ABSTRACT Introduction The COVID‐19 pandemic significantly disrupted colorectal cancer (CRC) diagnosis and treatment globally. Most research on long‐term impacts has focused on population‐level outcomes, overlooking disparities in under‐screened groups. This study examines the long‐term effects of COVID‐19 disruptions on health inequalities and healthcare costs in Victoria, Australia. Methods A Markov microsimulation model (PRISM‐CRC), containing socioeconomic quintiles in Victoria, estimated health outcomes in a population aged 50–74 years from 2023–2037. The model simulated the development of CRC, considering the expected population increase in CRC cases projected by the Victorian Cancer Registry (VCR) due to COVID‐19 disruptions and counterfactual scenarios with no disruptions. The model estimated CRC case numbers, CRC deaths, and total costs of CRC screening and treatment by quintile. Screened status, stage of diagnosis, and survival were obtained using a dataset linked to patients diagnosed with CRC in 2009–2021 from the VCR. Results Post COVID‐19, CRC cases and mortality increased across all quintiles, with the greatest impacts in the most disadvantaged groups. Quintile 2 showed the largest relative cancer cases increase (21.7%), followed by quintile 1 (16.3%), whilst quintile 5 increased only 1.2%. CRC deaths rose 30.1% in quintile 1 and 28% in quintile 2, compared to 1.6% in quintile 5. Combined screening, diagnostic testing and treatment costs increased 21.4% in quintiles 1 and 24.8% in quintiles 2, versus 3.4% in quintile 5. Overall, the post‐COVID‐19 period intensifies the social gradient in CRC incidence, mortality, and healthcare costs. Conclusion Our study underscores the significant impact of COVID‐19 disruptions on worsening cancer inequalities. Targeted CRC screening interventions are essential to protect vulnerable populations. Enhanced demographic data from screening programs will help better understand non‐participants and groups with low participation rates.

Background Adults with mental illness have higher smoking prevalence and face greater financial burdens from smoking compared with the general population. Aims This study explores how individuals’ psychological distress and smoking status are jointly associated with household expenditure patterns in Australia. Method Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey over three waves. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10) and the mental health domain of Medical Outcomes Study Short-Form General Health Survey (SF-36 MHD). Household expenditure categories included alcohol, clothing, education, fuel, general insurance, medicines, health practitioners, groceries, meals eaten out, internet, utilities, public transport and rent. Regression models using the generalised estimating equation technique compared expenditure data, controlling for age, gender, household composition, socioeconomic position, education level and wave of data collection. Results Smokers and ex-smokers showed significant differences in expenditure across K10 psychological distress levels. At low and moderate distress levels, smokers spent more on alcohol and rent and less on insurance, health practitioners, meals out and medicines. At high distress levels, only education expenditure was significantly lower for smokers. Across SF-36 MHD tertiles, smokers spent less on education, insurance and medicine, but more on alcohol, especially at lower and moderate distress levels. Conclusions Smoking cessation for those with moderate psychological distress may be associated with a reallocation of spending, benefiting both households and their local communities. Targeted interventions addressing smoking cessation and mental health are crucial for reducing financial and health inequities.

BACKGROUND:Optimal Care Pathways (OCPs) are national pathway-based frameworks designed to promote timely, coordinated, evidence-based cancer care through tumour-specific action points. However, population-level evidence on associations between OCP alignment, survival, and healthcare costs, remains limited. OBJECTIVE:To examine factors associated with OCP alignment and its relationship with five-year survival and hospital costs among people with colon cancer in Victoria, Australia. METHODS:A retrospective cohort study used linked administrative data from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset, and hospital cost collections (2009-2022). Adult colon cancer cases (ICD-10 C18) were classified by alignment with OCP action-points. Multivariable logistic regression identified predictors of OCP alignment. Five-year survival was analysed using parametric survival models, and generalised linear models examined associations between OCP alignment and hospital costs. RESULTS:Among 26,260 colon cancer cases, OCP alignment was more common among patients with Stage II-III disease, females, and those from advantaged areas. Five-year survival improved following OCP implementation, with OCP-aligned care independently associated with better survival (HR 0.91, 95% CI 0.84-0.99). Total hospital costs did not differ significantly by alignment status, although, aligned care was associated with greater multidisciplinary service utilisation across domains. Disease stage was the strongest determinant of hospital costs. CONCLUSIONS:Alignment with OCP action points was associated with improved survival without higher overall hospital costs. Persistent socioeconomic and geographic differences in alignment highlight the need for strategies to ensure benefits are realised across populations.

