, he served as the ENSP Director of Po- licy and Strategy where he was responsible for coordinating and advocating the ENSP policies at the EU level, working in concert with European organizations involved in tobacco control and health promotion. Mr Radu-Loghin has more than two decades of experience in tobacco control at national and international levels. He also served for three years as a board member for the Framework Convention Alliance (FCA) where he helped develop the organization’s 2013 strategic plan.

10- EQUIPT Acknowledgement………………………………………… 12 Final Project Published articles…………………………………………… 13 EQUIPT: protocol of a comparative effectiveness research study evaluating cross- Conference context transferability of economic evidence on tobacco control……………………13

Understanding the stakeholders’ intention to use economic decision-support tools: A EQUIPT crosssectional study with the Tobacco Return on Investment tool………………… 13/14 Herramienta de retorno de la inversión en control del tabaquismo: ¿Qué opinan Publications aquellos que toman decisiones? (A return on investment tool in tobacco control: What do stakeholders think?)…………………………………………………………………14

Similarities and differences between stakeholders’ opinions on using Health Technology Assessment (HTA) information across five European countries: results from the EQUIPT survey…………………………………………………………………………………… 15

Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia (Cost-utility of brief advice for quitting smoking in Murcia Region)…………… 15/16

Work in progress…………………………………………… 16

Section A: Modelling Return on Investment……………………………………………16

Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review………………………………………………………16

EQUIPTMOD: Development and Application of an Economic Model to assess the Im- pact of Smoking Cessation……………………………………………………………17

Are changes in the current provision of smoking cessation services cost-effective? An analysis based on the EQUIPT ROI model……………………………………… 17/18

Cost-effectiveness of smoking cessation in Germany: results from the EQUIPT model… 18

The effect of implementing smoking cessation interventions in Hungary……………19

Optimising usability of an economic decision support tool: the case for the Tobacco Return on Investment model……………………………………………………… 19/20

Section B: Understanding parameterisation in the ROI models………………………20

Effectiveness and reach estimates for modelling return on investment from smoking cessation interventions…………………………………………………………………20

Section C: Exploring transferability of ROI models……………………………………21

Parameter importance in the adaptation of a tobacco control return on investment model in relation to cross-context transferability of economic evidence………………21

Utility of parameter uncertainty analysis in transferring economic evidence to countries with scarce resources: empirical evidence based on the EQUIPT model……… 21/22

-11 EQUIPT Section D: Contextualising the ROI model……………………………………………… 22 Understanding perceived availability and importance of tobacco control interventions to Final Project inform European adoption of a UK economic study…………………………………… 22 Conference Contextual visualisation to inform the transferability of economic evidence on tobacco control across European countries……………………………………………………… 23

Exploring the views of stakeholders in five European countries in the context of colla- EQUIPT borative, public health research: a mixed methods approach to UK data……………24

Publications Role of decision-support tools in narrowing the evidence-to-action gap in tobacco control……………………………………………………………………………………25

“International workshop” as a method to facilitate cross-country transferability of economic evidence: an empirical case study………………………………………… 25/26

Acknowledgement: These publications and works in progress were produced as part of the EQUIPT project funded from the European Community’s Seventh Framework Programme under grant agreement No. 602270 (EQUIPT).

12- EQUIPT: Protocol of a comparative effectiveness EQUIPT research study evaluating cross-context transferability of economic evidence on tobacco Final Project control Pokhrel S, Evers S, Leidl R, et al. (2014) BMJ Open 014;4:e006945. doi:10.1136/ Conference bmjopen-2014-006945

ABSTRACT published Introduction: Tobacco smoking claims 700 000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion articles annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base—the English Tobacco Return on Investment (ROI) tool—to other EU member states.

Methods and analysis: EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decisionmakers, following transferability criteria. Stakeholders’ needs and intention to use ROI tools in sample countries (Ger- many, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centra- lised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe.

Understanding the stakeholders’ intention to use economic decision-support tools: A cross-sectional study with the Tobacco Return on Invest- ment tool Cheung, K. L., Evers, S. M., Hiligsmann, M., Vokó, Z., Pokhrel, S., Jones, T., Muñoz, C., Wolfenstetter, S.B., Jozwiak-Hagymasy, J., & de Vries, H. (2016). Health Policy 120, 46-54

ABSTRACT Background: Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understan- ding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e. the Return on Investment tool.

Methods: Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA’s were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool.

Findings: Ninety-three stakeholders participated. Significant differences in beliefs -13 were found between non-intenders and intenders: risk perception, attitude, social sup- EQUIPT port, and self-efficacy towards using the tool. Regression showed that demographics, Final Project pre-motivational and motivational factors explained 69% of the variation in intention. Discussion: This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic Conference decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies. published articles Herramienta de retorno de la inversión en control del tabaquismo: ¿Qué opinan aquellos que toman decisiones? (A return on investment tool in tobacco control: What do stakeholders think?) Muñoz, C., Trapero-Bertran, M., Cheung, K. L., Evers, S., Hiligsmann, M., de Vries, H., & López-Nicolás, Á. (2016). Gaceta Sanitaria, 30(2):121–125

resumen Introducción: El Proyecto Europeo EQUIPT pretende adaptar una herramienta de retorno de la inversiónen tabaco para varios países, con el fin de proporcionar infor- mación sobre el retorno de invertir enestrategias y justificar la toma de decisiones. El objetivo de este estudio es identificar las necesidades delos usuarios en Espa˜na para documentar la transferibilidad de la herramienta.

Métodos: Entrevistas telefónicas con actores relevantes sobre la implementación de la HerramientaEQUIPT, intención de uso y estrategias de control del tabaco.

Resultados: La herramienta puede a˜nadir valor a la información utilizada al to- mar decisiones y abogarpor políticas coste-efectivas. Como inconvenientes, conocer cómo funcionará la herramienta, así como laformación y el tiempo que requerirá la consistencia y los cálculos internos.

Conclusión: Se recogen conocimientos e ideas de los potenciales usuarios para ayudar a adaptar la Herra-mienta EQUIPT, de modo que proporcione ayuda en la toma de decisiones eficientes.

ABSTRACT Introduction: The European EQUIPT study will co-create a return on investment tool in several countries, aiming to provide decision makers with information and justification on the returns that can be generated by investing in tobacco control. This study aimed to identify the needs of potential users in Spain in order to provide information on the transferability of the tool.

Methods: Telephone interviews with stakeholders were conducted including questions about the implementation of the tool, intended use and tobacco control interventions.

Results: Implementing the tool could provide added value to the information used in decisionmaking to advocate for cost-effective policies. The main drawback would be the training and time needed to learn how the tool works and for internal calculations.

Conclusion: Knowledge and ideas from potential users collected in this study could inform the EQUIPT Tool adaptation. Thus, stakeholders could have an instrument that assists them on making healthcare decisions.

14- Similarities and differences between stakehol- EQUIPT ders’ opinions on using Health Technology As- sessment (HTA) information across five European Final Project countries: results from the EQUIPT survey Vokó, Z., Cheung, K. L., Józwiak-Hagymásy, J., Wolfenstetter, S., Jones, T., Muñoz, Conference C., Evers, S.M.A.A., Hiligsmann, M., de Vries, H., Pokhrel, S., and on behalf of the EQUIPT Study Group (2016). Health Research Policy and Systems, 14(1), 1

published ABSTRACT Background: The European-study on Quantifying Utility of Investment in Protection articles from Tobacco (EQUIPT) project aimed to study transferability of economic evidence by co-creating the Tobacco Return On Investment (ROI) tool, previously developed in the United Kingdom, for four sample countries (Germany, Hungary, Spain and the Netherlands). The EQUIPT tool provides policymakers and stakeholders with custo- mized information about the economic and wider returns on the investment in evidence-based tobacco control, including smoking cessation interventions. A Stakehol- der Interview Survey was developed to engage with the stakeholders in early phases of the development and country adaptation of the ROI tool. The survey assessed stakeholders’ information needs, awareness about underlying principles used in economic analyses, opinion about the importance, effectiveness and cost-effectiveness of tobacco control interventions, and willingness to use a Health Technology Assessment (HTA) tool such as the ROI tool.

Methods: A cross sectional study using a mixed method approach was conducted among 5 participating stakeholders in the sample countries and the United Kingdom. The individual questionnaire contained open-ended questions as well as single choice and 7- or 3-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders about underlying principles used in economic analysis are analysed by country and stakeholder categories.

Results: Stakeholders considered it important that the decisions on the investments in tobacco control interventions should be supported by scientific evidence, including prevalence of smoking, cost of smoking, quality of life, mortality due to smoking, and effectiveness, cost-effectiveness and budget impact of smoking cessation interventions. The proposed ROI tool was required to provide this granularity of information. The majority of the stakeholders were aware of the general principles of economic analyses used in decision making contexts but they did not appear to have in-depth knowledge about specific technical details. Generally, stakeholders’ answers showed larger variability by country than by stakeholder category.

Conclusions: Stakeholders across different European countries viewed the use of HTA evidence to be an important factor in their decision-making process. Further, they considered themselves to be capable of interpreting the results from a ROI tool and were highly motivated to use it.

Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia (Costutility of brief advice for quitting smoking in Murcia Region) López-Nicolás A, Trapero-Bertran M, Muñoz C. (forthcoming). Atención Primaria (APRIM-OA-13-953R1)

ABSTRACT Objective: To perform a cost-utility analysis of brief advice to quit smoking in the Region of Murcia.

-15 EQUIPT Design: A cost-utility analysis of brief advice to quit smoking versus non-intervention was performed. A Markov model was used to estimate the costs (Euros, 2014) from Final Project the perspective of the National Health System and the health outcomes measured in quality-adjusted life years (QALY). The time horizon of the analysis was 20 years and costs and health outcomes were discounted at 3%. Conference Univariate and multivariate deterministic sensitivity analyses were performed. Loca- tion: Region of Murcia. Participants: Smokers in the Region of Murcia. Interventions: brief advice to quit smoking. Key measures: Quality Adjusted Life Years (QALYs). contained open-ended questions published as well as single choice and 7- or 3-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders articles about underlying principles used in economic analysis are analysed by country and stakeholder categories.

Results: With a time horizon of 5 years (2018), the incremental cost-effectiveness ratio (ICER) would stand at 172,400 Euros per QALY gained; at 10 years (2023) the ICER was 30,300 Euros per QALY gained; and, for the maximum horizon considered by the model, the ICER was 7,260 Euros per QALY gained.

Conclusions: The brief advice intervention was more efficient in the long term than in the short term and, depending on the Spanish cost-utility threshold, public funding for this intervention would be recommended.

EQUIPT Section A: Model-based economic evaluations in smoking Final Project cessation and their transferability to new contexts: a systematic review Conference Berg, M. et al. on behalf of the EQUIPT Study Group

ABSTRACT work Aims: To identify different types of models used in economic evaluations of smoking cessation, to analyse the quality of the included models examining their attributes and in progress to ascertain their transferability to a new context.

Methods: A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, NHS EED, and HTA was conducted. Transferability scores based on EURONHEED criteria were used. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider an adult population and were not from a high income country were ex- cluded from the analysis.

Findings: Among the 64 economic evaluations included in the review, a state-transition Markov model was the most frequently used method (n=30/64) with Quality Adjusted Life Years (QALYs) being the most frequently used outcome measure in a lifetime horizon. A small number of the included studies (13/64) were eligible based on the EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97 with an average score of 0.75. The average score per section was 0.69 (range 0.35-0.92). Relative transferability of the studies could not be established due to a limitation present in the EURONHEED method.

Conclusion: All existing economic evaluations in smoking cessation lack one or more key study attribute for them to be fully transferable to a new context.

16- EQUIPT EQUIPTMOD: Development and Application of an Economic Model to assess the Impact of Smoking Final Project Cessation Conference Coyle D. et al. on behalf of the EQUIPT Study Group

ABSTRACT Introduction: Although there are clear benefits to public health measures to reduce work smoking, there is also increasing pressure on public health providers to justify the investment in tobacco control measures. These decision makers need tools to help in progress assess the returns on investment (ROI) of programs. The EQUIPT project has been funded to adapt an existing ROI tool for England to four core European countries (Germany, the Netherlands, Spain and Hungary). The objective of this paper is to describe the methods for EQUIPTMOD, the economic model at the core of the ROI tool and to identify the key outcomes associated with both continued and cessation of smoking.

Methods: EQUIPTMOD is designed to facilitate the determination of an optimal package of smoking cessation interventions. EQUIPTMOD uses a Markov state transition cohort model to estimate the lifetime costs, quality adjusted life years (QALYs) and life years associated with a current smoker and former smoker. It utilises population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with the associated costs and utility effects of disease. To illustrate the potential for the ROI tool, costs, QALYs and life expectancy were estimated for the average current smoker in England based on the assumption that they continue smoking over the next 12 months and that they cease smoking within the next 12 months. All outcomes were discounted at a rate of 3% per annum.

Results: Over a lifetime horizon, continuing smoking reduced life expectancy by 0.66 years, reduced QALYs by 1.09 QALYs and resulted in higher disease related health care costs - £4,961 than if the smoker ceased smoking in the next 12 months. For each age-sex category, costs were lower and QALYs higher for those who quit smoking in the first twelve months than those who did not. As has been observed elsewhere, lifetime QALYs tended to be higher for females than males. However, QALYs for males who quit smoking were higher than for females who did not quit smoking.

Discussion: EQUIPTMOD will facilitate the assessment of the cost effectiveness of alternative strategies as developed within the EQUIPT ROI tool. The demonstrated results indicate the large potential benefits from smoking cessation both at an individual and population level.

Are changes in the current provision of smoking cessation services cost-effective? An analysis based on the EQUIPT ROI model Anraad, C. et al. on behalf of the EQUIPT Study Group

ABSTRACT Objective: To assess the cost-effectiveness of national level policy changes regarding smoking cessation support programmes in the Netherlands and England, from a quasi-societal perspective.

Methods: The European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) Return on Investment model, a Markov-based state transi

-17 tion economic model, was used to estimate costs (healthcare and productivity loss EQUIPT costs) and benefits (quality-adjusted life years (QALY) gained) of changing the current provision of smoking cessation support programmes. A number of policy scenarios Final Project were designed based on literature review, uptake data and consultation with policy makers. The scenarios included scaling up effective support programmes (bupropion, group-based behavioural therapy, SMS text messaging support), scaling down inef- Conference fective or extremely costly support programmes (mono Nicotine Replacement Therapy (NRT) use, one-to-one behavioural therapy), increasing the reach of top-level services to increase the number of potential quitters (brief physician advice), or integration of these options. Changes in the provision of these services were compared to the cur- work rent practice. Results were expressed as Incremental Net Benefit, Incremental Cost-Ef- fectiveness Ratio and Benefit-Cost Ratio. A sequential analysis was done to identify in progress the optimal scenario.

Results: An integrated scenario included: increases in uptake of GP brief advice and mobile phone text message support; proportions of mono NRT users moving to bupropion and; proportions of one-to-one behavioural support users moving to group therapy. This integrated scenario was dominant over all scenarios that involved only one policy change (i.e. selected scaling up/down and increasing reach) and over the current practice, in both the Netherlands and England.

Conclusions: This study provides a financial argument that current provision of smoking cessation support programmes in England and the Netherlands may benefit from re-alignment.

Cost-effectiveness of smoking cessation in Ger- many: results from the EQUIPT model Huber, M. et al. on behalf of the EQUIPT Study Group

ABSTRACT Background: In Germany the mortality rate of lung cancer for females is still rising and smoking is the biggest risk factor for lung cancer. Smoking prevention and cessation mirror key leverage points to prevent the negative consequences of smoking in Germany. Evaluating the cost effectiveness of respective interventions is necessary to foster their practical implementation.

Methods: A Markov-based state transition model was used to evaluate the effects of increased uptake rates for three interventions, group-based behavioural support, financial incentives and Varenicline for smoking cessation in Germany over a lifetime horizon.

Results: Irrespective of evaluated uptakes, all three interventions were cost saving. The highest cost savings were seen for the financial incentive programme (2.67 EUR per EUR invested), followed by group-based behavioural support (1.61 EUR per EUR invested). Varenicline had lower cost savings (1.02 EUR per EUR invested) but was still dominant. A moderate uptake increase of 1% for all three interventions led to 14,893 QALYs gained and averaged to intervention costs of 18.80 EUR per smoker in Germany. Avoided disease cost played a significant role for the return on investment over a lifetime horizon.

Conclusions: Increasing the uptake rates of group-based behavioural support, financial incentive programs and Varenicline for smoking cessation leads to cost savings from a healthcare perspective. Germany specific regulation should be taken into account to enable intervention implementation.

18- The effect of implementing smoking cessation in- EQUIPT terventions in Hungary Final Project Németh, B. et al. on behalf of the EQUIPT Study Group

Conference ABSTRACT Background: Smoking constitutes a major societal burden in Hungary. The prevalence of smoking is 32.3% among males and 23.5% among females. The total number of deaths related to smoking was 20,470 in 2010. The aim was to use a Tobacco work Return on Investment (ROI) model to evaluate the effects of implementing smoking cessation interventions. in progress Methods: Interviews with local stakeholders were conducted as part of the EQUIPT project to assess their needs and the usability of the EQUIPT Tobacco ROI model. The model itself uses local inputs gathered from the literature and is able to compare the current investment package with an alternative package that can be set up by the user. The ROI model calculates various outcomes including total costs and Incremental Cost-effectiveness Ratios (ICERs). We assessed two scenarios; the first meant introducing a social marketing campaign and the second included doubling the uptake of group-based behavioural support therapies and pro-active telephone support.

