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Bardach A, Ruvinsky S, Moreno C, Perelli L, Kyaw MH, Spinardi J, Mendoza CF, Carballo CM, Roel M, Espinola N. Pediatric COVID-19 in Argentina: a comprehensive analysis of disease and economic burden through official data and a systematic literature review. Front Pediatr 2024; 12:1352260. [PMID: 38606369 PMCID: PMC11007211 DOI: 10.3389/fped.2024.1352260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Background Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents. Methods We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0-18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023. Results A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%-28% of cases were asymptomatic, 68%-88% were mild or moderate, and 3%-10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC. Conclusion Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.
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Affiliation(s)
- Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS). CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
- Research Department, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carolina Moreno
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas Perelli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Moe H. Kyaw
- Vaccine Scientific Affairs, Pfizer Inc., New York, NY, United States
| | - Julia Spinardi
- Vaccine Medical Affairs, Emerging Markets, Pfizer Inc., Itapevi, Brazil
| | | | | | - Macarena Roel
- Research Department, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia Espinola
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
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Buekens P, Berrueta M, Ciapponi A, Bardach A, Mazzoni A, Rodriguez-Cairoli F, Gottlieb SL, Kampmann B, Parker EPK, Xiong X, Zaraa S, Stergachis A. Safe in pregnancy: A global living systematic review and meta-analysis of COVID-19 vaccines in pregnancy. Vaccine 2024; 42:1414-1416. [PMID: 38341289 DOI: 10.1016/j.vaccine.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Center for Research in Epidemiology and Public Health, CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina; Center for Research in Epidemiology and Public Health, CONICET, Buenos Aires, Argentina
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Sami L Gottlieb
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Beate Kampmann
- Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Charite Centre for Global Health, Charité Universitätsmedizin, Berlin, Germany
| | - Edward P K Parker
- Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Xu Xiong
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sabra Zaraa
- Comparative Health Outcomes, Policy, Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Andy Stergachis
- Comparative Health Outcomes, Policy, Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
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Alcaraz A, Lazo E, Casarini A, Rodriguez-Cairoli F, Augustovski F, Bardach A, Perelli L, Palacios A, Pichon-Riviere A, Espinola N. Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America. Front Public Health 2024; 11:1321319. [PMID: 38414564 PMCID: PMC10898166 DOI: 10.3389/fpubh.2023.1321319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. Methods We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model. Results In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico. Discussion Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Elena Lazo
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Casarini
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Sandoval MM, Ruvinsky S, Palermo MC, Alconada T, Brizuela ME, Wierzbicki ER, Cantos J, Bardach A, Ciapponi A, Gagetti P. Antimicrobial resistance of Streptococcus pneumoniae from invasive pneumococcal diseases in Latin American countries: a systematic review and meta-analysis. Front Public Health 2024; 12:1337276. [PMID: 38317800 PMCID: PMC10839967 DOI: 10.3389/fpubh.2024.1337276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Background Invasive pneumococcal disease has declined since pneumococcal conjugate vaccine introduction in Latin America and the Caribbean (LAC). However, serotype distribution and antimicrobial resistance patterns have changed. Methods We conducted a systematic review to evaluate the frequency of antimicrobial resistance of Streptococcus pneumoniae from invasive disease in LAC. Articles published between 1 January 2000, and 27 December 2022, with no language restriction, were searched in major databases and gray literature. Pairs of reviewers independently selected extracted data and assessed the risk of bias in the studies. The quality of antimicrobial resistance (AMR) studies was evaluated according to WHO recommendations (PROSPERO CRD42023392097). Results From 8,600 records identified, 103 studies were included, with 49,660 positive samples of S. pneumoniae for AMR analysis processed. Most studies were from Brazil (29.1%) and Argentina (18.4%), were cross-sectional (57.3%), reported data on AMR from IPD cases (52.4%), and were classified as moderate risk of bias (50.5%). Resistance to penicillin was 21.7% (95%IC 18.7-25.0, I2: 95.9), and for ceftriaxone/cefotaxime it was 4.7% (95%IC 3.2-6.9, I2: 96.1). The highest resistance for both penicillin and ceftriaxone/cefotaxime was in the age group of 0 to 5 years (32.1% [95%IC 28.2-36.4, I2: 87.7], and 9.7% [95%IC 5.9-15.6, I2: 96.9] respectively). The most frequent serotypes associated with resistance were 14 for penicillin and 19A for ceftriaxone/cefotaxime. Conclusion Approximately one-quarter of invasive pneumococcal disease isolates in Latin America and the Caribbean displayed penicillin resistance, with higher rates in young children. Ongoing surveillance is essential to monitor serotype evolution and antimicrobial resistance patterns following pneumococcal conjugate vaccine introduction.
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Affiliation(s)
| | - Silvina Ruvinsky
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Coordinación de Investigación, Hospital de Pediatría “Dr. Juan P. Garrahan”, Buenos Aires, Argentina
| | | | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Martín Eduardo Brizuela
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Unidad de Pediatría, Hospital General de Agudos Vélez Sarsfield, Buenos Aires, Argentina
| | | | - Joaquín Cantos
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Paula Gagetti
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Servicio Antimicrobianos, National Reference Laboratory (NRL), Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
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Palacios A, Espinola N, Gonzalez JM, Rojas-Roque C, Rivas MM, Kanevski D, Morisset P, Augustovski F, Pichon-Riviere A, Bardach A. Budget impact analysis of venetoclax for the management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina. PLoS One 2024; 19:e0295798. [PMID: 38175833 PMCID: PMC10766175 DOI: 10.1371/journal.pone.0295798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina. METHODS A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos). RESULTS For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and $0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results. CONCLUSION The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, United Kingdom
| | - Natalia Espinola
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Juan Martin Gonzalez
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, United Kingdom
| | | | | | | | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Cuello JF, Bardach A, Gromadzyn G, Ruiz Johnson A, Comandé D, Aguirre E, Ruvinsky S. Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review. Neurosurg Rev 2023; 47:24. [PMID: 38159156 DOI: 10.1007/s10143-023-02263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/16/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.
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Affiliation(s)
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Guido Gromadzyn
- Neurosurgery Department, Hospital Garrahan, Buenos Aires, Argentina
| | | | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Emilio Aguirre
- Neurosurgery Department, Hospital Cordero, San Fernando, Argentina
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Perelli L, Alcaraz A, Vianna CMDM, Espinola N, Cairoli FR, Bardach A, Palacios A, Balan D, Johns P, Augustovski F, Pichón-Rivière A. Health and economic burden of sugar-sweetened beverages consumption in Brazil. CAD SAUDE PUBLICA 2023; 39:e00249422. [PMID: 38126558 PMCID: PMC10740399 DOI: 10.1590/0102-311xen249422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/14/2023] [Accepted: 08/31/2023] [Indexed: 12/23/2023] Open
Abstract
Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.
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Affiliation(s)
- Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Centre for Health Economics, University of York, York, U.K
| | - Dario Balan
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Paula Johns
- ACT Promoção da Saúde, Rio de Janeiro, Brasil
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Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic Review and Meta-analysis of Deaths Attributable to Antimicrobial Resistance, Latin America. Emerg Infect Dis 2023; 29:2335-2344. [PMID: 37877573 PMCID: PMC10617342 DOI: 10.3201/eid2911.230753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Antimicrobial resistance is a pressing global health concern, leading to 4.95 million deaths in 2019. We conducted a systematic review and meta-analysis to assess the lethality attributed to infections caused by multidrug-resistant organisms (MDROs) in Latin America and the Caribbean. A comprehensive search of major databases retrieved relevant studies from 2000-2022. We included 54 observational studies, primarily from Brazil, Argentina, and Colombia. The most commonly studied organism was methicillin-resistant Staphylococcus aureus. The overall unadjusted case fatality rate related to MDROs was 45.0%; higher adjusted lethality was observed in persons infected with MDROs than in those infected with other pathogens (adjusted odds ratio 1.93, 95% CI 1.58-2.37). A higher lethality rate was seen in patients who did not receive appropriate empirical treatment (odds ratio 2.27, 95% CI 1.44-3.56). These findings underscore the increased lethality associated with antimicrobial resistance in Latin America and the Caribbean.
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Palacios A, Alcaraz A, Casarini A, Rodriguez Cairoli F, Espinola N, Balan D, Perelli L, Augustovski F, Bardach A, Pichon-Riviere A. The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade. Health Econ 2023; 32:2655-2672. [PMID: 37525366 DOI: 10.1002/hec.4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 03/15/2023] [Accepted: 06/12/2023] [Indexed: 08/02/2023]
Abstract
Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue.
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Affiliation(s)
- Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, UK
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Casarini
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Natalia Espinola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Lucas Perelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CONICET (National Scientific and Technical Research Council, Argentina), Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires (UBA), Buenos Aires, Argentina
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Alcaraz A, Adedeji A, Pichón-Riviere A, Amara Ekeruche M, Casarini A, Rodríguez Cairoli F, Espinola N, Roberti J, Palacios A, Bardach A. Estimating the Effectiveness of Health Warnings on Cigarette Packaging in Nigeria: A Modeling Study. Nicotine Tob Res 2023; 25:1736-1743. [PMID: 37262432 DOI: 10.1093/ntr/ntad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Tobacco consumption is associated with nearly 30 000 deaths annually in Nigeria alongside other adverse health and economic effects. Our objective was to estimate the health and economic implications of the current cigarette labeling policies (text-only HWs); new health warnings policies in the country (adding graphic health warnings with up to 60% coverage), and plain packaging policy as recommended by the World Health Organization. AIMS AND METHODS We used a probabilistic state-transition individual microsimulation model, considering natural history, healthcare costs, and quality-of-life losses associated with main tobacco-attributable diseases; and the potential effects of packaging and labeling policies. We used three scenarios: (1) text-only health warnings (HWs) covering 50% of the pack, (2) introduction of graphic HWs of 50% (and later increasing to 80%) of the pack, and (3) plain packaging with HWs covering 80% of the pack. RESULTS A total of 748 deaths are averted in the current situation; 7478 and 14 208 deaths can be averted with the new policy and with plain packaging, respectively. The number of cardiac, cerebrovascular, and cancer events that could be averted by adopting text and graphic HWs are 3093, 5093, and 1346, respectively; increasing to 5876, 9676, and 2557, respectively, with plain packaging. Up to 251 794 years were lost because of early deaths and disability, and ₦144.6 billion (USD 469 million) in health costs could be saved with HWs covering 50% to 80% of the pack over 10 years. With plain packaging and graphic HWs covering 80% of the package 478,408 years and ₦274.7 billion (USD 895 million) would be saved. CONCLUSIONS The new cigarette labeling policy in Nigeria may yield significant health and economic benefits over 10 years. Moving the current policy to plain packaging can significantly improve these benefits. IMPLICATIONS The new cigarette labeling policy that Nigeria is implementing should aim to achieve 100% compliance with its current regulation and the logical next step: Plain packaging with large warnings. The present study adds evidence of the potential health effects and cost savings of these levels of implementation, which is valuable for local policymakers.
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Affiliation(s)
- Andrea Alcaraz
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Adeniran Adedeji
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Andrés Pichón-Riviere
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Mma Amara Ekeruche
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Agustín Casarini
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Natalia Espinola
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Publisher Correction: cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:56. [PMID: 37620882 PMCID: PMC10463684 DOI: 10.1186/s12962-023-00466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Palacios A, Rodriguez-Cairoli F, Balan D, Rojas-Roque C, Moreno-López C, Braun B, Augustovski F, Pichon-Riviere A, Bardach A. Budget Impact Analysis of the FreeStyle Libre Flash Continuous Glucose Monitoring System ® in Patients with Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus with Multiple Daily Insulin Injections in Argentina. Appl Health Econ Health Policy 2023; 21:637-650. [PMID: 37062046 DOI: 10.1007/s40258-023-00800-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the budget impact of the potential coverage of FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for glycemia monitoring in all type 1 diabetes mellitus (T1DM) patients and in those with type 2 diabetes mellitus (T2DM) with multiple daily insulin injections, from the social security and the private third-party payer's perspective in Argentina. METHODS A budget impact model was developed to estimate the cost difference between the self-monitoring of blood glucose (standard of care) and FSL over 5 years. Input parameters were retrieved from local literature complemented by expert opinion. Health care costs were estimated by a micro-costing approach and reported in USD as of April 2022 (1 USD = 113.34 Argentine pesos). One-way sensitivity and scenario analyses were conducted. RESULTS From a social security third-party payer perspective, the incorporation of FSL was associated with net savings per member per month (PMPM) of $0.026 (Year 1) to $0.097 (Year 5) and net savings PMPM of $0.002 (Year 1) to $0.008 (Year 5) for T1DM and T2DM patients, respectively. Similar findings are reported from the private third-party payer perspective. The budget impact results were more sensitive to the acquisition costs of the FSL and test strips. CONCLUSION The potential coverage of FSL in patients with T1DM and T2DM with multiple daily insulin injections could be associated with small financial savings considering current technology acquisition costs (FSL and test strips) for social security and the private sector third-party payers in Argentina.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
- Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina.
- Centre for Health Economics (CHE), University of York, York, UK.
| | - Federico Rodriguez-Cairoli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carolina Moreno-López
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Barbara Braun
- Departamento de Clínica Médica y Diabetología, Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina
| | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), Buenos Aires, Argentina
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Bardach A, Alconada T, Palermo C, Rojas-Roque C, Sandoval MM, Gomez J, Pinto T, Ciapponi A. Burden of Disease of Gonorrhoea in Latin America: Systematic Review and Meta-analysis. Infect Dis Ther 2023:10.1007/s40121-023-00814-0. [PMID: 37261611 DOI: 10.1007/s40121-023-00814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae causes gonorrhoea, a globally neglected but increasing disease. This systematic review and meta-analysis reviewed the epidemiology and economic burden of gonorrhoea in Latin America and the Caribbean (LAC). METHODS We searched PubMed, EMBase, Cochrane Library, EconLIT, CINAHL, CRD, LILACS, Global Health, Global Dissertations and Theses, SciELO, Web of Science databases, countries' ministries of health, and the IHME's Global Burden of Disease databases. Studies published in the last 10 years (20 years for economic studies) were included if conducted in any LAC country, without language restrictions. The main outcome measures were incidence/prevalence, proportion of co-infections, case fatality rates, specific mortality/hospitalisation rates, direct/indirect costs, and impact of gonorrhoea on quality of life. To assess evidence quality, we used a checklist developed by the US National Heart, Lung, and Blood Institute for observational studies and trial control arms, the Cochrane Effective Practice Organization of Care Group tool for randomised controlled trials, and the CICERO checklist for economic studies. RESULTS We identified 1290 articles; 115 included epidemiological studies and one included an economic study. Ministry of health data from Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay were identified. Gonorrhoea prevalence was 1.46% (95% confidence interval [CI] 1.00-2.00%) from 48 studies and 5.68% (95% CI 4.23-7.32%) from 58 studies for non-high-risk and high-risk populations, respectively. Cumulative incidence for the high-risk population was 2.05 cases per 100 persons/year. Few published studies were rated as "good" in the risk of bias assessments. Variations in the methodology of the sources and limited information found in the countries' surveillance systems hinder the comparison of data. CONCLUSION The burden of gonorrhoea in LAC is not negligible. Our results provide public health and clinical decision support to assess potential interventions to prevent gonorrhoea. TRIAL REGISTRATION The protocol is registered on PROSPERO (CRD42021253342). The study was funded by GlaxoSmithKline Biologicals SA (GSK study identifier VEO-000025).
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Affiliation(s)
- Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina
| | - Tomás Alconada
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina
| | - Carolina Palermo
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina
| | - María Macarena Sandoval
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina
| | | | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, C1014CPV, Buenos Aires, Argentina.
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Sandoval MM, Bardach A, Rojas-Roque C, Alconada T, Gomez JA, Pinto T, Palermo C, Ciapponi A. Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review. J Antimicrob Chemother 2023; 78:1322-1336. [PMID: 37192385 PMCID: PMC10232280 DOI: 10.1093/jac/dkad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/23/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). OBJECTIVES To conduct a systematic review of AMR in N. gonorrhoeae in LAC. METHODS Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR SurveillanceNetwork databases were searched. AMR study quality was evaluated according to WHO recommendations. RESULTS AMR data for 38, 417 isolates collected in 1990-2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%-8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%-98%, 20.7%-90% and 5.9%-89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. CONCLUSIONS This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342.
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Affiliation(s)
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | | | - Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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Pichon-Riviere A, Bardach A, Rodríguez Cairoli F, Casarini A, Espinola N, Perelli L, Reynales-Shigematsu LM, Llorente B, Pinto M, Saenz De Miera Juárez B, Villacres T, Peña Torres E, Amador N, Loza C, Castillo-Riquelme M, Roberti J, Augustovski F, Alcaraz A, Palacios A. Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study. Tob Control 2023:tc-2022-057618. [PMID: 37142423 DOI: 10.1136/tc-2022-057618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.
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Affiliation(s)
- Andrés Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Agustín Casarini
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Natalia Espinola
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Tatiana Villacres
- Health Economics, Pontificia Universidad Católica del Ecuador, Quito, Pichincha, Ecuador
| | | | | | - César Loza
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Itkin B, Straminsky S, Cáceres H, Onassis M, García AE, Avanzi L, Kaminszczik L, Serna Sejas R, Rapaccioli M, Billordo G, Lavaccara D, Lanzavecchia J, Gibbons L, Settecase E, Bardach A. Comparison of mortality in patients on chemotherapy or immunotherapy during and before COVID-19 pandemic. Multicenter matched cohort study in Argentina. Rev Peru Med Exp Salud Publica 2023; 40:161-169. [PMID: 38232262 DOI: 10.17843/rpmesp.2023.402.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/14/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVES. Motivation for the study. The impact of the COVID-19 pandemic on the risk of death in cancer patients on chemotherapy and immunotherapy is controversial. Published studies mainly compared patients on anti-cancer therapy to those off treatment or COVID-19 positive cancer patients to COVID-19 negative ones. Few studies were conducted in developing countries. Main findings. Mortality didn't increase in unvaccinated outpatients on active intravenous oncology treatment during the COVID-19 pandemic. Implications. This is the first propensity score-matched cohort study evaluating the impact of the COVID-19 pandemic on the population of unvaccinated oncology patients receiving intravenous anticancer therapy. . To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. MATERIALS AND METHODS. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up. RESULTS. A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19. CONCLUSIONS. Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.
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Affiliation(s)
- Boris Itkin
- Hospital Juan A. Fernández, Buenos Aires, Argentina
| | | | | | | | | | - Laura Avanzi
- Policlínico Modelo de Cipolletti, Rio Negro, Argentina
| | | | | | | | | | | | | | - Luz Gibbons
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Eugenia Settecase
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:21. [PMID: 37005606 PMCID: PMC10066967 DOI: 10.1186/s12962-023-00430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. METHODS Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. FINDINGS Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. INTERPRETATION The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective.
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Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Ciapponi A, Berrueta M, P K Parker E, Bardach A, Mazzoni A, Anderson SA, Argento FJ, Ballivian J, Bok K, Comandé D, Goucher E, Kampmann B, Munoz FM, Rodriguez Cairoli F, Santa María V, Stergachis AS, Voss G, Xiong X, Zamora N, Zaraa S, Buekens PM. Safety of COVID-19 vaccines during pregnancy: A systematic review and meta-analysis. Vaccine 2023:S0264-410X(23)00332-8. [PMID: 37012114 PMCID: PMC10040368 DOI: 10.1016/j.vaccine.2023.03.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Background Assessment of COVID-19 vaccines safety during pregnancy is urgently needed. Methods We conducted a systematic review and meta-analysis to evaluate the safety of COVID-19 vaccines, including their components and technological platforms used in other vaccines during pregnancy and animal studies to complement direct evidence. We searched literature databases from its inception to September 2021 without language restriction, COVID-19 vaccine websites, and reference lists of other systematic reviews and the included studies. Pairs of reviewers independently selected, data extracted, and assessed the risk of bias of the studies. Discrepancies were resolved by consensus. (PROSPERO CRD42021234185). Results We retrieved 8,837 records from the literature search; 71 studies were included, involving 17,719,495 pregnant persons and 389 pregnant animals. Most studies (94%) were conducted in high-income countries, were cohort studies (51%), and 15% were classified as high risk of bias. We identified nine COVID-19 vaccine studies, seven involving 309,164 pregnant persons, mostly exposed to mRNA vaccines. Among non-COVID-19 vaccines, the most frequent exposures were AS03 and aluminum-based adjuvants. A meta-analysis of studies that adjusted for potential confounders showed no association with adverse outcomes, regardless of the vaccine or the trimester of vaccination. Neither the reported rates of adverse pregnancy outcomes nor reactogenicity exceeded expected background rates, which was the case for ASO3- or aluminum-adjuvanted non-COVID-19 vaccines in the proportion meta-analyses of uncontrolled studies/arms. The only exception was postpartum hemorrhage after COVID-19 vaccination (10.40%; 95% CI: 6.49-15.10%), reported by two studies; however, the comparison with non-exposed pregnant persons, available for one study, found non-statistically significant differences (adjusted OR 1.09; 95% CI 0.56-2.12). Animal studies showed consistent results with studies in pregnant persons. Conclusion We found no safety concerns for currently administered COVID-19 vaccines during pregnancy. Additional experimental and real-world evidence could enhance vaccination coverage. Robust safety data for non-mRNA-based COVID-19 vaccines are still needed.
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Affiliation(s)
- Agustín Ciapponi
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Mabel Berrueta
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Edward P K Parker
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Ariel Bardach
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Agustina Mazzoni
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Steven A Anderson
- US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Fernando J Argento
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Jamile Ballivian
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Karin Bok
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Daniel Comandé
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Erin Goucher
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
| | - Beate Kampmann
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, the Gambia; Charité Centre for Global Health, Universitätsmedizin Charité Berlin, Germany.
| | - Flor M Munoz
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Federico Rodriguez Cairoli
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Victoria Santa María
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Andy S Stergachis
- School of Pharmacy and School of Public Health, University of Washington, 1959 NE Pacific St, BOX 357631, Seattle, WA, USA.
| | - Gerald Voss
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway.
| | - Xu Xiong
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Natalia Zamora
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Sabra Zaraa
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, USA.
| | - Pierre M Buekens
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
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19
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Ciapponi A, Berrueta M, Ballivian J, Bardach A, Mazzoni A, Anderson S, Argento FJ, Bok K, Comandé D, Goucher E, Kampmann B, Parker EPK, Rodriguez-Cairoli F, Santa Maria V, Stergachis A, Voss G, Xiong X, Zaraa S, Munoz FM, Karron RA, Gottlieb SL, Buekens PM. Safety, immunogenicity, and effectiveness of COVID-19 vaccines for pregnant persons: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e32954. [PMID: 36862871 PMCID: PMC9981247 DOI: 10.1097/md.0000000000032954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Numerous vaccines have been evaluated and approved for coronavirus disease 2019 (COVID-19). Since pregnant persons have been excluded from most clinical trials of COVID-19 vaccines, sufficient data regarding the safety of these vaccines for the pregnant person and their fetus have rarely been available at the time of product licensure. However, as COVID-19 vaccines have been deployed, data on the safety, reactogenicity, immunogenicity, and efficacy of COVID-19 vaccines for pregnant persons and neonates are becoming increasingly available. A living systematic review and meta-analysis of the safety and effectiveness of COVID-19 vaccines for pregnant persons and newborns could provide the information necessary to help guide vaccine policy decisions. METHODS AND ANALYSIS We aim to conduct a living systematic review and meta-analysis based on biweekly searches of medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries to systematically identify relevant studies of COVID-19 vaccines for pregnant persons. Pairs of reviewers will independently select, extract data, and conduct risk of bias assessments. We will include randomized clinical trials, quasi-experimental studies, cohort, case-control, cross-sectional studies, and case reports. Primary outcomes will be the safety, efficacy, and effectiveness of COVID-19 vaccines in pregnant persons, including neonatal outcomes. Secondary outcomes will be immunogenicity and reactogenicity. We will conduct paired meta-analyses, including prespecified subgroup and sensitivity analyses. We will use the grading of recommendations assessment, development, and evaluation approach to evaluate the certainty of evidence.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Jamile Ballivian
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | - Fernando J. Argento
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Karin Bok
- National Institute of Allergy and Infectious Diseases (NIAID), Vaccine Research Center, Bethesda, MD
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Erin Goucher
- School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Beate Kampmann
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Edward P. K. Parker
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Victoria Santa Maria
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Andy Stergachis
- School of Pharmacy and School of Public Health, University of Washington, Seattle, WA
| | - Gerald Voss
- Coalition for Epidemic Preparedness Innovations, Oslo, Norway
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans
| | - Sabra Zaraa
- School of Pharmacy and School of Public Health, University of Washington, Seattle, WA
| | - Flor M. Munoz
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Ruth A. Karron
- Center for Immunization Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sami L. Gottlieb
- Medical Officer, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Pierre M. Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans
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Palacios A, Rodriguez Cairoli F, Balan D, Balmaceda C, Augustovski F, Pichon-Riviere A, Bardach A. Budget impact analysis of the freestyle libre flash continuous glucose monitoring system® in patients with diabetes mellitus type 1 in Chile. Expert Rev Pharmacoecon Outcomes Res 2023; 23:353-363. [PMID: 36701814 DOI: 10.1080/14737167.2023.2171989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To estimate the budget impact of covering the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for type 1 Diabetes Mellitus patients (T1DM), compared to self-monitoring of blood glucose (SMBG), from the perspective of public and private third-party payers in Chile. METHODS A budget impact model was developed to estimate the cost difference between SMBG and FSL over five years. Two FSL coverage schemes were assessed. Input parameters were retrieved from the literature review and complemented by expert opinion. Healthcare costs were estimated by a micro-costing approach and reported in USD. RESULTS For a public sector third-party payer, incorporating FSL implied a cost increase up to USD 0.013 per member per month (PMPM) for the fifth year under the broad coverage scheme and a net saving of 0.0001 PMPM (all years) under the restricted coverage scheme. From a private sector third-party payer, incorporating FSL implied savings up to USD 0.028 PMPM (fifth year) for the broad coverage scheme and up to USD 0.012 PMPM (fifth year) for the restricted scheme. CONCLUSION Incorporating the FSL for T1DM patients was associated with a marginal incremental cost for the public sector third-party payer and cost savings in Chile's private healthcare sector.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Centre for Health Economics, University of York, York, UK.,Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Balmaceda
- Centre for Health Economics, University of York, York, UK.,Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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21
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Rodríguez Cairoli F, Guevara Vásquez G, Bardach A, Espinola N, Perelli L, Balan D, Palacios A, Augustovski F, Pichón-Riviere A, Alcaraz A. [Burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El SalvadorCarga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador]. Rev Panam Salud Publica 2023; 47:e80. [PMID: 37197598 PMCID: PMC10184580 DOI: 10.26633/rpsp.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/03/2023] [Indexed: 05/19/2023] Open
Abstract
Objective To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador.
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Affiliation(s)
- Federico Rodríguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
- Federico Rodríguez Cairoli,
| | - Giovanni Guevara Vásquez
- Universidad Católica de El Salvador (UNICAES)Santa AnaEl SalvadorUniversidad Católica de El Salvador (UNICAES), Santa Ana, El Salvador.
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Darío Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Andrés Pichón-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentinaInstituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
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Alcaraz A, Perelli L, Rodriguez MB, Palacios A, Bardach A, Gittens-Baynes KA, Vianna C, Guevara G, García-Martí S, Ciapponi A, Augustovski F, Belizán M, Pichon-Riviere A. What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue. Rev Peru Med Exp Salud Publica 2023; 40:86-93. [PMID: 37377242 DOI: 10.17843/rpmesp.2023.401.12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/29/2023] [Indexed: 06/29/2023] Open
Abstract
In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
| | | | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Kimberly-Ann Gittens-Baynes
- The University of the West Indies, HEU, Centre for Health Economics, (UWI-HEU), St. Augustine Campus, Trinidad and Tobago
| | - Cid Vianna
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - María Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
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Ciapponi A, Barreira F, Perelli L, Bardach A, Gascón J, Molina I, Morillo C, Prado N, Riarte A, Torrico F, Villar JC, Reidel S, Gibbons L, Sosa-Estani S. Direct evidence gap on fixed versus adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: Systematic review and individual patient data meta-analysis. Trop Med Int Health 2023; 28:2-16. [PMID: 36420767 DOI: 10.1111/tmi.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the comparative efficacy and safety of a fixed dose of benznidazole (BZN) with an adjusted-dose for Trypanosoma cruzi-seropositive adults without cardiomyopathy. METHODS We conducted a systematic review and individual participant data (IPD) meta-analysis following Cochrane methods, and the PRISMA-IPD statement for reporting. Randomised controlled trials (RCTs) allocating participants to fixed or adjusted doses of BZN for T. cruzi-seropositive adults without cardiomyopathy were included. We searched (December 2021) Cochrane, MEDLINE, EMBASE, LILACS and trial registries and contacted Chagas experts. Selection, data extraction, risk of bias assessment using the Cochrane tool, and a GRADE summary of finding tables were performed independently by pairs of reviewers. We conducted a random-effects IPD meta-analysis using the one-stage strategy, or, if that was impossible, the two-stage strategy. RESULTS Five RCTs (1198 patients) were included, none directly comparing fixed with adjusted doses of BZN. Compared to placebo, BZN therapy was strongly associated with negative qPCR and sustainable parasitological clearance regardless of the type of dose and subgroup analysed. For negative qPCR, the fixed/adjusted rate of odds ratios (RORF/A ) was 8.83 (95% CI 1.02-76.48); for sustained parasitological clearance, it was 4.60 (95% CI 0.40-52.51), probably indicating at least non-inferior effect of fixed doses, with no statistically significant interactions by scheme for global and most subgroup estimations. The RORF/A for treatment interruption due to adverse events was 0.44 (95% CI 0.14-1.38), probably indicating no worse tolerance of fixed doses. CONCLUSIONS We found no direct comparison between fixed and adjusted doses of BZN. However, fixed doses versus placebo are probably not inferior to weight-adjusted doses of BZN versus placebo in terms of parasitological efficacy and safety. Network IPD meta-analysis, through indirect comparisons, may well provide the best possible answers in the near future. REGISTRATION The study protocol was registered in PROSPERO (CRD42019120905).
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Affiliation(s)
- Agustín Ciapponi
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Fabiana Barreira
- Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
| | - Lucas Perelli
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,International Health Program, Catalan Institute of Health, Barcelona, Spain
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Nilda Prado
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Adelina Riarte
- Instituto Nacional de Parasitología Dr. M Fatala Chaben, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Faustino Torrico
- Parasitología y Enfermedades Infecciosas, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Juan Carlos Villar
- Departamento de Investigaciones, Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Sara Reidel
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Luz Gibbons
- Departamento de Evaluación de Tecnologías Sanitarias, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Centro de Investigaciones Epidemiológicas y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Chagas Clinical Project, Drugs for Neglected Diseases Initiative, Río de Janeiro, Brazil
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Javier Balan D, Bardach A, Palermo C, Alconada T, Sandoval M, Nieto Guevara J, Gomez J, Ciapponi A. Economic burden of herpes zoster in Latin America: A systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2131167. [PMID: 36519226 PMCID: PMC9794010 DOI: 10.1080/21645515.2022.2131167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This systematic review describes herpes zoster (HZ) economic burden in terms of healthcare resource use and cost outcomes in the Latin America and Caribbean (LAC) region. We searched online databases from 1 January 2000 to 20 February 2020 to identify eligible publications. We identified 23 publications that reported direct costs, indirect costs, and resources associated with HZ and its complications. The primary direct medical resources reported in the different studies were visits to doctors, transportation, days in the hospital, nursing, medication schedules, and physical therapy. Direct total costs per patient ranged from $99.99 to $4177.91. The highest cost was found in Brazil. Direct costs are, in average, 81.39% higher than indirect costs. The cost per patient that includes postherpetic neuralgia treatment is 115% higher on average for the directs and 73% for the indirect costs. Brazil reported a higher total cost per patient than Argentina and Mexico, while for indirect costs per patient, Brazil and Argentina had higher costs than Mexico, respectively. A meta-analysis on the number of days due to HZ hospitalization, performed on non-immunosuppressed patients over 65 years of age from three studies, resulted in a cumulative measure of 4.5 days of hospitalization. In the LAC region, the economic burden of HZ and associated complications is high, particularly among high-risk populations and older age groups. Preventative strategies such as vaccination could help avoid or reduce the HZ-associated disease economic burden in the LAC region.
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Affiliation(s)
- Dario Javier Balan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Carolina Palermo
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Tomás Alconada
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Macarena Sandoval
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina,CONTACT Agustin Ciapponi Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Ruvinsky S, Voto C, Roel M, Fustiñana A, Veliz N, Brizuela M, Rodriguez S, Ulloa-Gutierrez R, Bardach A. Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems. Front Pediatr 2022; 10:881765. [PMID: 35547540 PMCID: PMC9082071 DOI: 10.3389/fped.2022.881765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background With the emergence of the COVID-19 pandemic, increasing numbers of cases of the multisystem inflammatory syndrome in children (MIS-C) have been reported worldwide; however, it is unclear whether this syndrome has a differential pattern in children from Latin America and the Caribbean (LAC). We conducted a systematic review and meta-analysis to analyze the epidemiological, clinical, and outcome characteristics of patients with MIS-C in LAC countries. Methods A systematic literature search was conducted in the main electronic databases and scientific meetings from March 1, 2020, to June 30, 2021. Available reports on epidemiological surveillance of countries in the region during the same period were analyzed. Results Of the 464 relevant studies identified, 23 were included with 592 patients with MIS-C from LAC. Mean age was 6.6 years (IQR, 6-7.4 years); 60% were male. The most common clinical manifestations were fever, rash, and conjunctival injection; 59% showed Kawasaki disease. Pool proportion of shock was 52%. A total of 47% of patients were admitted to the pediatric intensive care unit (PICU), 23% required mechanical ventilation, and 74% required vasoactive drugs. Intravenous gamma globulin alone was administered in 87% of patients, and in combination with steroids in 60% of cases. Length of hospital stay was 10 days (IQR, 9-10) and PICU stay 5.75 (IQR, 5-6). Overall case fatality ratio was 4% and for those hospitalized in the PICU it was 7%. Conclusion Limited information was available on the clinical outcomes. Improvements in the surveillance system are required to obtain a better epidemiologic overview in the region.
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Affiliation(s)
- Silvina Ruvinsky
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carla Voto
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Macarena Roel
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Fustiñana
- Servicio de Emergencias, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia Veliz
- Área de Internación, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Martin Brizuela
- Hospital General de Agudos “Vélez Sarsfield”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana Rodriguez
- Coordinación de Investigación Clínica y Sanitaria, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños Dr. Carlos Sáenz Herrrera, Caja Costarricense de Seguro Social & Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Ariel Bardach
- Center for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS) and National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Dubin A, Loudet CI, Hurtado FJ, Pozo MO, Comande D, Gibbons L, Cairoli FR, Bardach A. Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis. Rev Bras Ter Intensiva 2022; 34:279-286. [PMID: 35946659 DOI: 10.5935/0103-507x.20220026-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate. METHODS We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate. RESULTS We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them. CONCLUSION Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.PROSPERO registration: CRD42019130387.
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Affiliation(s)
- Arnaldo Dubin
- Serviço de Terapia Intensiva, Sanatorio Otamendi - Buenos Aires, Argentina
| | - Cecilia Inés Loudet
- Intensive Care Service, Hospital Interzonal de Agudos General San Martín - La Plata, Argentina
| | | | - Mario Omar Pozo
- Serviço de Terapia Intensiva, Hospital Británico - Buenos Aires, Argentina
| | - Daniel Comande
- Centro de Investigación de Epidemiología y Salud Pública - Buenos Aires, Argentina
| | - Luz Gibbons
- Centro de Investigación de Epidemiología y Salud Pública - Buenos Aires, Argentina
| | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria - Buenos Aires, Argentina
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27
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Bardach A, Casarini A, Rodriguez Cairoli F, Adeniran A, Castradori M, Akanonu P, Onyekwena C, Espinola N, Pichon-Riviere A, Palacios A. The estimated benefits of increasing cigarette prices through taxation on the burden of disease and economic burden of smoking in Nigeria: A modeling study. PLoS One 2022; 17:e0264757. [PMID: 35235606 PMCID: PMC8890735 DOI: 10.1371/journal.pone.0264757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, tobacco consumption continues to cause a considerable burden of preventable diseases. Although the smoking prevalence in Nigeria may be declining over the last years, the absolute number of active smokers remains one of the highest in Africa. Little is known about the disease burden and economic costs of cigarette smoking in Nigeria. Consequently, there is an evidence gap to inform the design and implementation of an effective policy for tobacco control. METHODS We applied a microsimulation model to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct medical costs and indirect costs (e.g., productivity loss costs, informal caregivers' costs). We also modeled the health and economic impact of different scenarios of tobacco price increases through taxes. RESULTS We estimated that smoking is responsible for approximately 29,000 annual deaths in Nigeria. This burden corresponds to 816,230 DALYs per year. In 2019, the total economic burden attributable to tobacco was estimated at ₦ 634 billion annually (approximately U$D 2.07 billion). If tobacco cigarettes' prices were to be raised by 50% through taxes, more than 30,000 deaths from smoking-attributable diseases would be averted in 10 years, with subsequent savings on direct and indirect costs of ₦597 billion and increased tax revenue collection of ₦369 billion. CONCLUSION In Nigeria, tobacco is responsible for substantial health and economic burden. Increasing tobacco taxes could reduce this burden and produce net economic benefits.
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Affiliation(s)
- Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Casarini
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | | | | | | | | | | | - Natalia Espinola
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Korang SK, von Rohden E, Veroniki AA, Ong G, Ngalamika O, Siddiqui F, Juul S, Nielsen EE, Feinberg JB, Petersen JJ, Legart C, Kokogho A, Maagaard M, Klingenberg S, Thabane L, Bardach A, Ciapponi A, Thomsen AR, Jakobsen JC, Gluud C. Vaccines to prevent COVID-19: A living systematic review with Trial Sequential Analysis and network meta-analysis of randomized clinical trials. PLoS One 2022; 17:e0260733. [PMID: 35061702 PMCID: PMC8782520 DOI: 10.1371/journal.pone.0260733] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 is rapidly spreading causing extensive burdens across the world. Effective vaccines to prevent COVID-19 are urgently needed. METHODS AND FINDINGS Our objective was to assess the effectiveness and safety of COVID-19 vaccines through analyses of all currently available randomized clinical trials. We searched the databases CENTRAL, MEDLINE, Embase, and other sources from inception to June 17, 2021 for randomized clinical trials assessing vaccines for COVID-19. At least two independent reviewers screened studies, extracted data, and assessed risks of bias. We conducted meta-analyses, network meta-analyses, and Trial Sequential Analyses (TSA). Our primary outcomes included all-cause mortality, vaccine efficacy, and serious adverse events. We assessed the certainty of evidence with GRADE. We identified 46 trials; 35 trials randomizing 219 864 participants could be included in our analyses. Our meta-analyses showed that mRNA vaccines (efficacy, 95% [95% confidence interval (CI), 92% to 97%]; 71 514 participants; 3 trials; moderate certainty); inactivated vaccines (efficacy, 61% [95% CI, 52% to 68%]; 48 029 participants; 3 trials; moderate certainty); protein subunit vaccines (efficacy, 77% [95% CI, -5% to 95%]; 17 737 participants; 2 trials; low certainty); and viral vector vaccines (efficacy 68% [95% CI, 61% to 74%]; 71 401 participants; 5 trials; low certainty) prevented COVID-19. Viral vector vaccines decreased mortality (risk ratio, 0.25 [95% CI 0.09 to 0.67]; 67 563 participants; 3 trials, low certainty), but comparable data on inactivated, mRNA, and protein subunit vaccines were imprecise. None of the vaccines showed evidence of a difference on serious adverse events, but observational evidence suggested rare serious adverse events. All the vaccines increased the risk of non-serious adverse events. CONCLUSIONS The evidence suggests that all the included vaccines are effective in preventing COVID-19. The mRNA vaccines seem most effective in preventing COVID-19, but viral vector vaccines seem most effective in reducing mortality. Further trials and longer follow-up are necessary to provide better insight into the safety profile of these vaccines.
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Affiliation(s)
- Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Elena von Rohden
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Giok Ong
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Owen Ngalamika
- Dermatology & Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia
| | - Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Joshua Buron Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johanne Juul Petersen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Legart
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Afoke Kokogho
- United States Army Medical Research Directorate West Africa, Henry M. Jackson Foundation Medical Research International (HJFMRI), Walter Reed Army Institute of Research, Abuja, Nigeria
| | - Mathias Maagaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, The Zealand Region of Denmark, Køge, Denmark
| | - Sarah Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ariel Bardach
- Argentine Cochrane Center. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Center. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Allan Randrup Thomsen
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
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Dubin A, Loudet CI, Hurtado FJ, Pozo MO, Comande D, Gibbons L, Cairoli FR, Bardach A. Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis. Rev Bras Ter Intensiva 2022. [PMID: 35946659 PMCID: PMC9354115 DOI: 10.5935/0103-507x.20220026-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate. Methods We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate. Results We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them. Conclusion Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies. PROSPERO registration: CRD42019130387
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Affiliation(s)
- Arnaldo Dubin
- Intensive Care Service, Sanatorio Otamendi - Buenos Aires, Argentina
- Corresponding author: Arnaldo Dubin, Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Calle 42, 577 (1900) La Plata, Argentina, E-mail:
| | - Cecilia Inés Loudet
- Intensive Care Service, Hospital Interzonal de Agudos General San Martín - La Plata, Argentina
| | | | - Mario Omar Pozo
- Intensive Care Service, Hospital Británico - Buenos Aires, Argentina
| | - Daniel Comande
- Centro de Investigación de Epidemiología y Salud Pública - Buenos Aires, Argentina
| | - Luz Gibbons
- Centro de Investigación de Epidemiología y Salud Pública - Buenos Aires, Argentina
| | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria - Buenos Aires, Argentina
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Santoro A, López Osornio A, Williams I, Wachs M, Cejas C, Havela M, Bardach A, López A, Augustovski F, Pichón Riviere A, Rubinstein A. Development and application of a dynamic transmission model of health systems' preparedness and response to COVID-19 in twenty-six Latin American and Caribbean countries. PLOS Glob Public Health 2022; 2:e0000186. [PMID: 36962316 PMCID: PMC10021760 DOI: 10.1371/journal.pgph.0000186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
The global impact of COVID-19 has challenged health systems across the world. This situation highlighted the need to develop policies based on scientific evidence to prepare the health systems and mitigate the pandemic. In this scenario, governments were urged to predict the impact of the measures they were implementing, how they related to the population's behavior, and the capacity of health systems to respond to the pandemic. The overarching aim of this research was to develop a customizable and open-source tool to predict the impact of the expansion of COVID-19 on the level of preparedness of the health systems of different Latin American and the Caribbean countries, with two main objectives. Firstly, to estimate the transmission dynamics of COVID-19 and the preparedness and response capacity of health systems in those countries, based on different scenarios and public policies implemented to control, mitigate, or suppress the spread of the epidemic. Secondly, to facilitate policy makers' decisions by allowing the model to adjust its parameters according to the specific pandemic trajectory and policy context. How many infections and deaths are estimated per day?; When are the peaks of cases and deaths expected, according to the different scenarios?; Which occupancy rate will ICU services have along the epidemiological curve?; When is the optimal time increase restrictions in order to prevent saturation of ICU beds?, are some of the key questions that the model can respond, and is publicly accessible through the following link: http://shinyapps.iecs.org.ar/modelo-covid19/. This open-access and open code tool is based on a SEIR model (Susceptible, Exposed, Infected and Recovered). Using a deterministic epidemiological model, it allows to frame potential scenarios for long periods, providing valuable information on the dynamics of transmission and how it could impact on health systems through multiple customized configurations adapted to specific characteristics of each country.
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Affiliation(s)
- Adrián Santoro
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Alejandro López Osornio
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Ivan Williams
- Faculty of Economics, University of Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | - Martín Wachs
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Cintia Cejas
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Maisa Havela
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Analía López
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Federico Augustovski
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Andrés Pichón Riviere
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
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Ciapponi A, Rodríguez Cairoli F, Solioz G, Rojas-Roque C, Hernández-Vásquez A, Palacios A, Bardach A. Intercambio desde los cigarrillos convencionales a los sistemas electrónicos de administración de nicotina: revisión sistemática rápida con metaanálisis y aspectos económicos. Rev Peru Med Exp Salud Publica 2021; 38:537-550. [DOI: 10.17843/rpmesp.2021.384.7776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/17/2021] [Indexed: 11/06/2022] Open
Abstract
Objetivos. Evaluar cómo y en qué medida se produce un intercambio desde los cigarrillos convencionales (CC) a los sistemas electrónicos de administración de nicotina (SEAN). Materiales y métodos. Se realizó una revisión sistemática hasta agosto de 2019. El desenlace primario fue la proporción de un intercambio completo o parcial de CC a los SEAN y sus aspectos económicos. Los desenlaces secundarios como medidas de resultado fueron la probabilidad de intercambio y la tendencia en el intercambio por países. Resultados. Se encontraron 3628 referencias y se incluyeron 49 estudios con datos epidemiológicos y económicos. Los estudios económicos sobre la elasticidad cruzada de precios mostraron que los CC son parcialmente intercambiables por SEAN. La mayoría de los estudios reportaron que la prevalencia del consumo de cigarrillos electrónicos se incrementó con el tiempo. Tres estudios reportaron una reducción significativa de los CC consumidos por día entre fumadores duales (convencionales más SEAN) en comparación con los consumidores de CC. El odds ratio ajustado y combinado de dejar los CC entre consumidores de SEAN en comparación con quienes nunca consumieron o lo hicieron en el pasado fue de 1,19 (IC95%: 1,09-1,30; heterogeneidad 0%). Los estudios longitudinales mostraron una creciente prevalencia del uso de cigarrillos electrónicos, principalmente en adolescentes. Se encontró una relación negativa entre el consumo y aumento de precio de CC y electrónicos. Conclusión. La probabilidad de dejar de fumar CC entre consumidores habituales de SEAN se incrementó respecto a los consumidores que nunca o que solían consumir SEAN. Estudios económicos reportaron que los cigarrillos electrónicos son parcialmente intercambiables por los CC.
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Alonso JP, Belizán M, Comolli M, González L, Roberti J, Pichón-Riviere A, Bardach A. [Formative research for the design and implementation of a strategy to increase colorectal cancer screening in the workplace in Argentina]. CAD SAUDE PUBLICA 2021; 37:e00313620. [PMID: 34816962 DOI: 10.1590/0102-311x00313620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
The workplace has great potential to disseminate information and implement health promotion activities such as cancer prevention and early detection. Due to the challenges of deploying health interventions in this setting, formative studies are needed to adjust the design and implementation of successful strategies. To inform the intervention's design and implementation and improve the adherence rate to screening with fecal occult blood test in a workplace in Argentina, a formative study was conducted to identify potential barriers and facilitators. The formative study adopted a qualitative methodological design. Interviews were held with 10 individuals in charge of key areas in the institution where the main study was conducted, besides 8 focus groups with workers over 50 years of age. Challenges were identified at the institutional level for the intervention's implementation, such as workers' geographic dispersion and the complexity of the institution's flowchart, as well as at the population level, such as low knowledge about colorectal cancer and diagnostic tests and low risk perception. The facilitators featured the intervention's acceptability and the availability of human and material resources to proceed with the intervention, such as institutional communications channels for disseminating the information and logistics for distribution of diagnostic kits. The formative study allowed identifying resources and potential barriers that informed the intervention's design and implementation.
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Affiliation(s)
- Juan Pedro Alonso
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina
| | - María Belizán
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Mariana Comolli
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Lucas González
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Javier Roberti
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Itkin B, Garcia A, Straminsky S, Adelchanow ED, Pereyra M, Haab GA, Bardach A. Prevalence of HER2 overexpression and amplification in cervical cancer: A systematic review and meta-analysis. PLoS One 2021; 16:e0257976. [PMID: 34591928 PMCID: PMC8483403 DOI: 10.1371/journal.pone.0257976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
The reported rates of HER2 positivity in cervical cancer (CC) range from 0% to 87%. The importance of HER2 as an actionable target in CC would depend on HER2 positivity prevalence. Our aim was to provide precise estimates of HER2 overexpression and amplification in CC, globally and by relevant subgroups. We conducted a PRISMA compliant meta-analytic systematic review. We searched Medline, EMBASE, Cochrane database, and grey literature for articles reporting the proportion of HER2 positivity in CC. Studies assessing HER2 status by immunohistochemistry or in situ hybridization in invasive disease were eligible. We performed descriptive analyses of all 65 included studies. Out of these, we selected 26 studies that used standardized American Society of Clinical Oncology / College of American Pathologists (ASCO/CAP) Guidelines compliant methodology. We conducted several meta-analyses of proportions to estimate the pooled prevalence of HER2 positivity and subgroup analyses using geographic region, histology, tumor stage, primary antibody brand, study size, and publication year as moderators. The estimated pooled prevalence of HER2 overexpression was 5.7% (CI 95%: 1.5% to 11.7%) I2 = 87% in ASCO/CAP compliant studies and 27.0%, (CI 95%: 19.9% to 34.8%) I2 = 96% in ASCO/CAP non-compliant ones, p < 0.001. The estimated pooled prevalence of HER2 amplification was 1.2% (CI 95%: 0.0% to 5.8%) I2 = 0% and 24.9% (CI 95%: 12.6% to 39.6%) I2 = 86%, respectively, p = 0.004. No other factor was significantly associated with HER2 positivity rates. Our results suggest that a small, but still meaningful proportion of CC is expected to be HER2-positive. High heterogeneity was the main limitation of the study. Variations in previously reported HER2 positivity rates are mainly related to methodological issues.
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Affiliation(s)
- Boris Itkin
- Department of Oncology, Juan A Fernández Hospital, Buenos Aires, Argentina
| | - Agustin Garcia
- Department of Oncology, María Curie Hospital, Buenos Aires, Argentina
| | - Samanta Straminsky
- Department of Oncology, Juan A Fernández Hospital, Buenos Aires, Argentina
| | | | - Matias Pereyra
- Department of Pathology, Juan A Fernández Hospital, Buenos Aires, Argentina
| | | | - Ariel Bardach
- Center for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS)—National Scientific and Technical Research Council—Argentina, Buenos Aires, Argentina
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Ciapponi A, Bardach A, Mazzoni A, Alconada T, Anderson SA, Argento FJ, Ballivian J, Bok K, Comandé D, Erbelding E, Goucher E, Kampmann B, Karron R, Munoz FM, Palermo MC, Parker EPK, Rodriguez Cairoli F, Santa María V, Stergachis AS, Voss G, Xiong X, Zamora N, Zaraa S, Berrueta M, Buekens PM. Safety of components and platforms of COVID-19 vaccines considered for use in pregnancy: A rapid review. Vaccine 2021; 39:5891-5908. [PMID: 34489131 PMCID: PMC8360993 DOI: 10.1016/j.vaccine.2021.08.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rapid assessment of COVID-19 vaccine safety during pregnancy is urgently needed. METHODS We conducted a rapid systematic review, to evaluate the safety of COVID-19 vaccines selected by the COVID-19 Vaccines Global Access-Maternal Immunization Working Group in August 2020, including their components and their technological platforms used in other vaccines for pregnant persons. We searched literature databases, COVID-19 vaccine pregnancy registries, and explored reference lists from the inception date to February 2021 without language restriction. Pairs of reviewers independently selected studies through COVIDENCE, and performed the data extraction and the risk of bias assessment. Discrepancies were resolved by consensus. Registered on PROSPERO (CRD42021234185). RESULTS We retrieved 6757 records and 12 COVID-19 pregnancy registries from the search strategy; 38 clinical and non-clinical studies (involving 2,398,855 pregnant persons and 56 pregnant animals) were included. Most studies (89%) were conducted in high-income countries and were cohort studies (57%). Most studies (76%) compared vaccine exposures with no exposure during the three trimesters of pregnancy. The most frequent exposure was to AS03 adjuvant, in the context of A/H1N1 pandemic influenza vaccines, (n = 24) and aluminum-based adjuvants (n = 11). Only one study reported exposure to messenger RNA in lipid nanoparticles COVID-19 vaccines. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03), corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns. CONCLUSION This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted, given their novelty. Our findings support current WHO guidelines recommending that pregnant persons may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Steven A Anderson
- US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Fernando J Argento
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Jamile Ballivian
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Karin Bok
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Emily Erbelding
- National Institute of Allergy and Infectious Diseases, 1 Center Dr # 7A03, Bethesda, USA.
| | - Erin Goucher
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
| | - Beate Kampmann
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia.
| | - Ruth Karron
- Bloomberg School of Public Health, Johns Hopkins University, 7CX5+8W Baltimore, MD, USA.
| | - Flor M Munoz
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, USA.
| | - María Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Edward P K Parker
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Victoria Santa María
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Andy S Stergachis
- School of Pharmacy and School of Public Health, University of Washington, MM2R+78 Seattle, WA, USA.
| | - Gerald Voss
- TuBerculosis Vaccine Initiative (TBVI), GHF4+6W Lelystad, the Netherlands.
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
| | - Natalia Zamora
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, MM2R+78 Seattle, WA, USA.
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Pierre M Buekens
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
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Itkin B, Straminsky S, Garcia A, Adelchanow E, Pereyra M, Acosta Haab G, Bardach A. 814P Prevalence of HER2 overexpression and amplification in uterine cervical cancer: A systematic review and a meta-analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Alcaraz A, Pichon-Riviere A, Palacios A, Bardach A, Balan DJ, Perelli L, Augustovski F, Ciapponi A. Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models. BMC Public Health 2021; 21:1460. [PMID: 34315428 PMCID: PMC8317409 DOI: 10.1186/s12889-021-11046-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. METHODS We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. RESULTS We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). CONCLUSIONS There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO PROTOCOL NUMBER CRD42020121025 .
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Dario Javier Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Ciapponi A, Bardach A, Comandé D, Berrueta M, Argento FJ, Rodriguez Cairoli F, Zamora N, Santa María V, Xiong X, Zaraa S, Mazzoni A, Buekens P. COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes. PLoS One 2021; 16:e0253974. [PMID: 34185807 PMCID: PMC8241118 DOI: 10.1371/journal.pone.0253974] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). METHODS We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR's results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. RESULTS We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28-100%), mild respiratory symptoms (20-79%), raised C-reactive protein (28-96%), lymphopenia (34-80%), and pneumonia signs in diagnostic imaging (7-99%). The most frequent maternal outcomes were C-section (23-96%) and preterm delivery (14-64%). Most of their babies were asymptomatic (16-93%) or presented fever (0-50%), low birth weight (5-43%) or preterm delivery (2-69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36-2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05-4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. CONCLUSION This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Fernando J. Argento
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | - Natalia Zamora
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Victoria Santa María
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, Seattle, WA, United States of America
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
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Gulayin PE, Irazola V, Gutierrez L, Elorriaga N, Lanas F, Mores N, Ponzo J, Calandrelli M, Poggio R, Rubinstein A, Bardach A. Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America. J Public Health (Oxf) 2021; 42:107-117. [PMID: 30649400 DOI: 10.1093/pubmed/fdy226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/11/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.
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Affiliation(s)
- Pablo Elías Gulayin
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Laura Gutierrez
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Natalia Elorriaga
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Nora Mores
- Municipalidad de Marcos Paz, Buenos Aires, Argentina
| | - Jaqueline Ponzo
- Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | - Rosana Poggio
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Comisión Nacional de Investigaciones Científico Tecnológicas, Argentina
| | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Comisión Nacional de Investigaciones Científico Tecnológicas, Argentina
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Pingray V, Widmer M, Ciapponi A, Hofmeyr GJ, Deneux C, Gülmezoglu M, Bloemenkamp K, Oladapo OT, Comandé D, Bardach A, Vázquez P, Cormick G, Althabe F. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG 2021; 128:1732-1743. [PMID: 34165867 PMCID: PMC9292664 DOI: 10.1111/1471-0528.16819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate uterine tamponade devices’ effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols. Search strategy PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021. Study selection Randomised and non‐randomised comparative studies. Outcomes Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom‐catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76–7.14) and hysterectomy (RR 4.14, 95% CI 0.48–35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07–15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47–41.09) with the use of the condom‐catheter or surgical glove balloon. One non‐randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11–1.03) and hysterectomy (RR 0.49, 95% CI 0.04–5.38) after the inclusion of the Bakri balloon. The second non‐randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32–2.81) and hysterectomy (RR 1.84, 95% CI 0.44–7.69) after the inclusion of Ebb or Bakri balloon. Conclusions The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting. Tweetable abstract Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery. Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.
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Affiliation(s)
- V Pingray
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - M Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - A Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - G J Hofmeyr
- University of Botswana, Gaborone, Botswana.,Effective Care Research Unit, University of the Witwatersrand/Walter Sisulu University, Mthatha, South Africa
| | - C Deneux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, U1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Paris, France
| | - M Gülmezoglu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Concept Foundation, Geneva, Switzerland
| | - K Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - O T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - D Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - A Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - P Vázquez
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - G Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - F Althabe
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ciapponi A, Bardach A, Mazzoni A, Alconada T, Anderson S, Argento FJ, Ballivian J, Bok K, Comandé D, Erbelding E, Goucher E, Kampmann B, Karron R, Munoz FM, Palermo MC, Parker EPK, Cairoli FR, Santa MV, Stergachis A, Voss G, Xiong X, Zamora N, Zaraa S, Berrueta M, Buekens PM. Safety of COVID-19 vaccines, their components or their platforms for pregnant women: A rapid review. medRxiv 2021:2021.06.03.21258283. [PMID: 34127978 PMCID: PMC8202435 DOI: 10.1101/2021.06.03.21258283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women with COVID-19 are at an increased risk of severe COVID-19 illness as well as adverse pregnancy and birth outcomes. Many countries are vaccinating or considering vaccinating pregnant women with limited available data about the safety of this strategy. Early identification of safety concerns of COVID-19 vaccines, including their components, or their technological platforms is therefore urgently needed. METHODS We conducted a rapid systematic review, as the first phase of an ongoing full systematic review, to evaluate the safety of COVID-19 vaccines in pregnant women, including their components, and their technological platforms (whole virus, protein, viral vector or nucleic acid) used in other vaccines, following the Cochrane methods and the PRISMA statement for reporting (PROSPERO-CRD42021234185).We searched literature databases, COVID-19 and pregnancy registries from inception February 2021 without time or language restriction and explored the reference lists of relevant systematic reviews retrieved. We selected studies of any methodological design that included at least 50 pregnant women or pregnant animals exposed to the vaccines that were selected for review by the COVAX MIWG in August 2020 or their components or platforms included in the COVID-19 vaccines, and evaluated adverse events during pregnancy and the neonatal period.Pairs of reviewers independently selected studies through the COVIDENCE web software and performed the data extraction through a previously piloted online extraction form. Discrepancies were resolved by consensus. RESULTS We identified 6768 records, 256 potentially eligible studies were assessed by full-text, and 37 clinical and non-clinical studies (38 reports, involving 2,397,715 pregnant women and 56 pregnant animals) and 12 pregnancy registries were included.Most studies (89%) were conducted in high-income countries. The most frequent study design was cohort studies (n=21), followed by surveillance studies, randomized controlled trials, and registry analyses. Most studies (76%) allowed comparisons between vaccinated and unvaccinated pregnant women (n=25) or animals (n=3) and reported exposures during the three trimesters of pregnancy.The most frequent exposure was to AS03 adjuvant in the context of A/H1N1 pandemic influenza vaccines (n=24), followed by aluminum-based adjuvants (n=11). Aluminum phosphate was used in Respiratory Syncytial Virus Fusion candidate vaccines (n=3) and Tdap vaccines (n=3). Different aluminum-based adjuvants were used in hepatitis vaccines. The replication-deficient simian adenovirus ChAdOx1 was used for a Rift Valley fever vaccine. Only one study reported exposure to messenger RNA (mRNA) COVID-19 vaccines that also used lipid nanoparticles. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03) - corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns. CONCLUSION This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines that were selected for review by the COVAX MIWG or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted given their novelty. Our findings support current WHO guidelines recommending that pregnant women may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.
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Bardach A, Alcaraz A, Roberti J, Ciapponi A, Augustovski F, Pichon-Riviere A. Optimizing Tobacco Advertising Bans in Seven Latin American Countries: Microsimulation Modeling of Health and Financial Impact to Inform Evidence-Based Policy. Int J Environ Res Public Health 2021; 18:5078. [PMID: 34064880 PMCID: PMC8151006 DOI: 10.3390/ijerph18105078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In Latin America, tobacco smoking prevalence is between 6.4% and 35.2%. Governments have been making efforts to support the regulation of advertising and, in many cases, banning advertising and promotion of tobacco altogether. The objective of this study was to evaluate the potential impact on health and economic outcomes of optimizing a ban on tobacco advertising and sponsorship in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru. METHODS We built a probabilistic microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths, events, healthy years of life) and costs. To populate the model, we performed a rapid review of literature to calculate intervention effectiveness. RESULTS With current policies, over 10 years, in Argentina, Bolivia, Brazil, Chile, and Colombia a total of 50,000 deaths and 364,000 disease events will be averted, saving $7.2 billion. If the seven countries strengthened their policies and implemented a comprehensive ban with 100% compliance, 98,000 deaths and 648,000 events would be averted over 10 years, saving almost $15 billion in healthcare costs. CONCLUSIONS Optimizing a ban on tobacco advertising and sponsorship would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy.
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Affiliation(s)
- Ariel Bardach
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Andrea Alcaraz
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
| | - Javier Roberti
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Agustín Ciapponi
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Federico Augustovski
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Andrés Pichon-Riviere
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
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Palacios A, Rojas-Roque C, González L, Bardach A, Ciapponi A, Peckaitis C, Pichon-Riviere A, Augustovski F. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. Pharmacoeconomics 2021; 39:485-502. [PMID: 33782865 DOI: 10.1007/s40273-021-01014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC). METHODS In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies. RESULTS We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV. CONCLUSION This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835).
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Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Lucas González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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Mandrik OL, Severens JLH, Bardach A, Ghabri S, Hamel C, Mathes T, Vale L, Wisløff T, Goldhaber-Fiebert JD. Critical Appraisal of Systematic Reviews With Costs and Cost-Effectiveness Outcomes: An ISPOR Good Practices Task Force Report. Value Health 2021; 24:463-472. [PMID: 33840423 DOI: 10.1016/j.jval.2021.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 05/22/2023]
Affiliation(s)
- Olena Lena Mandrik
- Health Economic and Decision Science (HEDS), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, England, UK.
| | - J L Hans Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ariel Bardach
- Health Technology Assessment (HTA) and Health Economic Evaluations Department, IECS - Instituto de Efectividad Clínica y Sanitaria Asociación Civil, Buenos Aires, Argentina
| | - Salah Ghabri
- French National Authority for Health (HAS), Saint-Denis La Plaine, France
| | - Candyce Hamel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tim Mathes
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle, NBL, England, UK
| | - Torbjørn Wisløff
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jeremy D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research (CHP/PCOR), Stanford University Stanford, CA, USA
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Gonzalez L, Bardach A, Palacios A, Peckaitis C, Ciapponi A, Pichón-Riviere A, