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Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. LANCET GLOBAL HEALTH 2020; 9:e130-e143. [PMID: 33275950 PMCID: PMC7820390 DOI: 10.1016/s2214-109x(20)30425-3] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/24/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990-2020, and forecasts for 2050. METHODS We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050. FINDINGS In 2020, an estimated 43·3 million (95% UI 37·6-48·4) people were blind, of whom 23·9 million (55%; 20·8-26·8) were estimated to be female. We estimated 295 million (267-325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147-179) were female; 258 million (233-285) to have mild vision impairment, of whom 142 million (55%; 128-157) were female; and 510 million (371-667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205-365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (-29·4 to -27·7) and prevalence of mild vision impairment decreased slightly (-0·3%, -0·8 to -0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia. INTERPRETATION Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages. FUNDING Brien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.
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202
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A framework for indirect elicitation of the public health impact of gambling problems. BMC Public Health 2020; 20:1717. [PMID: 33198709 PMCID: PMC7670710 DOI: 10.1186/s12889-020-09813-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.
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Bozzani FM, Sumner T, Mudzengi D, Gomez GB, White R, Vassall A. Informing Balanced Investment in Services and Health Systems: A Case Study of Priority Setting for Tuberculosis Interventions in South Africa. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1462-1469. [PMID: 33127017 PMCID: PMC7640941 DOI: 10.1016/j.jval.2020.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Health systems face nonfinancial constraints that can influence the opportunity cost of interventions. Empirical methods to explore their impact, however, are underdeveloped. We develop a conceptual framework for defining health system constraints and empirical estimation methods that rely on routine data. We then present an empirical approach for incorporating nonfinancial constraints in cost-effectiveness models of health benefit packages for the health sector. METHODS We illustrate the application of this approach through a case study of defining a package of services for tuberculosis case-finding in South Africa. An economic model combining transmission model outputs with unit costs was developed to examine the cost-effectiveness of alternative screening and diagnostic algorithms. Constraints were operationalized as restrictions on achievable coverage based on: (1) financial resources; (2) human resources; and (3) policy constraints around diagnostics purchasing. Cost-effectiveness of the interventions was assessed under one "unconstrained" and several "constrained" scenarios. For the unconstrained scenario, incremental cost-effectiveness ratios were estimated with and without the costs of "relaxing" constraints. RESULTS We find substantial differences in incremental cost-effectiveness ratios across scenarios, leading to variations in the decision rules for prioritizing interventions. In constrained scenarios, the limiting factor for most interventions was not financial, but rather the availability of human resources. CONCLUSIONS We find that optimal prioritization among different tuberculosis control strategies in South Africa is influenced by whether and how constraints are taken into consideration. We thus demonstrate both the importance and feasibility of considering nonfinancial constraints in health sector resource allocation models.
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Affiliation(s)
- Fiammetta M Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK.
| | - Tom Sumner
- TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK
| | | | - Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Richard White
- TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK; Sanofi Pasteur SA, Vaccine Epidemiology and Modelling, Lyon, France
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Fernandes S, Were V, Gutman J, Dorsey G, Kakuru A, Desai M, Kariuki S, Kamya MR, ter Kuile FO, Hanson K. Cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine for malaria during pregnancy: an analysis using efficacy results from Uganda and Kenya, and pooled data. Lancet Glob Health 2020; 8:e1512-e1523. [PMID: 33137287 PMCID: PMC7686013 DOI: 10.1016/s2214-109x(20)30369-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prevention of malaria infection during pregnancy in HIV-negative women currently relies on the use of long-lasting insecticidal nets together with intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Increasing sulfadoxine-pyrimethamine resistance in Africa threatens current prevention of malaria during pregnancy. Thus, a replacement for IPTp-SP is urgently needed, especially for locations with high sulfadoxine-pyrimethamine resistance. Dihydroartemisinin-piperaquine is a promising candidate. We aimed to estimate the cost-effectiveness of intermittent preventive treatment in pregnancy with dihydroartemisinin-piperaquine (IPTp-DP) versus IPTp-SP to prevent clinical malaria infection (and its sequelae) during pregnancy. METHODS We did a cost-effectiveness analysis using meta-analysis and individual trial results from three clinical trials done in Kenya and Uganda. We calculated disability-adjusted life-years (DALYs) arising from stillbirths, neonatal death, low birthweight, mild and moderate maternal anaemia, and clinical malaria infection, associated with malaria during pregnancy. Cost estimates were obtained from data collected in observational studies, health-facility costings, and from international drug procurement databases. The cost-effectiveness analyses were done from a health-care provider perspective using a decision tree model with a lifetime horizon. Deterministic and probabilistic sensitivity analyses using appropriate parameter ranges and distributions were also done. Results are presented as the incremental cost per DALY averted and the likelihood that an intervention is cost-effective for different cost-effectiveness thresholds. FINDINGS Compared with three doses of sulfadoxine-pyrimethamine, three doses of dihydroartemisinin-piperaquine, delivered to a hypothetical cohort of 1000 pregnant women, averted 892 DALYs (95% credibility interval 274 to 1517) at an incremental cost of US$7051 (2653 to 13 038) generating an incremental cost-effectiveness ratio (ICER) of $8 (2 to 29) per DALY averted. Compared with monthly doses of sulfadoxine-pyrimethamine, monthly doses of dihydroartemisinin-piperaquine averted 534 DALYS (-141 to 1233) at a cost of $13 427 (4994 to 22 895), resulting in an ICER of $25 (-151 to 224) per DALY averted. Both results were highly robust to most or all variations in the deterministic sensitivity analysis. INTERPRETATION Our findings suggest that among HIV-negative pregnant women with high uptake of long-lasting insecticidal nets, IPTp-DP is cost-effective in areas with high malaria transmission and high sulfadoxine-pyrimethamine resistance. These data provide a comprehensive overview of the current evidence on the cost-effectiveness of IPTp-DP. Nevertheless, before a policy change is advocated, we recommend further research into the effectiveness and costs of different regimens of IPTp-DP in settings with different underlying sulfadoxine-pyrimethamine resistance. FUNDING Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Hygiene and Tropical Medicine.
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Affiliation(s)
- Silke Fernandes
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Vincent Were
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Kara Hanson
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Chronic Severe Sleep Problems among Non-Nordic Immigrants. Data from a Population Postal Survey in Mid-Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217886. [PMID: 33126423 PMCID: PMC7663434 DOI: 10.3390/ijerph17217886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/05/2022]
Abstract
Sweden has a large population of both recent and established immigrants with high prevalence of risk factors for ill health. Here, we aimed to explore the prevalence of chronic severe sleep problems (CSSP) among non-Nordic-born persons, and to evaluate the risk for CSSP when fully adjusted for covariates. Our additional hypothesis was that lengthier time since immigration would reduce the risk for CSSP. We used data from a large-population postal survey covering life and health issues among inhabitants in mid-Sweden. Relationship between different countries of birth and CSSP was assessed in logistic analyses for more severe and longstanding pain, sex, employment, mental disability, gastrointestinal problems, and length of stay (short, middle time, and up to ten years of stay). Persons of non-Nordic birth reported significantly more often CSSP, regardless of short or long-term stay. Our findings indicate that non-Nordic birth, regardless of residence time and covariates, was an independent and significant predictor for CSSP. The findings may contribute to increasing awareness in healthcare personnel to recognize chronic sleep problems among immigrant patients. Thus, our study might contribute to developing strategies to enhance health for minorities.
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206
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Barr RD. The challenges of delivering cost-effective and affordable care to children with cancer in the developing world. Cancer 2020; 127:676-678. [PMID: 33107984 DOI: 10.1002/cncr.33279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022]
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Asouri M, Sahraian MA, Karimpoor M, Fattahi S, Motamed N, Doosti R, Amirbozorgi G, Sadaghiani S, Mahboudi F, Akhavan-Niaki H. Molecular Detection of Epstein-Barr Virus, Human Herpes Virus 6, Cytomegalovirus, and Hepatitis B Virus in Patients with Multiple Sclerosis. Middle East J Dig Dis 2020; 12:171-177. [PMID: 33062222 PMCID: PMC7548094 DOI: 10.34172/mejdd.2020.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease with significant morbidity. A wide spectrum of risk factors has been suggested that triggers the development of MS. Among them, several viral infections have been implicated to play a role in MS pathogenesis. We aimed to evaluate the relationship between viral diseases, including Epstein–Barr virus (EBV), human herpes virus 6 (HHV-6), cytomegalovirus (CMV), and hepatitis B virus (HBV) and MS in the present case-control study. METHODS About 100 patients with confirmed MS and age- and sex-matched individuals were selected as case and control groups, respectively. The patients were randomly selected from individuals diagnosed by neurologists based on the clinical signs and symptoms and imaging procedures. RESULTS More than 100 patients with MS and patients who were referred for other causes were analyzed for the presence of DNA of EBV, HHV6, CMV, and HBV separately. 9.37% of the control group had a positive test for the DNA of EBV in a real-time polymerase chain reaction (PCR), while the frequency of positive test result was zero in the case group (p = 0.0012). HBV DNA was not detected in both the case and control groups. The prevalence of CMV was 0.88 and zero in the control and case groups, respectively (p = 0.3410). For HHV6, 9.73 % of the control group had a positive result, while this test was positive in 5.88% of the patients with MS (p = 0.2959). CONCLUSION We detected a significantly higher number of individuals with DNA of EBV in their blood among the control group compared with the case group. In conclusion, the results suggest a surprisingly adverse association between MS and EBV, and no association was found between the presence of DNA of HBV, CMV, and HHV6 and MS.
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Affiliation(s)
- Mohsen Asouri
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.,North Research Center, Pasteur Institute of Iran, Amol, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center; Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Karimpoor
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Sadegh Fattahi
- North Research Center, Pasteur Institute of Iran, Amol, Iran
| | - Nima Motamed
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Rozita Doosti
- Multiple Sclerosis Research Center; Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokufeh Sadaghiani
- Multiple Sclerosis Research Center; Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Mahboudi
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Haleh Akhavan-Niaki
- Zoonoses Research Center, North Research Center, Pasteur Institute of Iran, Amol, Iran.,Department of Genetics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
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208
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de David CN, Deligne LDMC, da Silva RS, Malta DC, Duncan BB, Passos VMDA, Cousin E. The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study. Popul Health Metr 2020; 18:12. [PMID: 32993673 PMCID: PMC7526352 DOI: 10.1186/s12963-020-00205-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. METHODS We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. RESULTS The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. CONCLUSIONS Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.
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Affiliation(s)
- Caroline Nespolo de David
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600 Sala 414, Bairro Santa Cecilia, Porto Alegre, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rodolfo Souza da Silva
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600 Sala 414, Bairro Santa Cecilia, Porto Alegre, 90035-003, Brazil.,Telehealth Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600 Sala 414, Bairro Santa Cecilia, Porto Alegre, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Ewerton Cousin
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600 Sala 414, Bairro Santa Cecilia, Porto Alegre, 90035-003, Brazil.
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209
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McLeod M, Sandiford P, Kvizhinadze G, Bartholomew K, Crengle S. Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis. BMJ Open 2020; 10:e037145. [PMID: 32973060 PMCID: PMC7517554 DOI: 10.1136/bmjopen-2020-037145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55-74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years. DESIGN A Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets. SETTING New Zealand. PARTICIPANTS Population aged 55-74 years in 2011. INTERVENTIONS Biennial LDCT screening for lung cancer compared with usual care. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and 'health-adjusted life expectancy' (HALE) were measured. RESULTS LDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival. CONCLUSION A national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.
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Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Sandiford
- Waitemata District Health Board, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | | | | | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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210
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Chao TE. Beyond outcomes: applying cost-effectiveness analysis to policy making. Br J Anaesth 2020; 125:850-852. [PMID: 32948296 DOI: 10.1016/j.bja.2020.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Tiffany E Chao
- Santa Clara Valley Medical Center, San Jose, CA, USA; Stanford School of Medicine, Stanford, CA, USA.
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211
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Yebyo HG, Zappacosta S, Aschmann HE, Haile SR, Puhan MA. Global variation of risk thresholds for initiating statins for primary prevention of cardiovascular disease: a benefit-harm balance modelling study. BMC Cardiovasc Disord 2020; 20:418. [PMID: 32942999 PMCID: PMC7495829 DOI: 10.1186/s12872-020-01697-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background We previously showed that the 10-year cardiovascular disease (CVD) risk threshold to initiate statins for primary prevention depends on the baseline CVD risk, age, sex, and the incidence of statin-related harm outcome and competing risk for non-CVD death. As these factors appear to vary across countries, we aimed in this study to determine country-specific thresholds and provide guidelines a quantitative benefit-harm assessment method for local adaptation. Methods For each of the 186 countries included, we replicated the benefit-harm balance analysis using an exponential model to determine the thresholds to initiate statin use for populations aged 40 to 75 years, with no history of CVD. The analyses took data inputs from a priori studies, including statin effect estimates (network meta-analysis), patient preferences (survey), and baseline incidence of harm outcomes and competing risk for non-CVD (global burden of disease study). We estimated the risk thresholds above which the benefits of statins were more likely to outweigh the harms using a stochastic approach to account for statistical uncertainty of the input parameters. Results The 5th and 95th percentiles of the 10-year risk thresholds above which the benefits of statins outweigh the harms across 186 countries ranged between 14 and 20% in men and 19–24% in women, depending on age (i.e., 90% of the country-specific thresholds were in the ranges stated). The median risk thresholds varied from 14 to 18.5% in men and 19 to 22% in women. The between-country variability of the thresholds was slightly attenuated when further adjusted for age resulting, for example, in a 5th and 95th percentiles of 14–16% for ages 40–44 years and 17–21% for ages 70–74 years in men. Some countries, especially the islands of the Western Pacific Region, had higher thresholds to achieve net benefit of statins at 25–36% 10-year CVD risks. Conclusions This extensive benefit-harm analysis modeling shows that a single CVD risk threshold, irrespective of age, sex and country, is not appropriate to initiate statin use globally. Instead, countries need to carefully determine thresholds, considering the national or subnational contexts, to optimize benefits of statins while minimizing related harms and economic burden.
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Affiliation(s)
- Henock G Yebyo
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
| | - Sofia Zappacosta
- School of Public Health, Mekelle University, Ayder, Mekelle, Ethiopia.,Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians Universität, Marchioninistrasse 15, 81377, Munich, Germany
| | - Hélène E Aschmann
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Sarah R Haile
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
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Damerow SM, Weerasinghe M, Madsen LB, Hansen KS, Pearson M, Eddleston M, Konradsen F. Using ex-ante economic evaluation to inform research priorities in pesticide self-poisoning prevention: the case of a shop-based gatekeeper training programme in rural Sri Lanka. Trop Med Int Health 2020; 25:1205-1213. [PMID: 32687625 PMCID: PMC7589374 DOI: 10.1111/tmi.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
OBJECTIVES Suicide by pesticide self-poisoning is a major public health challenge in low- and middle-income countries. While effectiveness studies are required to test alternative prevention approaches, economic evidence is lacking to inform decision-making in research priority setting. Therefore, this study aimed to estimate the costs of a shop-based gatekeeper training programme for pesticide vendors seeking to prevent pesticide self-poisoning in rural Sri Lanka and assess its potential for cost-effectiveness. METHODS Ex-ante cost and cost-effectiveness threshold (CET) analyses were performed from a governmental perspective based on a three-year analytic horizon, using 'no programme' as a comparator. A programme model targeting all 535 pesticide shops in the North Central Province and border areas was applied. Total programme costs (TPC) were estimated in 2019 USD using an ingredients approach and 3% annual discounting. The Sri Lankan gross domestic product per capita and life years saved were used as CET and effectiveness measure, respectively. Sensitivity analyses were performed. RESULTS TPC were estimated at 31 603.03 USD. TPC were sensitive to cost changes of training material and equipment and the programme lifetime. The programme needs to prevent an estimated 0.23 fatal pesticide self-poisoning cases over three years to be considered cost-effective. In the sensitivity analyses, the highest number of fatal cases needed to be prevented to obtain cost-effectiveness was 4.55 over three years. CONCLUSIONS From an economic perspective, the programme has a very high potential to be cost-effective. Research assessing its effectiveness should therefore be completed, and research analysing its transferability to other settings prioritised.
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Affiliation(s)
- Sabine Margarete Damerow
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lizell Bustamante Madsen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Schultz Hansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Strauss GP, Pelletier-Baldelli A, Visser KF, Walker EF, Mittal VA. A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis. Schizophr Res 2020; 222:104-112. [PMID: 32522469 PMCID: PMC7572550 DOI: 10.1016/j.schres.2020.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Abstract
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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Affiliation(s)
- Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
| | | | | | | | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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214
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Gaitzsch H, Benard J, Hugon-Rodin J, Benzakour L, Streuli I. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 2020; 23:479-491. [PMID: 31897607 DOI: 10.1007/s00737-019-01009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.
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Affiliation(s)
- Hélène Gaitzsch
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Julie Benard
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | | | - Lamyae Benzakour
- Division for Liaison Psychiatry and Crisis Intervention, Department of Mental Health, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Isabelle Streuli
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
- Hélène Gaitzsch Medical Resident Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
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Scoriels L, Genaro LT, Mororó LG, Keffer S, Guimarães ALD, Ribeiro PV, Tannos FM, Novaes C, França AI, Goldenstein N, Sahakian BJ, Cavalcanti MT, Fisher M, Vinogradov S, Panizzutti R. Auditory versus visual neuroscience-informed cognitive training in schizophrenia: Effects on cognition, symptoms and quality of life. Schizophr Res 2020; 222:319-326. [PMID: 32448677 PMCID: PMC9703880 DOI: 10.1016/j.schres.2020.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive impairments are related to deficits in primary auditory and visual sensory processes in schizophrenia. These impairments can be remediated by neuroscience-informed computerized cognitive trainings that target auditory and visual processes. However, it is not clear which modality results in greater improvements in cognition, symptoms and quality of life. We aimed to investigate the impact of training auditory versus visual cognitive processes in global cognition in patients with schizophrenia. METHODS Seventy-nine schizophrenia participants were randomly assigned to either 40 h of auditory or visual computerized training. Auditory and visual exercises were chosen to be dynamically equivalent and difficulties increased progressively during the training. We evaluated cognition, symptoms and quality of life before, after 20 h, and after 40 h of training. ClinicalTrials.gov (1R03TW009002-01). RESULTS Participants who received the visual training showed significant improvements in global cognition compared to the auditory training group. The visual training significantly improved attention and reasoning and problem-solving, while the auditory training improved reasoning and problem-solving only. Schizophrenia symptoms improved after training in both groups, whereas quality of life remained unchanged. Interestingly, there was a significant and positive correlation between improvements in attention and symptoms in the visual training group. CONCLUSIONS We conclude that the visual training and the auditory training are differentially efficient at remediating cognitive deficits and symptoms of clinically stable schizophrenia patients. Ongoing follow-up of participants will evaluate the durability of training effects on cognition and symptoms, as well as the potential impact on quality of life over time.
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Affiliation(s)
- Linda Scoriels
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil,Department of Psychiatry, University of Cambridge, United Kingdom
| | - Larissa T. Genaro
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Luana G.C. Mororó
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Stella Keffer
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza D.V. Guimarães
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Paulo V.S. Ribeiro
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Filippe M. Tannos
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Caroline Novaes
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil,Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Aniela I. França
- Faculdade de Letras, Universidade Federal do Rio de Janeiro, Brazil
| | - Nelson Goldenstein
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | | | | | - Melissa Fisher
- Department of Psychiatry, University of Minnesota, United States
| | | | - Rogerio Panizzutti
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
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Kirigia JM, Muthuri RNDK. The discounted money value of human lives lost due to COVID-19 in Spain. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-04-2020-0116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeTo estimate the discounted money value of human lives lost (DMVHL) due to COVID-19 in Spain.Design/methodology/approachThe study employs the human capital approach to estimate the DMVHL (assuming Spain's life expectancy of 83 years and a 3% discount rate) of the 20,453 human lives lost in Spain from COVID-19 as of 19 April 2020. Sensitivity analysis was conducted alternately assuming (a) 5% and 10% discount rate; and (b) global life expectancy of 72 years, and the world's highest life expectancy of 87.1 years.FindingsThe 20,453 human lives lost due to COVID-19 had a total DMVHL of Int$ 9,629,234,112, and an average of Int$ 470,798 per human life lost. Alternate re-estimation of the economic model with a 5% and 10% discount rates led to 19.8% and 47.4% reductions in the DMVHL, respectively. Re-calculation of the economic model using the global life expectancy of 72 years, while holding the discount rate constant at 3%, diminished the DMVHL by 41%. While the re-run of the same model using the world's highest life expectancy of 87.1 years instead, it increased the DMVHL by 18%.Research limitations/implicationsThe study omits the value of health systems inputs used in preventing, diagnosing and treating COVID-19 cases; and the negative impact of COVID-19 on the agriculture, education, finance, manufacturing, travel, tourism, and trade sectors.Social implicationsThere is a need to use this kind of evidence to advocate for increased investments into the strengthening of the national health system, IHR capacities, and coverage of safe water and sanitation facilities.Originality/valueIn Spain, no other study had attempted to estimate the net present value of human lives lost from COVID-19.
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217
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Kim YE, Jo MW, Park H, Oh IH, Yoon SJ, Pyo J, Ock M. Updating Disability Weights for Measurement of Healthy Life Expectancy and Disability-adjusted Life Year in Korea. J Korean Med Sci 2020; 35:e219. [PMID: 32657086 PMCID: PMC7358061 DOI: 10.3346/jkms.2020.35.e219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The present study aimed to update the methodology to estimate cause-specific disability weight (DW) for the calculation of disability adjusted life year (DALY) and health-adjusted life expectancy (HALE) based on the opinion of medical professional experts. Furthermore, the study also aimed to compare and assess the size of DW according to two analytical methods and estimate the most valid DW from the perspective of years lost due to disability and HALE estimation. METHODS A self-administered web-based survey was conducted ranking five causes of disease. A total of 901 participants started the survey and response data of 806 participants were used in the analyses. In the process of rescaling predicted probability to DW on a scale from 0 to 1, two models were used for two groups: Group 1 (physicians and medical students) and Group 2 (nurses and oriental medical doctors). In Model 1, predicted probabilities were rescaled according to the normal distribution of DWs. In Model 2, the natural logarithms of predicted probabilities were rescaled according to the asymmetric distribution of DWs. RESULTS We estimated DWs for a total of 313 causes of disease in each model and group. The mean of DWs according to the models in each group was 0.490 (Model 1 in Group 1), 0.378 (Model 2 in Group 1), 0.506 (Model 1 in Group 2), and 0.459 (Model 2 in Group 2), respectively. About two-thirds of the causes of disease had DWs of 0.2 to 0.4 in Model 2 in Group 1. In Group 2, but not in Group 1, there were some cases where the DWs had a reversed order of severity. CONCLUSION We attempted to calculate DWs of 313 causes of disease based on the opinions of various types of medical professionals using the previous analysis methods as well as the revised analysis method. The DWs from this study can be used to accurately estimate DALY and health life expectancy, such as HALE, in the Korean population.
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Affiliation(s)
- Young Eun Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Min Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - In Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seok Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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218
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van Lier A, de Gier B, McDonald SA, Mangen MJJ, van Wijhe M, Sanders EAM, Kretzschmar ME, van Vliet H, de Melker HE. Disease burden of varicella versus other vaccine-preventable diseases before introduction of vaccination into the national immunisation programme in the Netherlands. ACTA ACUST UNITED AC 2020; 24. [PMID: 31064637 PMCID: PMC6505181 DOI: 10.2807/1560-7917.es.2019.24.18.1800363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction Estimating burden of disease (BoD) is an essential first step in the decision-making process on introducing new vaccines into national immunisation programmes (NIPs). For varicella, a common vaccine-preventable disease, BoD in the Netherlands was unknown. Aim To assess national varicella BoD and compare it to BoD of other vaccine-preventable diseases before their introduction in the NIP. Methods In this health estimates reporting study, BoD was expressed in disability-adjusted life years (DALYs) using methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project. As no parameters/disease model for varicella (including herpes zoster) were available in the BCoDE toolkit, incidence, disease progression model and parameters were derived from seroprevalence, healthcare registries and published data. For most other diseases, BoD was estimated with existing BCoDE-parameters, adapted to the Netherlands if needed. Results In 2017, the estimated BoD of varicella in the Netherlands was 1,800 (95% uncertainty interval (UI): 1,800–1,900) DALYs. Herpes zoster mainly contributed to this BoD (1,600 DALYs; 91%), which was generally lower than the BoD of most current NIP diseases in the year before their introduction into the NIP. However, BoD for varicella was higher than for rotavirus gastroenteritis (1,100; 95%UI: 440–2,200 DALYs) and meningococcal B disease (620; 95%UI: 490–770 DALYs), two other potential NIP candidates. Conclusions When considering the introduction of a new vaccine in the NIP, BoD is usually estimated in isolation. The current approach assesses BoD in relation to other vaccine-preventable diseases’ BoD, which may help national advisory committees on immunisation and policymakers to set vaccination priorities.
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Affiliation(s)
- Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marie-Josée J Mangen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Maarten van Wijhe
- Department of Science and Environment, Roskilde University, Roskilde, Denmark.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Elisabeth A M Sanders
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Hans van Vliet
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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219
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Spronk I, Haagsma JA, Edgar DW, van Baar ME, Polinder S, Wood FM. Comparison of three different methods to estimate the burden of disease of burn injuries in Western Australia in 2011-2018. Burns 2020; 46:1424-1431. [PMID: 32593481 DOI: 10.1016/j.burns.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Priority setting and resource allocation in health care, surveillance and interventions is based increasingly on burden of disease. Several methods exist to calculate the non-fatal burden of disease of burns expressed in years lived with disability (YLDs). The aim of this study was to assess the burden of disease due to burns in Western Australia 2011-2018 and compare YLD outcomes between three existing methods. METHODS Data from the Burns Service of Western Australia was used. Three existing methods to assess YLDs were compared: the Global Burden of Disease (GBD) method, a method dedicated to assess injury YLDs (Injury-VIBES), and a method dedicated to assess burns YLDs (INTEGRIS-burns). RESULTS Incidence data from 2,866 burn patients were used. Non-fatal burden of disease estimates differed substantially between the different methods. Estimates for 2011-2018 ranged between 610 and 1,085 YLDs per 100.000 based on the Injury-VIBES method; between 209 and 324 YLDs based on the INTEGRIS-burns method; and between 89 and 120 YLDs based on the GBD method. YLDs per case were three to nine times higher when the Injury-VIBES method was applied compared to the other methods. Also trends in time differed widely through application of the different methods. There was a strong increase in YLDs over the years when the Injury-VIBES method was applied, a slight increase when the INTEGRIS-burns method was applied and a stable pattern when the GBD method was applied. CONCLUSION This study showed that the choice for a specific method heavily influences the non-fatal burden of disease expressed in YLDs, both in terms of annual estimates as well as in trends over time. By addressing the methodological limitations evident in previously published calculations of the non-fatal burden of disease, the INTEGRIS-burns seems to present a method to provide the most robust estimates to date, as it is the only method adapted to the nature of burn injuries and their recovery.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Juanita A Haagsma
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame, Western Australia, Australia; Fiona Wood Foundation, Murdoch, Western Australia, Australia.
| | - Margriet E van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Murdoch, Western Australia, Australia
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Devine A, Howes RE, Price DJ, Moore KA, Ley B, Simpson JA, Dittrich S, Price RN. Cost-Effectiveness Analysis of Sex-Stratified Plasmodium vivax Treatment Strategies Using Available G6PD Diagnostics to Accelerate Access to Radical Cure. Am J Trop Med Hyg 2020; 103:394-403. [PMID: 32372747 PMCID: PMC7356471 DOI: 10.4269/ajtmh.19-0943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Tafenoquine has been licensed for the single-dose radical cure of Plasmodium vivax in adults; however, it is only recommended in patients with > 70% of normal glucose-6-phosphate dehydrogenase (G6PD) activity. Because this may hinder widespread use, we investigated sex-based treatment strategies in which all adult patients are tested with a qualitative G6PD rapid diagnostic test (RDT). Glucose-6-phosphate dehydrogenase normal males are prescribed tafenoquine in all three strategies, whereas G6PD normal females are prescribed either a low-dose 14-day primaquine regimen (PQ14, total dose 3.5 mg/kg) or a high-dose 7-day primaquine regimen (PQ7, total dose 7 mg/kg), or referred to a healthcare facility for quantitative G6PD testing before prescribing tafenoquine. Patients testing G6PD deficient are prescribed a weekly course of primaquine for 8 weeks. We compared the cost-effectiveness of these three strategies to usual care in four countries using a decision tree model. Usual care in Ethiopia does not include radical cure, whereas Afghanistan, Indonesia, and Vietnam prescribe PQ14 without G6PD screening. The cost per disability-adjusted life-year (DALY) averted was expressed through incremental cost-effectiveness ratios (ICERs). Compared with usual care, the ICERs for a sex-based treatment strategy with PQ7 for females from a healthcare provider perspective were $127 per DALY averted in Vietnam, $466 in Ethiopia, $1,089 in Afghanistan, and $4,443 in Indonesia. The PQ14 and referral options cost more while averting fewer DALYs than PQ7. This study provides an alternative cost-effective mode of rolling out tafenoquine in areas where initial testing with only a G6PD RDT is feasible.
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Affiliation(s)
- Angela Devine
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia;,Address correspondence to Angela Devine, Division of Global and Tropical Health, Menisci School of Health Research, Charles Darwin University, P. O. Box 41096, Casuarina NT 0811, Australia. E-mail:
| | - Rosalind E. Howes
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland;,Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David J. Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia;,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Kerryn A. Moore
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;,Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Benedikt Ley
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sabine Dittrich
- Malaria and Fever Programme, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N. Price
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Park B, Ock M, Jo MW, Lee HA, Lee EK, Park B, Park H. Health gap for multimorbidity: comparison of models combining uniconditional health gap. Qual Life Res 2020; 29:2475-2483. [DOI: 10.1007/s11136-020-02514-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
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Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P, Veerman L, Mantilla Herrera AM, Lal A, Peeters A, Carter R. Priority-setting for obesity prevention-The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One 2020; 15:e0234804. [PMID: 32559212 PMCID: PMC7304600 DOI: 10.1371/journal.pone.0234804] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Ana Maria Mantilla Herrera
- Queensland Centre for Mental Health Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Anita Lal
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
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Sarker AR, Sultana M. Cost-effective analysis of childhood malaria vaccination in endemic hotspots of Bangladesh. PLoS One 2020; 15:e0233902. [PMID: 32470101 PMCID: PMC7259743 DOI: 10.1371/journal.pone.0233902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/14/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Bangladesh has a history of endemic malaria transmission, with 17.5 million people at risk. The objective of this study was to assess the cost-effectiveness of universal childhood malaria vaccination in Chittagong Hill Tracts (CHT) of Bangladesh with newly developed RTS,S/AS01 malaria vaccines. METHODS A decision model was been developed using Microsoft® Excel to examine the potential impact of future vaccination in Bangladesh. We estimated the economic and health burden due to malaria and the cost-effectiveness of malaria vaccination from the health system and societal perspective. The primary outcomes include the incremental cost per Disability-Adjusted Life Year (DALY) averted, incremental cost per case averted, and the incremental cost per death averted. RESULTS Introducing childhood malaria vaccination in CHT in Bangladesh for a single birth cohort could prevent approximately 500 malaria cases and at least 30 deaths from malaria during the first year of vaccination. The cost per DALY averted of introducing the malaria vaccine compared to status quo is US$ 2,629 and US$ 2,583 from the health system and societal perspective, respectively. CONCLUSIONS Introduction of malaria vaccination in CHT region is estimated to be a cost-effective preventive intervention and would offer substantial future benefits particularly for young children vaccinated today. Policies should, thus, consider the operational advantages of targeting these populations, particularly in the CHT area, with the vaccine along with other malaria control initiatives.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Health and Social Development, Deakin University, Burwood, Melbourne, Australia
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The burden of disease in Saudi Arabia 1990-2017: results from the Global Burden of Disease Study 2017. Lancet Planet Health 2020; 4:e195-e208. [PMID: 32442495 PMCID: PMC7653403 DOI: 10.1016/s2542-5196(20)30075-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/02/2019] [Accepted: 03/17/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Availability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country. METHODS We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990-2010 (before the health-care investments and reform) and 2010-17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries. FINDINGS Age-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of -0·58%), and this decrease was further accelerated from 2010 to 2017 (-2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010-17 the decrease was not as low as in Saudi Arabia (-1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990-2010 and 2010-17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region. INTERPRETATION Decreases in mortality continued at greater rates in Saudi Arabia during the period of 2010-17 than in 1990-2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability. FUNDING Bill & Melinda Gates Foundation.
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Duarte HA, Babigumira JB, Enns EA, Stauffer DC, Shafer RW, Beck IA, Garrison LP, Chung MH, Frenkel LM, Bendavid E. Cost-effectiveness analysis of pre-ART HIV drug resistance testing in Kenyan women. EClinicalMedicine 2020; 22:100355. [PMID: 32490370 PMCID: PMC7256304 DOI: 10.1016/j.eclinm.2020.100355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of pre-treatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitor (NNRTI) agents is increasing in sub-Saharan Africa, which may decrease the effectiveness of efavirenz-based antiretroviral therapy (ART) programs. However, due to recent safety concerns, there has been hesitancy to replace efavirenz-based ART with dolutegravir in women of reproductive potential. Our objective was to evaluate whether PDR testing for women not initiating dolutegravir-based ART would be a cost-effective strategy to address the challenges posed by PDR. METHODS We developed an HIV drug resistance model that simulates the emergence and transmission of resistance mutations, calibrated to the Kenyan epidemic. We modeled three care strategies for PDR testing among women not initiating dolutegravir-based ART: no PDR testing, PDR testing with a low-cost point mutation assay, known as oligonucleotide ligation assay (OLA), and PDR testing with consensus sequencing. Using a health sector perspective, this model was used to evaluate the health outcomes, lifetime costs, and cost-effectiveness under each strategy over a 15-year time horizon starting in 2019. FINDINGS OLA and CS PDR testing were projected to have incremental cost-effectiveness ratios (ICER) of $10,741/QALY gained and $134,396/QALY gained, respectively, which are not cost-effective by national income standards. Viral suppression rates among women at 12 months after ART initiation were 87·8%, 89·0%, and 89·3% with no testing, OLA testing, and CS testing, respectively. PDR testing with OLA and CS were associated with a 0.5% and 0.6% reduction in incidence rate compared to no PDR testing. Initial PDR prevalence among women was 13.1% in 2019. By 2034, this prevalence was 17·6%, 17·4%, and 17·3% with no testing, OLA testing, and CS testing, respectively. INTERPRETATION PDR testing for women is unlikely to be cost-effective in Kenya whether one uses a low-cost assay, such as OLA, or consensus sequencing. FUNDING National Institutes of Health, Gilead Sciences.
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Affiliation(s)
- Horacio A Duarte
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Joseph B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Eva A Enns
- School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States
| | - David C Stauffer
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Robert W Shafer
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ingrid A Beck
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
| | | | - Lisa M Frenkel
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, United States
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Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer 2020; 144:99-106. [PMID: 32317183 DOI: 10.1016/j.lungcan.2020.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55-74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. METHODS We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Māori (indigenous population) versus non-Māori), age and smoking status. RESULTS AND CONCLUSION We estimated 0.067 QALYs gained (95 % uncertainty interval (UI) 0.044 to 0.095) per eligible participant, at a cost of US$2843 ($2067-3797; 2011 $US). The overall incremental cost effectiveness ratio (ICER) was US$44,000 per QALY gained (95 % UI US$27,000 to US$70,000). The ICER was substantially lower for Māori, at US$26,000 per QALY gained (95 % UI US$17,000 to US$39,000). The cost-effectiveness varied by socio-demographics, from US$21,000 for 70-74 year old Māori females to US$60,000 for 55-59 year old non-Māori males. The two scenarios that lowered the ICER the most were halving the screening costs (ICER = US$33,000 per QALY), and improving the sensitivity (from 93.8% to 98%) and specificity (from 73.4% to 95%) of the screening test (ICER = US$23,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for the proposed target population under our modelling assumptions. However, it is likely to be cost-effective for Māori, a population group which carries a disproportionately high disease burden from lung cancer.
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Antonucci LA, Pergola G, Pigoni A, Dwyer D, Kambeitz-Ilankovic L, Penzel N, Romano R, Gelao B, Torretta S, Rampino A, Trojano M, Caforio G, Falkai P, Blasi G, Koutsouleris N, Bertolino A. A Pattern of Cognitive Deficits Stratified for Genetic and Environmental Risk Reliably Classifies Patients With Schizophrenia From Healthy Control Subjects. Biol Psychiatry 2020; 87:697-707. [PMID: 31948640 DOI: 10.1016/j.biopsych.2019.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schizophrenia risk is associated with both genetic and environmental risk factors. Furthermore, cognitive abnormalities are established core characteristics of schizophrenia. We aim to assess whether a classification approach encompassing risk factors, cognition, and their associations can discriminate patients with schizophrenia (SCZs) from healthy control subjects (HCs). We hypothesized that cognition would demonstrate greater HC-SCZ classification accuracy and that combined gene-environment stratification would improve the discrimination performance of cognition. METHODS Genome-wide association study-based genetic, environmental, and neurocognitive classifiers were trained to separate 337 HCs from 103 SCZs using support vector classification and repeated nested cross-validation. We validated classifiers on independent datasets using within-diagnostic (SCZ) and cross-diagnostic (clinically isolated syndrome for multiple sclerosis, another condition with cognitive abnormalities) approaches. Then, we tested whether gene-environment multivariate stratification modulated the discrimination performance of the cognitive classifier in iterative subsamples. RESULTS The cognitive classifier discriminated SCZs from HCs with a balanced accuracy (BAC) of 88.7%, followed by environmental (BAC = 65.1%) and genetic (BAC = 55.5%) classifiers. Similar classification performance was measured in the within-diagnosis validation sample (HC-SCZ BACs, cognition = 70.5%; environment = 65.8%; genetics = 49.9%). The cognitive classifier was relatively specific to schizophrenia (HC-clinically isolated syndrome for multiple sclerosis BAC = 56.7%). Combined gene-environment stratification allowed cognitive features to classify HCs from SCZs with 89.4% BAC. CONCLUSIONS Consistent with cognitive deficits being core features of the phenotype of SCZs, our results suggest that cognitive features alone bear the greatest amount of information for classification of SCZs. Consistent with genes and environment being risk factors, gene-environment stratification modulates HC-SCZ classification performance of cognition, perhaps providing another target for refining early identification and intervention strategies.
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Affiliation(s)
- Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy.
| | - Giulio Pergola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland
| | - Alessandro Pigoni
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | | | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Raffaella Romano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Gelao
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Grazia Caforio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Giuseppe Blasi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy.
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Li X, Willem L, Antillon M, Bilcke J, Jit M, Beutels P. Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries. BMC Med 2020; 18:82. [PMID: 32248817 PMCID: PMC7132892 DOI: 10.1186/s12916-020-01537-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) frequently causes acute lower respiratory infection in children under 5, representing a high burden in Gavi-eligible countries (mostly low-income and lower-middle-income). Since multiple RSV interventions, including vaccines and monoclonal antibody (mAb) candidates, are under development, we aim to evaluate the key drivers of the cost-effectiveness of maternal vaccination and infant mAb for 72 Gavi countries. METHODS A static Multi-Country Model Application for RSV Cost-Effectiveness poLicy (MCMARCEL) was developed to follow RSV-related events monthly from birth until 5 years of age. MCMARCEL was parameterised using country- and age-specific demographic, epidemiological, and cost data. The interventions' level and duration of effectiveness were guided by the World Health Organization's preferred product characteristics and other literature. Maternal vaccination and mAb were assumed to require single-dose administration at prices assumed to align with other Gavi-subsidised technologies. The effectiveness and the prices of the interventions were simultaneously varied in extensive scenario analyses. Disability-adjusted life years (DALYs) were the primary health outcomes for cost-effectiveness, integrated with probabilistic sensitivity analyses and Expected Value of Partially Perfect Information analysis. RESULTS The RSV-associated disease burden among children in these 72 countries is estimated at an average of 20.8 million cases, 1.8 million hospital admissions, 40 thousand deaths, 1.2 million discounted DALYs, and US$611 million discounted direct costs. Strategy 'mAb' is more effective due to its assumed longer duration of protection versus maternal vaccination, but it was also assumed to be more expensive. Given all parameterised uncertainty, the optimal strategy of choice tends to change for increasing willingness to pay (WTP) values per DALY averted from the current situation to maternal vaccination (at WTP > US$1000) to mAB (at WTP > US$3500). The age-specific proportions of cases that are hospitalised and/or die cause most of the uncertainty in the choice of optimal strategy. Results are broadly similar across countries. CONCLUSIONS Both the maternal and mAb strategies need to be competitively priced to be judged as relatively cost-effective. Information on the level and duration of protection is crucial, but also more and better disease burden evidence-especially on RSV-attributable hospitalisation and death rates-is needed to support policy choices when novel RSV products become available.
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Affiliation(s)
- Xiao Li
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.
| | - Lander Willem
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Marina Antillon
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.,Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland.,University of Basel, Petersplatz 1, Basel, Switzerland
| | - Joke Bilcke
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
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Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ 2020; 368:m791. [PMID: 32217608 PMCID: PMC7249252 DOI: 10.1136/bmj.m791] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for neck pain in the general population of 195 countries. DESIGN Systematic analysis. DATA SOURCE Global Burden of Diseases, Injuries, and Risk Factors Study 2017. MAIN OUTCOME MEASURES Numbers and age standardised rates per 100 000 population of neck pain point prevalence, annual incidence, and years lived with disability were compared across regions and countries by age, sex, and sociodemographic index. Estimates were reported with uncertainty intervals. RESULTS Globally in 2017 the age standardised rates for point prevalence of neck pain per 100 000 population was 3551.1 (95% uncertainty interval 3139.5 to 3977.9), for incidence of neck pain per 100 000 population was 806.6 (713.7 to 912.5), and for years lived with disability from neck pain per 100 000 population was 352.0 (245.6 to 493.3). These estimates did not change significantly between 1990 and 2017. The global point prevalence of neck pain in 2017 was higher in females compared with males, although this was not significant at the 0.05 level. Prevalence increased with age up to 70-74 years and then decreased. Norway (6151.2 (95% uncertainty interval 5382.3 to 6959.8)), Finland (5750.3 (5058.4 to 6518.3)), and Denmark (5316 (4674 to 6030.1)) had the three highest age standardised point prevalence estimates in 2017. The largest increases in age standardised point prevalence estimates from 1990 to 2017 were in the United Kingdom (14.6% (10.6% to 18.8%)), Sweden (10.4% (6.0% to 15.4%)), and Kuwait (2.6% (2.0% to 3.2%)). In general, positive associations, but with fluctuations, were found between age standardised years lived with disability for neck pain and sociodemographic index at the global level and for all Global Burden of Disease regions, suggesting the burden is higher at higher sociodemographic indices. CONCLUSIONS Neck pain is a serious public health problem in the general population, with the highest burden in Norway, Finland, and Denmark. Increasing population awareness about risk factors and preventive strategies for neck pain is warranted to reduce the future burden of this condition.
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Affiliation(s)
- Saeid Safiri
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Damian Hoy
- Global Alliance for Musculoskeletal Health
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Deepti Bettampadi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ahad Ashrafi-Asgarabad
- Department of Epidemiology, School of Health, Bam University of Medical Sciences, Bam, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Emma Smith
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Marita Cross
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Anthony D Woolf
- Royal Cornwall Hospital and University of Exeter Medical School, Truro, UK
| | - Lyn March
- Global Alliance for Musculoskeletal Health
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gary Collins
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Mpobela Agnarson A, Williams A, Kambili C, Mattson G, Metz L. The cost-effectiveness of a bedaquiline-containing short-course regimen for the treatment of multidrug-resistant tuberculosis in South Africa. Expert Rev Anti Infect Ther 2020; 18:475-483. [PMID: 32186925 DOI: 10.1080/14787210.2020.1742109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Bedaquiline-containing regimens have demonstrated improved outcomes over injectable-containing regimens in the long-term treatment of multidrug-resistant tuberculosis (MDR-TB). Recently, the World Health Organization (WHO) recommended replacing injectables in the standard short-course regimen (SCR) with a bedaquiline-containing regimen. The South African national TB program similarly recommends a bedaquiline-containing regimen. Here, we investigated the cost-effectiveness of a bedaquiline-containing SCR versus an injectable-containing SCR for the treatment of MDR-TB in South Africa.Methods: A Markov model was adapted to simulate the incidence of active patients with MDR-TB. Patients could transition through eight health states: active MDR-TB, culture conversion, cure, follow-up loss, secondary MDR-TB, extensively DR-TB, end-of-life care, and death. A 5% discount was assumed on costs and outcomes. Health outcomes were expressed as disability-adjusted life years (DALYs).Results: Over a 10-year time horizon, a bedaquiline-containing SCR dominated an injectable-containing SCR, with an incremental saving of US $982 per DALY averted. A bedaquiline-containing SCR was associated with lower total costs versus an injectable-containing SCR (US $597 versus $657 million), of which US $3.2 versus $21.9 million was attributed to adverse event management.Conclusions: Replacing an injectable-containing SCR with a bedaquiline-containing SCR is cost-effective, offering a cost-saving alternative with improved patient outcomes for MDR-TB.
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Affiliation(s)
| | - Abeda Williams
- Janssen Pharmaceutical South Africa, Pharmaceutical Division of Johnson and Johnson, Johannesburg, South Africa
| | | | - Gunnar Mattson
- Johnson & Johnson Global Public Health, New Brunswick, NJ, USA
| | - Laurent Metz
- Johnson & Johnson Global Public Health, New Brunswick, NJ, USA
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The global, regional, and national burden of gastro-oesophageal reflux disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5:561-581. [PMID: 32178772 PMCID: PMC7232025 DOI: 10.1016/s2468-1253(19)30408-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
Background Gastro-oesophageal reflux disease is a common chronic ailment that causes uncomfortable symptoms and increases the risk of oesophageal adenocarcinoma. We aimed to report the burden of gastro-oesophageal reflux disease in 195 countries and territories between 1990 and 2017, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods We did a systematic review to identify measurements of the prevalence of gastro-oesophageal reflux disease in geographically defined populations worldwide between 1990 and 2017. These estimates were analysed with DisMod-MR, a Bayesian mixed-effects meta-regression tool that incorporates predictive covariates and adjustments for differences in study design in a geographical cascade of models. Fitted values for broader geographical units inform prior distributions for finer geographical units. Prevalence was estimated for 195 countries and territories. Reports of the frequency and severity of symptoms among individuals with gastro-oesophageal reflux disease were used to estimate the prevalence of cases with no, mild to moderate, or severe to very severe symptoms at a given time; these estimates were multiplied by disability weights to estimate years lived with disability (YLD). Findings Data to estimate gastro-oesophageal reflux disease burden were scant, totalling 144 location-years (unique measurements from a year and location, regardless of whether a study reported them alongside measurements for other locations or years) of prevalence data. These came from six (86%) of seven GBD super-regions, 11 (52%) of 21 GBD regions, and 39 (20%) of 195 countries and territories. Mean estimates of age-standardised prevalence for all locations in 2017 ranged from 4408 cases per 100 000 population to 14 035 cases per 100 000 population. Age-standardised prevalence was highest (>11 000 cases per 100 000 population) in the USA, Italy, Greece, New Zealand, and several countries in Latin America and the Caribbean, north Africa and the Middle East, and eastern Europe; it was lowest (<7000 cases per 100 000 population) in the high-income Asia Pacific, east Asia, Iceland, France, Denmark, and Switzerland. Global prevalence peaked at ages 75–79 years, at 18 820 (95% uncertainty interval [95% UI] 13 770–24 000) cases per 100 000 population. Global age-standardised prevalence was stable between 1990 and 2017 (8791 [95% UI 7772–9834] cases per 100 000 population in 1990 and 8819 [7781–9863] cases per 100 000 population in 2017, percentage change 0·3% [–0·3 to 0·9]), but all-age prevalence increased by 18·1% (15·6–20·4) between 1990 and 2017, from 7859 (6905–8851) cases per 100 000 population in 1990 to 9283 (8189–10 400) cases per 100 000 population in 2017. YLDs increased by 67·1% (95% UI 63·5–70·3) between 1990 and 2017, from 3·60 million (1·93–6·12) in 1990 to 6·01 million (3·22–10·19) in 2017. Interpretation Gastro-oesophageal reflux disease is common worldwide, although less so in much of eastern Asia. The stability of our global age-standardised prevalence estimates over time suggests that the epidemiology of the disease has not changed, but the estimates of all-age prevalence and YLDs, which increased between 1990 and 2017, suggest that the burden of gastro-oesophageal reflux disease is nonetheless increasing as a result of ageing and population growth. Funding Bill & Melinda Gates Foundation.
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Bernabe E, Marcenes W, Hernandez C, Bailey J, Abreu L, Alipour V, Amini S, Arabloo J, Arefi Z, Arora A, Ayanore M, Bärnighausen T, Bijani A, Cho D, Chu D, Crowe C, Demoz G, Demsie D, Dibaji Forooshani Z, Du M, El Tantawi M, Fischer F, Folayan M, Futran N, Geramo Y, Haj-Mirzaian A, Hariyani N, Hasanzadeh A, Hassanipour S, Hay S, Hole M, Hostiuc S, Ilic M, James S, Kalhor R, Kemmer L, Keramati M, Khader Y, Kisa S, Kisa A, Koyanagi A, Lalloo R, Le Nguyen Q, London S, Manohar N, Massenburg B, Mathur M, Meles H, Mestrovic T, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mokdad A, Morrison S, Nazari J, Nguyen T, Nguyen C, Nixon M, Olagunju T, Pakshir K, Pathak M, Rabiee N, Rafiei A, Ramezanzadeh K, Rios-Blancas M, Roro E, Sabour S, Samy A, Sawhney M, Schwendicke F, Shaahmadi F, Shaikh M, Stein C, Tovani-Palone M, Tran B, Unnikrishnan B, Vu G, Vukovic A, Warouw T, Zaidi Z, Zhang Z, Kassebaum N. Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res 2020; 99:362-373. [PMID: 32122215 PMCID: PMC7088322 DOI: 10.1177/0022034520908533] [Citation(s) in RCA: 577] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank’s classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.
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Affiliation(s)
| | - E. Bernabe
- E. Bernabe, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Bessemer Road, London, SE5 9RS, UK.
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European Union state of health from 1990 to 2017: time trends and its enlargements' effects. Int J Public Health 2020; 65:175-186. [PMID: 32067062 DOI: 10.1007/s00038-020-01335-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We aimed to study health status' time trends in the European Union (EU) during 1990-2017 and its enlargements' impact. METHODS Using estimates from the Global Burden of Disease 2017 study and calculating age-sex-standardized rates, we have described time trends and analysed the differences between EU groups regarding the state of health. Interrupted time-series analyses were also performed in order to assess the enlargement impact in the EU state of health. RESULTS All age-sex-standardized rates (mortality, years of life lost, years lived with disability and disability-adjusted life years) declined (annualized rates of change of - 1.7%, - 1.52%, - 0.06% and - 1.01%, respectively) between 1990 and 2017 (except between 2014 and 2015). For EU-28, life expectancy and healthy life expectancy increased 5.9 and 4.6 years, respectively. With the EU-25 and EU-27 enlargements, all age-sex-standardized rates and life expectancies worsened (with statistical significance). The EU-28 enlargement revealed the same tendency, contrasting with the EU-15 one. CONCLUSIONS Overall, the EU health status is improving, despite changes in its composition over the years. However, the average EU state of health declined with the 2004, 2007 and 2013 EU enlargements.
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Prieto-Patron A, V. Hutton Z, Fattore G, Sabatier M, Detzel P. Reducing the burden of iron deficiency anemia in Cote D'Ivoire through fortification. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:1. [PMID: 32033590 PMCID: PMC7006106 DOI: 10.1186/s41043-020-0209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is highly prevalent in the Cote d'Ivoire and has severe health and economic consequences. In this paper, we apply a health economic model to quantify the burden of IDA, and the contribution of nationwide mandatory iron fortification of wheat flour and voluntary iron fortification of condiments to the reduction of this burden. METHODS The analysis for the population from 6 months to 64 years builds on published reviews and publicly available datasets and is stratified by age-groups and socioeconomic strata using comparative risk assessment model. RESULTS Without the impact of these fortification strategies, the annual burden of IDA is estimated at 242,100 disability adjusted life years (DALYs) and 978.1 million USD. Wheat flour and condiment fortification contributed to a reduction of the IDA burden by approximately 5% each. CONCLUSION In places with high prevalence of malaria and other infectious diseases, such as the Côte D'Ivoire, food fortification as a nutritional intervention should be accompanied with infectious disease prevention and control. The findings of this study provide additional input for policy makers about the magnitude of the impact and can support the conception of future fortification strategies.
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Affiliation(s)
| | - Zsuzsa V. Hutton
- Nestlé Research Center, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Giovanni Fattore
- Department of Policy Analysis and Public Management, CERGAS – Centre for Research in Healthcare Management, Bocconi University, Milan, Italy
| | - Magalie Sabatier
- Nestlé Research Center, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Patrick Detzel
- Nestlé Research Center, Vers-chez-les-Blanc, Lausanne, Switzerland
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Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines. Lancet HIV 2020; 7:e193-e200. [PMID: 32035041 PMCID: PMC7167509 DOI: 10.1016/s2352-3018(19)30400-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
Background The integrase inhibitor dolutegravir is being considered in several countries in sub-Saharan Africa instead of efavirenz for people initiating antiretroviral therapy (ART) because of superior tolerability and a lower risk of resistance emergence. WHO requested updated modelling results for its 2019 Antiretroviral Guidelines update, which was restricted to the choice of dolutegravir or efavirenz in new ART initiators. In response to this request, we modelled the risks and benefits of alternative policies for initial first-line ART regimens. Methods We updated an existing individual-based model of HIV transmission and progression in adults to consider information on the risk of neural tube defects in women taking dolutegravir at time of conception, as well as the effects of dolutegravir on weight gain. The model accounted for drug resistance in determining viral suppression, with consequences for clinical outcomes and mother-to-child transmission. We sampled distributions of parameters to create various epidemic setting scenarios, which reflected the diversity of epidemic and programmatic situations in sub-Saharan Africa. For each setting scenario, we considered the situation in 2018 and compared ART initiation policies of an efavirenz-based regimen in women intending pregnancy, and a dolutegravir-based regimen in others, and a dolutegravir-based regimen, including in women intending pregnancy. We considered predicted outcomes over a 20-year period from 2019 to 2039, used a 3% discount rate, and a cost-effectiveness threshold of US$500 per disability-adjusted life-year (DALY) averted. Findings Considering updated information on risks and benefits, a policy of ART initiation with a dolutegravir-based regimen rather than an efavirenz-based regimen, including in women intending pregnancy, is predicted to bring population health benefits (10 990 DALYs averted per year) and to be cost-saving (by $2·9 million per year), leading to a reduction in the overall population burden of disease of 16 735 net DALYs per year for a country with an adult population size of 10 million. The policy involving ART initiation with a dolutegravir-based regimen in women intending pregnancy was cost-effective in 87% of our setting scenarios and this finding was robust in various sensitivity analyses, including around the potential negative effects of weight gain. Interpretation In the context of a range of modelled setting scenarios in sub-Saharan Africa, we found that a policy of ART initiation with a dolutegravir-based regimen, including in women intending pregnancy, was predicted to bring population health benefits and be cost-effective, supporting WHO's strong recommendation for dolutegravir as a preferred drug for ART initiators. Funding Bill & Melinda Gates Foundation.
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Baber U, Leisman DE, Cohen DJ, Gibson CM, Henry TD, Dangas G, Moliterno D, Kini A, Krucoff M, Colombo A, Chieffo A, Sartori S, Witzenbichler B, Steg PG, Pocock SJ, Mehran R. Tailoring Antiplatelet Therapy Intensity to Ischemic and Bleeding Risk. Circ Cardiovasc Qual Outcomes 2020; 12:e004945. [PMID: 30606052 DOI: 10.1161/circoutcomes.118.004945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Balancing ischemic and bleeding risk is an evolving framework. METHODS AND RESULTS Our objectives were to simulate changes in risks for adverse events and event-driven costs with use of ticagrelor or prasugrel versus clopidogrel according to varying levels of ischemic and bleeding risk. Using the validated PARIS risk functions, we estimated 1-year ischemic (myocardial infarction or stent thrombosis) and bleeding (Bleeding Academic Research Consortium types 3 or 5) event rates among PARIS study participants who underwent percutaneous coronary intervention with drug-eluting stent implantation for an acute coronary syndrome and were discharged with aspirin and clopidogrel (n=1497). Simulated changes in adverse events with ticagrelor or prasugrel were calculated by applying treatment effects from randomized trials for a 1-year time horizon. Event costs were estimated using National Inpatient Sample data. Net costs were calculated between antiplatelet therapy groups according to level of ischemic and bleeding risk. After weighting events for quality-of-life impact, we calculated event rates and costs for risk-tailored treatment versus clopidogrel under multiple drug pricing assumptions. One-year rates (per 1000 person-years) for ischemic events were 12.6, 24.1, and 66.1, respectively, among those at low (n=630), intermediate (n=536), and high (n=331) ischemic risk. Analogous bleeding rates were 11.0, 23.9, and 66.2, respectively, among low (n=728), intermediate (n=634), and high (n=135) bleeding risk patients. Mean per event costs were $22 174 (ischemic) and $12 203 (bleeding). When risks for ischemia matched or exceeded bleeding, simulated utility-weighted event rates favored ticagrelor/prasugrel, whereas clopidogrel reduced utility-weighted events when bleeding exceeded ischemic risk. One-year costs were sensitive to drug pricing assumptions, and risk-tailored treatment with either agent progressed from cost incurring to cost saving with increasing generic market share. CONCLUSIONS Tailoring antiplatelet therapy intensity to patient risk may improve health utility and could produce cost savings in the first year after percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00998127.
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Affiliation(s)
- Usman Baber
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
| | - Daniel E Leisman
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.)
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Timothy D Henry
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (T.D.H.)
| | - George Dangas
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
| | - David Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington KY (D.M.)
| | - Annapoorna Kini
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
| | - Mitchell Krucoff
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (M.K.)
| | - Antonio Colombo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)
| | - Alaide Chieffo
- Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)
| | - Samantha Sartori
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
| | | | | | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P.)
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)
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Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L, Liu Y, Liu J, Qi J, Ran S, Yang S, Zhou M. Burden of Cardiovascular Diseases in China, 1990-2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol 2020; 4:342-352. [PMID: 30865215 DOI: 10.1001/jamacardio.2019.0295] [Citation(s) in RCA: 368] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Cardiovascular disease (CVD) remains the top cause of death in China. To our knowledge, no consistent and comparable assessments of CVD burden have been produced at subnational levels, and little is understood about the spatial patterns and temporal trends of CVD in China. Objective To determine the national and province-level burden of CVD from 1990 to 2016 in China. Design, Setting, and Participants Following the methodology framework and analytical strategies used in the 2016 Global Burden of Disease study, the mortality, prevalence, and disability-adjusted life-years (DALYs) of CVD in the Chinese population were examined by age, sex, and year and according to 10 subcategories. Estimates were produced for all province-level administrative units of mainland China, Hong Kong, and Macao. Exposures Residence in China. Main Outcomes and Measures Mortality, prevalence, and DALYs of CVD. Results The annual number of deaths owing to CVD increased from 2.51 million to 3.97 million between 1990 and 2016; the age-standardized mortality rate fell by 28.7%, from 431.6 per 100 000 persons in 1990 to 307.9 per 100 000 in 2016. Prevalent cases of CVD doubled since 1990, reaching nearly 94 million in 2016. The age-standardized prevalence rate of CVD overall increased significantly from 1990 to 2016 by 14.7%, as did rates for ischemic heart disease (19.1%), ischemic stroke (36.6%), cardiomyopathy and myocarditis (23.1%), and endocarditis (26.7%). Substantial reduction in the CVD burden, as measured by age-standardized DALY rate, was observed from 1990 to 2016 nationally, with a greater reduction in women (43.7%) than men (24.7%). There were marked differences in the spatial patterns of mortality, prevalence, and DALYs of CVD overall as well as its main subcategories, including ischemic heart disease, hemorrhagic stroke, and ischemic stroke. The CVD burden appeared to be lower in coastal provinces with higher economic development. The between-province gap in relative burden of CVD increased from 1990 to 2016, with faster decline in economically developed provinces. Conclusions and Relevance Substantial discrepancies in the total CVD burden and burdens of CVD subcategories have persisted between provinces in China despite a relative decrease in the CVD burden. Geographically targeted considerations are needed to tailor future strategies to enhance CVD health throughout China and in specific provinces.
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Xinying Zeng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haidong Wang
- Institute of Health Metrics and Evaluation, University of Washington, Seattle
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sha Ran
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Youyang County Center for Disease Control and Prevention, Chongqing, China
| | - Shiya Yang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Dianjiang County Center for Disease Control and Prevention, Chongqing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Gad M, Lord J, Chalkidou K, Asare B, Lutterodt MG, Ruiz F. Supporting the Development of Evidence-Informed Policy Options: An Economic Evaluation of Hypertension Management in Ghana. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:171-179. [PMID: 32113622 PMCID: PMC7065042 DOI: 10.1016/j.jval.2019.09.2749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Universal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study. METHODS Based on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme. RESULTS The evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 ($179 in 2017, 4% of gross national income per capita) compared with no treatment. Calcium channel blockers were more effective than diuretics but at a higher incremental cost: GH¢ 11 061 per disability-adjusted life-year avoided ($7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health. CONCLUSIONS Economic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets.
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Affiliation(s)
- Mohamed Gad
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK.
| | - Johanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, England, UK
| | - Kalipso Chalkidou
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK
| | - Brian Asare
- Ghana National Drugs Programme, Ministry of Health, Accra, Ghana
| | | | - Francis Ruiz
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK
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Vigo D, Jones L, Thornicroft G, Atun R. Burden of Mental, Neurological, Substance Use Disorders and Self-Harm in North America: A Comparative Epidemiology of Canada, Mexico, and the United States. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:87-98. [PMID: 31747307 PMCID: PMC6997975 DOI: 10.1177/0706743719890169] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the burden of mental, neurological, substance use disorders and self-harm (MNSS) in Canada, Mexico, and the United States. METHOD We extracted 2017 data from the Global Burden of Disease online database. Based on a previously developed framework to classify and aggregate the burden of specific disorders and symptoms, we reestimated the MNSS burden to include suicide, alcohol use, drug use, specific neurological, and painful somatic symptom disorders. We analyzed age-sex-specific patterns within and between countries. RESULTS The MNSS burden is the largest of all disorder groupings. It is lowest in Mexico, intermediate in Canada, and highest in the United States. Exceptions are alcohol use, bipolar, conduct disorders, and epilepsy, which are highest in Mexico; and painful somatic syndromes and headaches, which are highest in Canada. The burden of drug use disorders in the United States is twice the burden in Canada, and 7 times the burden in Mexico. MNSS become the most burdensome of all disorder groups by age 10, staying at the top until age 60, and show a distinct pattern across the lifetime. The top three MNSS disorders for men are a combination of substance use disorders and self-harm (United States), with the addition of painful somatic syndromes (Canada), and headaches (Mexico). For women, the top three are headaches and depression (all countries), drug use (United States), neurocognitive disorders (Mexico), and painful somatic syndromes (Canada). CONCLUSION MNSS are the most burdensome disease grouping and should be prioritized for funding in Canada, Mexico, and the United States.
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Affiliation(s)
- Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver,
Canada
- Department of Global Health & Social Medicine, Harvard Medical School,
Harvard University, Boston, MA, USA
| | - Laura Jones
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King’s College,
London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of
Public Health, Harvard University, Boston, MA, USA
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Abstract
In clinical glaucoma research, the measurement of patient reported outcomes, functional assessment of disability, and health economic impact is critical. However, valid, time-efficient and comprehensive tools are not available and several current instruments lack in the appropriate precision for measuring the various dimensions of glaucoma-related quality of life (QoL), including functioning and mobility. Furthermore, statistical methods are inconsistently and sometimes incorrectly used in otherwise sound clinical studies. Standardizing and improving methods of patient-centered data collection and analysis in glaucoma studies are imperative. This paper outlines recommendations and provides a discussion of some of the pertinent issues relating to the optimization of patient-reported outcomes research in glaucoma.
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241
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Yakhelef N, Audibert M, Ferlazzo G, Sitienei J, Wanjala S, Varaine F, Bonnet M, Huerga H. Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis. PLoS One 2020; 15:e0227138. [PMID: 31999746 PMCID: PMC6992347 DOI: 10.1371/journal.pone.0227138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death among HIV-positive patients. We assessed the cost-effectiveness of including lateral-flow urine lipoarabinomannan (LF-LAM) in TB diagnostic algorithms for severely ill or immunosuppressed HIV-positive patients with symptoms of TB in Kenya. METHODS From a decision-analysis tree, ten diagnostic algorithms were elaborated and compared. All algorithms included clinical exam. The costs of each algorithm were calculated using a 'micro-costing' method. The efficacy was estimated through a prospective study that included severely ill or immunosuppressed (CD4<200cells/μL) HIV-positive adults with symptoms of TB. The cost-effectiveness analysis was performed using the disability-adjusted life year (DALY) averted as effectiveness outcome. A 4% discount rate was applied. RESULTS The algorithm that added LF-LAM alone to the clinical exam lead to the least average cost per TB case detected (€47) and was the most cost-effective with a cost/DALY averted of €4.6. The algorithms including LF-LAM, microscopy and X-ray, and LF-LAM and Xpert in sputum, detected a high number of TB cases with a cost/DALY averted of €6.1 for each of them. In the comparisons of the algorithms two by two, using LF-LAM instead of microscopy (clinic&LAM vs clinicµscopy) and using LF-LAM along with GeneXpert in sputum instead of GeneXpert in urine along with GeneXpert in sputum, (clinic&LAM&Xpert_sputum vs clinic&Xpert_sputum&Xpert_urine) led to the highest increase in the cost-effectiveness ratios (ICERs): €-7.2 and €-12.6 respectively. In these two comparisons, using LF-LAM increased the number of TB patients detected while reducing costs. Adding LF-LAM to smear microscopy alone or to smear microscopy and Xray led to the highest increase in the additional number of TB cases detected (31 and 25 respectively) with an incremental efficiency estimated at 134 and 344 DALYs respectively. The ICERs were €22.0 and €8.6 respectively. CONCLUSION Including LF-LAM in TB diagnostic algorithms is cost-effective for severely ill or immunosuppressed HIV-positive patients.
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Affiliation(s)
| | - Martine Audibert
- Université Clermont Auvergne, CNRS, CERDI, Clermont-Ferrand, France
| | | | - Joseph Sitienei
- Division of National Strategic Health Programs, Ministry of Health, Nairobi, Kenya
- Médecins Sans Frontières, Nairobi, Kenya
| | - Steve Wanjala
- IRD UMI 233 TransVIHMI—UM–INSERM U1175, Montpellier, France
| | | | - Maryline Bonnet
- Epicentre, Paris, France
- IRD UMI 233 TransVIHMI—UM–INSERM U1175, Montpellier, France
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242
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Peng H, Yue L, Gao H, Zheng R, Liang P, Wang A, He A. Risk Assessment of Deep Venous Thrombosis and Its Influencing Factors in Burn Patients. J Burn Care Res 2020; 41:113-120. [PMID: 31600384 DOI: 10.1093/jbcr/irz121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study is to explore the relevant risk factors of deep venous thrombosis (DVT) in burn patients. A retrospective analysis was conducted for the medical records of 845 hospitalized burn patients from September 2012 to August 2017. Caprini thrombosis risk assessment scale (CTRAS) was employed for evaluating the risks of DVT. Based upon whether or not DVT occurred, they were divided into non-DVT group (n = 830) and DVT group (n = 15). Among 360 (42.7%) patients with high-risk Caprini scores, only 30 patients received color Doppler examination of lower limb veins, and 15 patients were diagnosed as DVT with a diagnostic rate of 1.8%. Caprini scores of non-DVT and DVT groups were 4.30 ± 2.71 and 9.87 ± 1.46 points, respectively. There was statistically significant difference (P < .05). As revealed by stepwise Logistic regression analysis, age, lower limb burn, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) were independent risk factors for DVT. Burn patients are particularly prone to develop DVT. Age, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) are risk factors. Aggressive preventive measures of DVT should be implemented.
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Affiliation(s)
- Huan Peng
- Department of Burn and Reconstruction of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Liqing Yue
- Nursing Department of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Hongmei Gao
- Nursing Department of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Ruolan Zheng
- Department of Burn and Reconstruction of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Penghui Liang
- Department of Burn and Reconstruction of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Ang Wang
- Department of Burn and Reconstruction of Xiangya Hospital, Central South University, Changsha City, Hunan, China
| | - Ailan He
- Nursing Department of Xiangya Hospital, Central South University, Changsha City, Hunan, China
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Spronk I, Edgar DW, van Baar ME, Wood FM, Van Loey NEE, Middelkoop E, Renneberg B, Öster C, Orwelius L, Moi AL, Nieuwenhuis M, van der Vlies CH, Polinder S, Haagsma JA. Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands. BMC Public Health 2020; 20:121. [PMID: 31996206 PMCID: PMC6988230 DOI: 10.1186/s12889-020-8233-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. Methods Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD). Results The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands. Conclusions This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands. .,Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Burn Injury Research Node, The University of Notre Dame, Fremantle, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Margriet E van Baar
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands.,Department Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Esther Middelkoop
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lotti Orwelius
- Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Mwesiga EK, Nakasujja N, Nakku J, Nanyonga A, Gumikiriza JL, Bangirana P, Akena D, Musisi S. One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda. PLoS One 2020; 15:e0218843. [PMID: 31995567 PMCID: PMC6988969 DOI: 10.1371/journal.pone.0218843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Hospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs. Objective We aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda. Methods A retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients. Results In 2018, 63% (95% CI: 60.2–65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24–36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients’ residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46–1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10–1.42)]. Conclusion Among first treatment contact patients in Uganda, there is a large burden of psychotic disorders. The burden was more prevalent among females as well as people of Pentecostal faith who seemed to use their church for faith-based healing. Incidence studies are warranted to determine if this phenomenon is replicated at illness onset.
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Affiliation(s)
- Emmanuel Kiiza Mwesiga
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Juliet Nakku
- National Psychiatric Teaching and Referral Hospital of Uganda, Kampala, Uganda
| | - Annet Nanyonga
- National Psychiatric Teaching and Referral Hospital of Uganda, Kampala, Uganda
| | - Joy Louise Gumikiriza
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Dickens Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Mulago, Uganda
- NURTURE Mental Health subgroup, College of Health Sciences, Makerere University, Mulago, Uganda
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245
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Greenhalgh S, Chandwani V. Advocating an attack against severe malaria: a cost-effectiveness analysis. BMC Public Health 2020; 20:17. [PMID: 31910842 PMCID: PMC6947859 DOI: 10.1186/s12889-019-8141-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/30/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. METHODS Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. RESULTS Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. CONCLUSION Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.
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Affiliation(s)
- Scott Greenhalgh
- Department of Mathematics, Siena College, 515 Loudon Road, Loudonville, NY, 12211, USA.
| | - Veda Chandwani
- Department of Biology, Siena College, 515 Loudon Road, Loudonville, NY, 12211, USA
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Drew J, Cleghorn C, Macmillan A, Mizdrak A. Healthy and Climate-Friendly Eating Patterns in the New Zealand Context. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:17007. [PMID: 31967488 PMCID: PMC7015541 DOI: 10.1289/ehp5996] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The global food system is driving both the climate crisis and the growing burden of noncommunicable disease. International research has highlighted the climate and health co-benefit opportunity inherent in widespread uptake of plant-based diets. Nevertheless, uncertainty remains as to what constitutes healthy and climate-friendly eating patterns in specific world regions. OBJECTIVES Using New Zealand as a case study, this research investigates the extent to which potential contextual differences may affect the local applicability of international trends. It further examines the potential for demand-end avenues to support a transition toward a healthier, more climate-friendly food system in New Zealand. METHODS A New Zealand-specific life-cycle assessment (LCA) database was developed by modifying cradle to point-of-sale reference emissions estimates according to the New Zealand context. This food emissions database, together with a New Zealand-specific multistate life-table model, was then used to estimate climate, health, and health system cost impacts associated with shifting current consumption to align with dietary scenarios that conform to the New Zealand dietary guidelines (NZDGs). RESULTS Whole plant foods, including vegetables, fruits, legumes, and whole grains were substantially less climate-polluting (1.2-1.8 kgCO2e/kg) than animal-based foods, particularly red and processed meats (12-21 kgCO2e/kg). Shifting population-level consumption to align with the NZDGs would confer diet-related emissions savings of 4-42%, depending on the degree of dietary change and food waste minimization pursued. NZDG-abiding dietary scenarios, when modeled out over the lifetime of the current New Zealand population, would also confer large health gains (1.0-1.5 million quality-adjusted life-years) and health care system cost savings (NZ$14-20 billion). DISCUSSION Guideline-abiding dietary scenarios, particularly those that prioritize plant-based foods, have the potential to confer substantial climate and health gains. This research shows that major contextual differences specific to New Zealand's food system do not appear to cause notable deviation from global trends, reinforcing recent international research. https://doi.org/10.1289/EHP5996.
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Affiliation(s)
- Jonathan Drew
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Cristina Cleghorn
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Alexandra Macmillan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
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Berkelmans GFN, Greving JP, van der Graaf Y, Visseren FLJ, Dorresteijn JAN. Would treatment decisions about secondary prevention of CVD based on estimated lifetime benefit rather than 10-year risk reduction be cost-effective? Diagn Progn Res 2020; 4:4. [PMID: 32318625 PMCID: PMC7161238 DOI: 10.1186/s41512-020-00072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/13/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To test the hypothesis that treatment decisions (treatment with a PCSK9-mAb versus no treatment) are both more effective and more cost-effective when based on estimated lifetime benefit than when based on estimated risk reduction over 10 years. METHODS A microsimulation model was constructed for 10,000 patients with stable cardiovascular disease (CVD). Costs and quality-adjusted life years (QALYs) due to recurrent cardiovascular events and (non)vascular death were estimated for lifetime benefit-based compared to 10-year risk-based treatment, with PCSK9 inhibition as an illustration example. Lifetime benefit in months gained and 10-year absolute risk reduction were estimated using the SMART-REACH model, including an individualized treatment effect of PCSK9 inhibitors based on baseline low-density lipoprotein cholesterol. For the different numbers of patients treated (i.e. the 5%, 10%, and 20% of patients with the highest estimated benefit of both strategies), cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), indicating additional costs per QALY gain. RESULTS Lifetime benefit-based treatment of 5%, 10%, and 20% of patients with the highest estimated benefit resulted in an ICER of €36,440/QALY, €39,650/QALY, or €41,426/QALY. Ten-year risk-based treatment decisions of 5%, 10%, and 20% of patients with the highest estimated risk reduction resulted in an ICER of €48,187/QALY, €53,368/QALY, or €52,390/QALY. CONCLUSION Treatment decisions (treatment with a PCSK9-mAb versus no treatment) are both more effective and more cost-effective when based on estimated lifetime benefit than when based on estimated risk reduction over 10 years.
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Affiliation(s)
- Gijs F. N. Berkelmans
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jacoba P. Greving
- grid.7692.a0000000090126352Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- grid.7692.a0000000090126352Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L. J. Visseren
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jannick A. N. Dorresteijn
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
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Hong W, Zhao Z, Shen Z, Sun B, Li S, Mekbib DB, Xu Y, Huang M, Xu D. Uncoupled relationship in the brain between regional homogeneity and attention function in first-episode, drug-naïve schizophrenia. Psychiatry Res Neuroimaging 2019; 294:110990. [PMID: 31706152 DOI: 10.1016/j.pscychresns.2019.110990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023]
Abstract
The relationship between the cognitive impairment and the structural and functional abnormalities in the brains of patients with schizophrenia (SZ) is not yet clear. This study aims to investigate the relationship, thereby exploring the neuromechanism underlying SZ. We collected multimodal MRI data from 68 first-episode, drug-naïve patients with SZ, and 64 well-matched healthy controls, and used regional homogeneity (ReHo) and gray matter volume (GMV) to assess the functional and structural integrity of the brains, respectively. We then evaluated in the entire brain the correlations between ReHo/GMV and the participants' neuropsychological assessment scores for each group using a partial correlation analysis controlling for age and sex. We found significant uncoupling between attention performance and mean ReHo in the left middle frontal gyrus, right superior/inferior parietal lobe (IPL), right angular gyrus (AG) and right middle/inferior temporal lobe (ITG) in SZ compared with healthy controls. Moreover, we found that the SZ group showed decreased GMV in the right IPL and AG, and a significant coupling between ReHo and GMV in the right ITG. Our findings suggest that the attention dysfunction found in SZ may be associated with the structural and functional abnormalities as well as the structure-function interrelation in several SZ-related brain regions.
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Affiliation(s)
- Wenjun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhiyong Zhao
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai 200062, China; Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China; Columbia University & New York State Psychiatric Institute, New York 10032, USA
| | - Zhe Shen
- College of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Bin Sun
- College of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Shangda Li
- College of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Destaw B Mekbib
- Zhejiang University Interdisciplinary Institute of Neuroscience and Technology, Hangzhou 310003, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China.
| | - Dongrong Xu
- Columbia University & New York State Psychiatric Institute, New York 10032, USA.
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Upscaling prevention, testing and treatment to control hepatitis C as a public health threat in Dar es Salaam, Tanzania: A cost-effectiveness model. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 88:102634. [PMID: 31882272 DOI: 10.1016/j.drugpo.2019.102634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/21/2019] [Accepted: 12/11/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hepatitis C (HCV) elimination strategies are required for low and middle-income countries (LMICs), because although treatment access is currently limited, this is unlikely to remain the case forever. We estimate and compare the impact, cost and cost-effectiveness of a variety of prevent, test and treat strategies for HCV in Dar es Salaam, Tanzania. METHODS A mathematical model. RESULTS Without intervention, the HCV epidemic in Dar es Salaam was estimated to result in US$29.1 million in disease costs between 2018 and 2030. Maintaining existing harm reduction coverage (4% needle and syringe program, 42% opioid substitution therapy) over this period was estimated to prevent 22% of injecting drug use-acquired HCV infections compared to a zero coverage scenario. Implementing antibody/RNA, serum-based HCV core antigen (HCVcAg) and dry blood spot (DBS) HCVcAg test/treat programs among PWID increased the total cost by US$0.7 million, US$3.1 million and US$6.5 million respectively by 2030; however this expenditure led to 57%, 61% and 73% reductions in annual incidence among PWID, 25%, 27% and 33% reductions overall annual incidence (PWID+non-PWID), and reduced HCV prevalence among PWID from 27% to 9%, 8% and 5%, respectively. The Ab/RNA, serum-based and DBS HCVcAg test/treat programs cost US$689, US$2857 and US$5400 per disability-adjusted life year averted, respectively, compared to no test/treat program. CONCLUSION Primary prevention among PWID can provide important reductions in HCV transmission in the absence of treatment availability. HCV Ab/RNA or serum-based HCVcAg test/treat programs among PWID are likely to be cost-effective in Dar es Salaam, with serum-based HCVcAg test/treat achieving greater impact due to a simpler diagnostic process and better retention in care. If used for regular testing of PWID, the additional coverage benefits of non-laboratory-based DBS HCVcAg tests in LMICs would outweigh their reduced sensitivity.
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