Results: Based on the model, introducing a social marketing campaign resulted in an ICER of 11,059 Hungarian Forints (HUF)/QALY on a 5-year time horizon and increased the number of quitters per 1,000 smokers from 10.35 to 10.65. The second scenario resulted in an ICER of 2,239 HUF/QALY and increased the number of quitters per 1,000 smokers to 10.43.

Conclusions: According to the results and the published Hungarian willingness to pay threshold, both scenarios are cost-effective. This analysis also demonstrated that the EQUIPT Tobacco ROI model can support decision making on smoking cessation interventions.

Optimising usability of an economic decision support tool: the case for the Tobacco Return on Investment model Cheung, K.L. et al. on behalf of the EQUIPT Study Group

ABSTRACT Background: Economic decision-support tools can provide valuable information for tobacco control stakeholders, but their usability may impact the adoption of such tools. The perception of a tool’s usability may impact motivational factors. This study aims (1) to illustrate a mixed-methods usability evaluation of an economic decision-support tool, and (2) to explore the effect of usability on motivational factors and the intention to use an economic decision-support tool for tobacco control.

Methods: A cross-sectional mixed methods design was used, including an heuristic evaluation, a thinking aloud approach, and a questionnaire testing and exploring the usability of the Tobacco Return on Investment model. The questionnaire also assessed motivational factors derived from the I-Change Model. Multiple regression analyses were conducted to investigate the relationships between usability and motivational factors.

Results: A total of 66 stakeholders evaluated the tool by using a thinking aloud procedure and completing a questionnaire. For the heuristic evaluation, four experts evaluated the interface. In total 21% of respondents perceived a good usability. A total of 118 usability problems were identified, from which 26 problems were catego- rised as most severe indicating a high priority to fix them prior to implementation. The -19 usability of the interface of an economic decision-support tool was shown to positively EQUIPT impact attitudes of stakeholders in the use of such a tool.

Final Project Conclusions: This evaluation provides input to aid optimisation of the usability of a decision-support tool. This is the first study where a high usability score significantly Conference predicted attitude to the use of an economic decision-support tool.

work in progress Section B: Effectiveness and reach estimates for modelling return on investment from smoking cessation interventions Robert West et al. on behalf of the EQUIPT Study Group

ABSTRACT Background and aims: Modelling likely return on investment from smoking cessation interventions such as mass media campaigns requires estimates of effectiveness and reach of the interventions. Such estimates can be arrived at in a number of ways, each with strengths and limitations. This paper describes the methods and results for parameter estimates for use in the EQUIPT project that aimed to create a return on investment model for use by European countries.

Methods: Estimates were derived for population-wide and clinical interventions aimed at promoting quit attempts and improving the success of quit attempts, including pharmacotherapies, behavioural support, social marketing campaigns, and smokefree legislation. The sources used were systematic reviews of effectiveness combined with survey data from England using the Smoking Toolkit Study, the most detailed survey of smoking cessation in Europe. The resulting estimates form a starting point for adjustment according to different national contexts.

Findings: Quit attempt rates were estimated to be increased by the following ratios for those reached, with percentage of smokers reached in brackets: 1) 20% by tax increases raising the cost of smoking 5% above the retail price index (100% reach), 2) 10% by enforced comprehensive indoor public smoking bans (100% reach), 3) 40% by brief opportunistic physician advice (21% reach), 4) 110% by use of a licensed nicotine product to reduce cigarette consumption (12% reach), 5) 3% by social marketing campaigns achieving 400 gross rating points (100% reach). Quit success rates were estimated to be increased by the following ratios: 6) 60% by prescribed single form licensed nicotine products, and bupropion (5% and 1% reach respectively), 7) 114% by prescribed dual form (transdermal patch plus a faster acting product) nicotine products (2% reach), 8) 130% by prescribed varenicline (5% reach), 9) 100% by prescribed nortripyline (0% reach), 10) 230% by prescribed cytisine (0% reach), 11) 40% by individual face to face behavioural support and telephone support (2% and 0.5% reach respectively), 12) 100% by group behavioural support (1% reach), 71% by SMS text messaging (0.5% reach), 13) 19% by printed self-help materials (1% reach). There was insufficient evidence to obtain reliable estimates for interventions such as websites, smartphone apps and e-cigarettes.

Conclusions: A wide range of population-wide and clinical interventions have demonstrated effectiveness in promoting smoking cessation. Clinical interventions tend to have greater effectiveness but lower reach.

20- Section C: EQUIPT Parameter importance in the adaptation of a tobacco control return on investment model Final Project in relation to cross-context transferability of economic evidence Conference Coyle, K. et al. on behalf of the EQUIPT Study Group

ABSTRACT work Objective: To explore a novel application of importance analysis to inform the focus of future research in the adaptation of a UK tobacco return on investment (ROI) model in progress to other European jurisdictions.

Methods: Using the existing UK ROI model, through Monte Carlo simulation, we created a set of values for all input parameters and outcome in terms of the net benefit of a tobacco intervention package compared to no interventions. Importance analysis was conducted using the dominance measure to rank each input parameter with respect to their impact on output uncertainty. Sensitivity analysis addressed the impact of results to alternate degrees of uncertainty within input parameters and to the willingness to pay (WTP) for a QALY.

Results: The most influential parameters were the background quit rate, the intervention uptake rate, the relapse rate. The cost of interventions with productivity losses due to smoking, utility associated with smoking status, the relative risk of stroke and CHD and the cost of smoking attributable diseases were of lesser importance. Other parameters were of negligible importance. Results were robust to alternate assumptions regarding WTP and to the degree of uncertainty surrounding each of the parameters.

Conclusions: Through a novel application of importance analysis we were able to identify those parameters which contributed greatest to output uncertainty. This will facilitate the adaptation of the existing model to further jurisdictions.

Utility of parameter uncertainty analysis in transferring economic evidence to countries with scarce resources: empirical evidence based on the EQUIPT model Németh, B. et al. on behalf of the EQUIPT Study Group

ABSTRACT Objective: To inform transferability of economic evidence to resource-poor countries. This was achieved by identifying key input parameters that can cause significant variation in the return-oninvestment (ROI) measures across different jurisdictions in the EQUIPT (European-study on Quantifying Utility of Investment in Protection from Tobacco) model.

Methods: Following a Markov state transition framework, the EQUIPT model was set up to predict the ROI measures for tobacco control interventions in five Euro- pean countries (UK, Spain, Germany, the Netherlands and Hungary) and is therefore (input) data-hungry. To be able to assess the extent to which the model would require country-specific data if it were to be transferred to Central and Eastern Europe (CEE), a one-way sensitivity analysis was conducted on all the input parameters collected from the five countries. Base case results were obtained through average values of all input parameters, which were then replaced one at a time with country-specific values. The resulting outcomes (i.e. changes in ROI measures) were evaluated tho- roughly using tornado diagrams. Finally, a short list of input parameters was -21 constructed to guide additional data collection from CEE to further evaluate the trans- EQUIPT ferability of the EQUIPT model.

Final Project Results: Sixteen input parameters causing significant variation in model outputs were identified. Fourteen of these input parameters caused variation that was considered large (>10%) in at least six of the eight ROI measures. This led to the construction of a Conference short list that included key parameters such as smoking prevalence, costs of smoking-related diseases, discount rates and a few general attributes of the population.

Conclusions: The short list of key parameters provides countries that have limited work time and other resources to conduct research (or have incomplete data on all the parameters) with an opportunity to adapt the EQUIPT Tobacco ROI model to their own in progress setting. These countries can choose to collect local values only for the key parameters and after applying those in the EQUIPT model, they will be able to generate results relevant to their own countries.

Section D: Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic study Kulchaitanaroaj, P. et al. on behalf of the EQUIPT Study Group

ABSTRACT Aims: The extent to which stakeholders in different European countries are aware of the availability of tobacco-control interventions and agree on their relative importance is unknown. In this study we assessed views of stakeholders from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data.

Methods: Stakeholders from Germany, Hungary, the Netherlands, Spain and the United Kingdom were asked to rate availability and importance of 30 tobacco-control and smoking cessation interventions in their country. A mean importance score across the whole sample for each intervention was calculated and used to rank the interventions. This ranking was compared with a ranking based on cost-effectiveness data derived from a review study. The Kendall rank (tau) correlation coefficient was used to assess agreement levels.

Results: Across 93 stakeholders (55.7% response rate), there was very low agreement on availability of the interventions (Kappa = 0.087; 95% CI = [0.062, 0.089]) and moderate agreement on their importance (Kappa = 0.385; 95% CI = [0.333, 0.471]). A ranking of importance was not statistically concordant with established cost-effectiveness (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [-0.09, 0.89]).

Conclusions: European stakeholders show low agreement on the availability but moderate agreement on the importance of tobacco-control interventions. These intrin- sic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with key stakeholders, focussing on better communication, has a potential to mitigate this challenge, and save scarce resources.

22- Contextual visualisation to inform the trans- EQUIPT ferability of economic evidence on tobacco control across European countries Final Project Jones, T.H., Lester-George, A, West, R., Voko, Z., Pokhrel, S and on behalf of the Conference EQUIPT Study Group

ABSTRACT Background: A vast body of economic research provides evidence for investing in work smoking cessation and prevention. Studies as to what makes such evidence transferable to contexts other than where they were first generated are sparse. in progress Objective: To map the variability of contextual factors that could be important to transfer a Tobacco Return on Investment (ROI) model from England to four additional European countries (Germany, Hungary, Spain and the Netherlands).

Methods: Scopus, Medline, Web of Science (WoS), governmental and non-governmental reports, published databases and article reference lists were searched to identify data that would support ‘contextual visualisation’ defined by a pre-de- termined list of domains (population, prevalence, perspective, policy and progress – the 5Ps). Available data in each domain across the five European countries were comparatively mapped to identify any major similarities and differences that could potentially impinge on the transfer of economic evidence related to smoking cessation and prevention.

Results: Similarities and differences across the five countries are discussed. Varia- tions in population (8:1) and relative wealth (almost 2:1 GDP in PPS) included levels both higher and lower than EU28 averages. Latest mortality data (all causes and deaths attributable to smoking (2004)) was quite dated and later mortality data (all causes, 2010-2012) had shown substantial falls since 2004. Prevalence in adults varied between 18.7% for current smokers in UK to 29% in Hungary, with large percentages of former smokers in Netherlands and the UK (Eurobarometer). Data for prevalence in children (aged 15yrs, 2009/10) showed the percentage of males who smoked was greater than females only in Hungary. Reliability of prevalence data for adults and children was uncertain. Similarities in perspectives included for: the ages when the majority of smokers started smoking; the main influence on them starting to smoke; the factors influencing their choice of cigarettes; their relative likelihood of being exposed to second-hand smoke in res- taurants; the proportion of smokers that made a quit attempt and; their main reason for their quit attempt. Substantial differences in perspective were found for: price as a factor influencing their choice of cigarette; the cost of a packet of cigarettes; the places where smokers purchased their cigarettes; the percentage of smokers who started smoking regularly before they were aged 15 and; their exposure to second hand smoke at work. Similarities in policies for tobacco control included picture health warnings on pac- kaging and security features to limit sales of counterfeit or smuggled products as the most popular. Overall the countries with the greatest percentages of respondents in favour of the listed policies were the UK (68.4%) and Hungary (67.7%) compared to the Netherlands (51.8%). Progress on implementation of the WHO FCTC varied with UK as the first and Ger- many as 33rd out of the 34 European countries included on the Tobacco Control Scale in 2013.

Conclusion: Successful transferability of economic evidence from a one country to another depends on, amongst other things, how well the variation in contextual parameters from evidence-transfer to evidence-recipient countries is understood. The 5Ps contextual visualisation, presented in this paper, could serve as a useful screening tool to this end.

-23 Exploring the views of stakeholders in five Eu- EQUIPT ropean countries in the context of collaborative, public health research: a mixed methods ap- Final Project proach to UK data Jones, T. H., Voko, Z., Cheung, K. L., Pokhrel, S. and on behalf of the EQUIPT Study Conference Group

ABSTRACT work Background: Stakeholders can be engaged in research at various levels - from informal consultations to robust, scientifically designed processes. The aims of such in progress engagement can also vary, such as from just improving dissemination of the findings to a much wider objective of informing the entire research process (design). Stakehol- der definition can also vary and the input that they provide may be of particular importance within a defined aspect of the project dependant on their role. When conducting a multinational study, stakeholder views across the countries involved can introduce another crucial dimension for consideration. Given the breadth of stakeholder data that could potentially be relevant, a single method of collection would seem inappropriate to inform the best development of the research.

Objective: To explore the engagement of stakeholders using a mixed methods approach within the context of a large-scale, multi-country, collaborative, public health research project, European study on quantifying utility of investment in protection from tobacco (EQUIPT).

Methods: The EQUIPT project utilised a semi-structured qualitative/quantitative survey to explore stakeholders’ views. We conducted a quantitative analysis of some of the data to contribute towards the development of a viable, practical decision support tool that was acceptable to decision makers. We analysed the stakeholders’ intention to use the research findings (including a decision support tool) using a quantitative method. This method was underpinned by the focus on stakeholders’ own behaviour (and behaviour change) in relation to public health decision making. Concurrently during the interviews stakeholders were provided with the opportunity for free ex- pression of their views on the use of the decision support tool in their own political and social environments. The quantitative data from the first two separate methods of analysis are discussed in the context of the results from the qualitative ‘free expres- sion’ data using a narrative approach.

Results: The mixed-method approach provided rich data that (a) informed the development/design of a decision support tool tailored to the needs of the stakeholders in each individual country; (b) helped to investigate the stakeholders’ perceptions of the facilitators and barriers to the use of the decision support tool; and finally (c) allowed us to consider the broader context within which the stakeholders will use the decision support tool in order to provide a greater level of customisation for the end-users.

Conclusion: Underlying the EQUIPT decision support tool is a complex model that incorporates data chosen for its accuracy and relevance. The integrity of this data is paramount. However, the use of the decision support tool relies on much more than this data. The EQUIPT case study demonstrates that a mixed method approach to the analysis of stakeholder engagement can provide additional, valuable input to the development of a data driven, economic model thus providing a greater potential for effective usage in a multi-national context.

24- Role of decision-support tools in narrowing EQUIPT the evidence-to-action gap in tobacco control Jones, T. Willmore, M. Crossfield, A. Dickens, A. Owen, L. West, R. Lester-George Final Project A. & Pokhrel, S Conference ABSTRACT Background: How local, context-specific, robust evidence translates into action (i.e. policy making) is sparsely understood. work Rationale: To explore decision makers’ and wider stakeholders’ views about the in progress use of the NICE Tobacco Return on Investment (ROI) tool in policy making.

Method: A group of decision makers and wider stakeholders were asked to state their experience of using the NICE Tobacco ROI Tool since its inception in a half-day workshop organised in London. A pre-workshop survey was conducted to understand what people had used the tool for, what they had liked and disliked about it and the facilitators and barriers to usage. The summarised results of the pre-survey, presented at the beginning of the workshop, led to more elaborate but structured discussions with all respondents around the pathway from tobacco evidence into (local) action. A post-workshop survey confirmed stakeholders’ views on how the ROI tool could improve translation of evidence into action.

Results: The majority of participants (60%) had used the ROI tool for input to policy proposals. The tool had also been used for writing reports (40%) and business cases (30%). Participants liked granularity and the up-to date data though 50% found it complex and time-consuming to use. The tool had been a facilitator for informing spending reviews (60%); participants noted such tools could inform disinvestment as well as investment decisions relating to stop smoking services.

Conclusion: Locally relevant evidence has a potential to feed into policy-making. A decision support tool co-created with stakeholders can facilitate the translation of evidence into action. These findings have fed into the development of the European ROI model (EQUIPT).

“International workshop” as a method to facilitate cross-country transferability of economic evidence: an empirical case study Huic, M. Nemeth, B. Kalo, Z. et al. on behalf of the EQUIPT Study Group.

Aims: to evaluate the transferability of policy proposals and their evidence base across Central and Eastern European (CEE) countries for the implementation of public health policies and to support the validation of the EQUIPT Tobacco ROI model in lower-income European countries.

Method: A one-day International workshop was held in Zagreb, Croatia, in June 2016. The twenty invited stakeholders were representatives of five different groups (policy makers, payers, patient representatives, healthcare providers, public health experts and HTA agencies) and came from eleven CEE countries (Bosnia and Herze- govina, Croatia, Czech Republic, Greece, Latvia, Montenegro, Poland, Serbia, Slova- kia, Slovenia and Ukraine). They filled out a pre-meeting survey on evidence use and tobacco control before they were familiarized with the model during the workshop. After a roundtable discussion, a post-meeting survey on the usability of the EQUIPT Tobacco ROI Tool was filled out.

-25 Results: Findings from the pre-meeting survey showed that quit rates and relapse EQUIPT rates are the most important outcomes that can justify investment decisions. Most of the responders (88%) gave the answer that budget constraint is the highest barrier Final Project to the adaptation of the tool. The post-meeting survey showed consensus among all participants that the EQUIPT Tobacco ROI Tool is able to support country-level policy decisions and makes it feasible to limit local data collection to the most relevant input Conference parameters and the rest of the influential factors can be gathered from international sources.

Conclusion: The workshop allowed the stakeholders to learn about the EQUIPT ROI work tool and its application through group work and discussions. The pre- and post-meeting surveys allowed researchers to quantify the value of the EQUIPT tool from the in progress transferability perspective. Setting up an international stakeholder advisory panel to support transferring the evidence base and the EQUIPT model to CEE countries was recommended.

26- -27 www.equipt.eu

This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement No. 602270(EQUIPT)