Introduction While health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).Methods and analysis This ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.Ethics and dissemination The Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).

OBJECTIVES:To promote equity in breast cancer screening for culturally and linguistically diverse (CALD) communities, language-specific initiatives were implemented in Victoria, Australia. This study aims to evaluate the cost-effectiveness of in-language short message service (SMS) reminders for overdue clients. METHODS:A cost-utility analysis was conducted to evaluate in-language SMS reminders for women aged between 50 and 72 years, overdue for their routine breast screen in 2021 (n = 3294), compared with English SMS. In-language SMS reminders to book a screen were sent to the women in the North Western and St Vincent's BreastScreen Reading and Assessment regions in Melbourne, Victoria. A Markov microsimulation model simulated the development of breast cancer, estimating the cost per quality-adjusted life-year (QALY) gained over a 50-year time horizon from a healthcare perspective. Healthcare costs were sourced from Australian studies and are in 2021 Australian dollars. RESULTS:Booking response rates were higher for the lapsed in-language SMS than the lapsed SMS sent in English (12.7% and 8.2%, respectively). Intervention costs averaged $1.24/person. The estimated cost/QALY was $1595 (95% uncertainty interval dominated to $7637). Because of the in-language initiative, there were an estimated 14 more breast cancers and 5 more ductal carcinomas in situ detected and 3 fewer breast cancer deaths. CONCLUSIONS:In-language SMS reminders to increase breast cancer screening targeting lapsed screeners from CALD communities were effective and cost-effective relative to the willingness-to-pay threshold of $50 000/QALY. Introducing these types of initiatives as standard practice can potentially increase equity in breast cancer screening for CALD groups in well-resourced countries.

BACKGROUND:Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia. METHODS:Linked datasets from a Victorian population-based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a p-value threshold < 0.05. RESULTS:A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty-one per cent (5086) of them reported CRC-related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = -0.060, p-value < 0.001) and regional and remote areas (CI = -0.065, p-value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced-stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45-49 age groups (65-69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70). CONCLUSIONS:Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.

Background: Governments around the world are considering regulating access to nicotine e-cigarettes to prevent uptake among youth however people that smoke tobacco may use them to assist with smoking cessation. The health and cost implications of regulating e-cigarette use among populations are unknown but have been explored in modelling studies. We reviewed health economic evaluation and simulation modelling studies that assessed long-term consequences and interpret their potential usefulness for decision-makers.Methods: A systematic review with a narrative synthesis was undertaken. Six databases were searched for modelling studies evaluating population-level e-cigarette control policies or interventions restricting e-cigarette use versus more liberalized use. Studies were required to report the outcomes of life years, quality-adjusted life years (QALYs) and/or healthcare costs. The quality of the studies was assessed using two quality assessment tools.Results: In total, 15 studies were included with nine for the United States and one each for the United Kingdom, Italy, Australia, Singapore, Canada, and New Zealand. Three studies included cost-utility analyses. Most studies involved health state transition (or Markov) closed cohort models. Many studies had limitations with their model structures, data input quality and transparency, and insufficient analyses handling model uncertainty. Findings were mixed with 11 studies concluding that policies permitting e-cigarette use lead to net benefits and 4 studies concluding net losses in life-years or QALYs and/or healthcare costs.Five studies had industry conflicts of interest.Conclusions: While authors did conclude net benefit than net harm in more of the studies so far conducted, the significant limitations that we identified with many of the studies in this review, make it uncertain whether or not countries can expect net population harms or benefits of restrictive versus unrestrictive e-cigarette policies. The generalizability of the findings is limited for decision-makers. In light of the deep uncertainty around the health and economic outcomes of e-cigarettes, simulation modelling methods and uncertainty analyses should be strengthened.

OBJECTIVES:Although substantial evidence exists on the costs and benefits of cancer care and screening programs for the general population, economic evidence of interventions addressing inequalities is less well known. This systematic review summarized economic evaluations of interventions addressing inequalities in cancer screening and care to inform decision makers on the value for money of such interventions. METHODS:Embase, MEDLINE, Cochrane Library, EconLit, and Scopus databases were searched for studies published from database inception to October 27, 2023. Studies were eligible for inclusion if they were economic evaluations of interventions to improve or address inequalities in cancer care among disadvantaged population groups. Study characteristics and cost-effectiveness results (US dollars 2023) were summarized. Study quality was assessed by 2 authors using the Drummond checklist. RESULTS:The searches yielded 2937 records, with 30 meeting the eligibility criteria for data extraction. In most of the studies (n = 27, 90%), interventions were considered cost-effective in addressing inequalities in cancer care and screening among disadvantaged populations. Notably, 60% of the studies were rated as high quality, 33.3% as good, and 6.7% as fair quality. CONCLUSIONS:This systematic review identified cost-effective strategies addressing inequalities in cancer screening and care that have the potential to be replicated in other locations. The interventions were mainly focused on screening programs, and few addressed equity gaps around risk reduction and diagnostic and treatment outcomes. This underscores the need for targeted approaches to address inequalities in under-researched priority population groups along the cancer care continuum.

Background Effective bowel cancer screening is freely available in Australia, however, there are inequities in utilisation amongst non-English speakers at home. This study estimates the health impacts and cost-effectiveness of recruitment interventions targeted at Arabic and Mandarin speaking populations in Victoria, Australia to increase bowel cancer screening participation.Methods A Markov microsimulation model simulated the development of bowel cancer, considering National Bowel Cancer Screening Program participation rates. Culturally specific recruitment interventions e.g., community education and tailored paid media for 50-74-year-olds were compared to usual practice. A cost-utility analysis was conducted over a 50-year time horizon from a healthcare perspective, to estimate the cost per quality-adjusted life year (QALY) based on plausible effectiveness levels. Costs are in 2019 Australian dollars.Results Intervention costs were $6.90 per person for the Arabic speaking group and $3.10 for Mandarin speakers. The estimated cost/QALY was $2,781 (95% uncertainty interval [UI]: $2,144 & horbar;$3,277) when screening increased by 0.2% in the Arabic group, and an estimated 5-6 additional adenoma and cancer cases were detected. In the Mandarin group, the estimated cost/QALY was $1,024/QALY (95%UI: $749 & horbar;$1,272) when screening increased by 1.1%, and an estimated 18-23 additional adenoma and cancer cases were detected.Conclusions Culturally specific recruitment interventions to increase bowel cancer screening are inexpensive and likely to be cost-effective. Improvements in capturing language spoken at home by the National program would facilitate more precise estimates of the effectiveness and cost-effectiveness of these interventions.

Background: Postnatal depression (PND) is a leading cause of illness and death among women following child-birth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum.Methods: This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score >= 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equip-ment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys.Discussion: If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms. Trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p

AbstractDental caries is the most prevalent oral disease across the life course. This study modeled the population health and economic impact of a 20% sugar sweetened beverages tax (SSB) for preventing dental caries compared to no intervention (societal and healthcare perspective). A cost‐effectiveness analysis according to quintiles of area‐level socioeconomic disadvantage was performed for the 2020 Australian population (0–100 years old) using a closed cohort Markov model. A qualitative assessment of implementation considerations (e.g., acceptability, equity, sustainability) was undertaken. Health outcomes were modeled as decayed teeth prevented and disability‐adjusted life years (DALYs) averted. The 10‐year and lifetime scenarios were modeled with probabilistic sensitivity analysis (Monte Carlo simulation, 2000 cycles). The 10‐year scenario from a societal perspective yielded cost‐savings of AUD$63.5M, healthcare cost‐savings of AUD$42.2M, 510,977 decayed teeth averted and 98.1 DALYs averted. The lifetime scenario resulted in societal cost savings of AUD$176.6M, healthcare cost‐savings of AUD$122.5M, 1,309,211 decayed teeth averted and 254.9 DALYs averted. Modeling indicated 71.5% and 74.5% cost‐effectiveness for the 10‐year and lifetime scenarios, respectively. A three‐fold health benefit for the least advantaged was found compared to the most advantaged. A 20% SSB tax in Australia is cost‐effective and promotes health equity.

This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways. This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture. The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences. The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal–Wallis test yielded a statistically significant difference in cost values between most care pathways (p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site. This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways.

Abstract Background Countries with best practice tobacco control measures have experienced significant reductions in smoking prevalence, but socioeconomic inequalities remain. Spending on tobacco products, particularly by low-income groups can negatively affect expenditure on other goods and services. This study aims to compare the household expenditure of adults who smoke tobacco products and those who formerly smoked across socioeconomic groups. Methods Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey, over 7 waves. Adults who never smoked were not included. Participants were continuing sample members across waves. Mean number of participants per wave was 2505, 25% were smokers and 75% ex-smokers. The expenditure variables investigated included tobacco products, alcohol, motor vehicle fuel, health practitioners, insurance, education, and meals eaten out. Regression models using the generalized estimating equation technique were employed to compare expenditure data aggregated across the waves by Socioeconomic Index for Areas (SEIFA) quintiles of relative socio-economic advantage/disadvantage while accounting for within-participant autocorrelation. Quintiles are ranked by information such as the income, occupation and access to material and social resources of the residents. Results Smokers from all quintiles spent significantly less per year on meals out, education and insurance than ex-smokers (p < 0.001). Smokers from quintiles 2–5 spent less on groceries, medicines, and health practitioners (p < 0.01). Smokers from quintiles 1 and 2 (most disadvantaged), spent less on motor vehicle fuel than ex-smokers ($280;95%CI: $126–$434), ($213;95%CI: $82–$344). Smokers from quintiles 2 and 3 spent more on alcohol ($212;95%CI: $86–$339), ($231.8;95%CI: $94–$370) than ex-smokers. Smokers from the least disadvantaged groups spent less on clothing than ex-smokers ($348;95%CI: $476–$221), ($501; 95%CI: $743–$258). Across the whole sample, smokers spent more than ex-smokers on alcohol ($230;95%CI:$95–$365) and less on meals out ($361;95%CI:$216–$379), groceries ($529;95%CI:$277–$781), education ($456;95%CI:$288–$624), medicine ($71;95%CI:$38–$104), health practitioners ($345;95%CI:$245–$444) and insurance ($318;95%CI:$229–$407). Conclusions Smoking cessation leads to reallocation of spending across all socioeconomic groups, which could have positive impacts on households and their local communities. Less spending on alcohol by ex-smokers across the whole sample could indicate a joint health improvement associated with smoking cessation.

OBJECTIVE:This study investigated variations in healthcare expenditure for colorectal cancer (CRC) patients in South Australia by socioeconomic position (SEP) and remoteness area.METHODS:Benefits incidence analysis (BIA) was used to examine healthcare expenditure and utilisation in relation to CRC patients by SEP and remoteness areas. Utilisation data was obtained for patients diagnosed with CRC in 2003-2013 from a dataset linked to a population-based cancer registry, Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), hospital and death data. Concentration indices estimated the distribution of health expenditure on MBS, MBS palliative care, PBS and general practitioners. Costs of claims data and length of stay in hospital were used as indicators of healthcare utilisation.RESULTS:The results indicated that MBS palliative healthcare services utilisation favoured the more advantaged groups for both SEP and remoteness area (Concentration index (CI)= 0.1681, t-value=54.42 (SEP) and CI=0.1546, t-value=41.64). MBS expenditure was also favourable to the more advantaged groups (CI: 0.0785 and 0.0493).PBS and MBS general practitioner expenditure were equal (-0.0093 to 0.0250).CONCLUSION:Overall MBS and PBS healthcare expenditure for CRC patients was close to equality, however utilisation of MBS-funded palliative healthcare services was less concentrated in low SEP and more remote areas.IMPLICATIONS FOR PUBLIC HEALTH:Whether the differences in palliative healthcare utilisation supplied by private providers are offset by other services requires investigation to determine if there is a need for initiatives to improve equality and give greater support to those who choose to die at home.

INTRODUCTIONThe gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA).METHODSA Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry.RESULTSWe predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1.CONCLUSIONInequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.

Introduction The short-term economic benefit of embedding best practice tobacco dependence treatment (TDT) into healthcare services prior to surgery across different populations and jurisdictions is largely unknown. The aim of this systematic review is to summarise the cost-effectiveness of preoperative smoking cessation interventions for preventing surgical complications compared with usual care. The results will provide hospital managers, clinicians, healthcare professionals and policymakers with a critical summary of the economic evidence on providing TDT routinely before surgery, aiding the development and dissemination of unified, best practice guidelines, that is, implementation of article 14 of the WHO Framework Convention on Tobacco Control. Methods and analysis A comprehensive search of peer-reviewed literature will be conducted from database inception until 23 June 2021 (Cochrane, Econlit, Embase, Health Technology Assessment, Medline Complete, Scopus). Published, English-language articles describing economic evaluations of preoperative smoking cessation interventions for preventing surgical complications will be included. One researcher will complete the searches and two researchers will independently screen results for eligible studies. Any disagreement will be resolved by the third researcher. A narrative summary of included studies will be provided. Study characteristics, economic evaluation methods and cost-effectiveness results will be extracted by one reviewer and descriptive analyses will be undertaken. A second reviewer will review data extracted for accuracy from 10% of the included studies. Reporting and methodological quality of the included studies will be evaluated independently by two reviewers using the Consolidated Health Economic Evaluation Reporting Standards statement and the Quality of Health Economic Studies Instrument checklist, respectively. Ethics and dissemination This research does not require ethics approval because the study is a planned systematic review of published literature. Findings will be presented at health economic, public health and tobacco control conferences, published in a peer-reviewed journal and disseminated via social media. Trial registration number CRD42021257740.

ObjectiveTo evaluate the implementation of a multicomponent survivorship programme for men with prostate cancer and their carers.DesignA single cohort study, guided by the RE-AIM framework.SettingMultiple health services in Australia.ParticipantsMen with prostate cancer and their carers, and health professionals.InterventionA 12-month telehealth programme that provided centralised and coordinated decision and information support, exercise and nutrition management, specialised clinical support and practical support to men and their carers.Data collectionMultiple sources of data including participant-reported health outcomes and experience of care, qualitative interviews, records of the programme were collected at different time points.ResultsReach: Of 394 eligible men at various stages of survivorship, 142 consented (36% consent rate) and 136 (96%) completed the programme. Adoption: All men participated in general care coordination and more than half participated in exercise and/or nutrition management interventions. Participation in the specialised support component (ie, psychosocial and sexual health support, continence management) was low despite the high level of need reported by men. Effectiveness: Overall, the men reported improvements in their experience of care. Implementation: Factors such as addressing service gaps, provision of specialised services, care coordination, adoption of needs-based and telehealth-based approaches were identified as enablers to the successful implementation of the programme. Issues such as insufficient integration with existing services, lack of resources and high caseload of the intervention team, men’s reluctance to discuss needs and lack of confidence with technology were barriers in implementing the programme.ConclusionSurvivorship interventions are relevant to men regardless of the stage of their disease and treatments undertaken. It is possible to provide access to a comprehensive model of survivorship care to promote the health and quality of life for men with prostate cancer.Trial registration numberThis study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000174381).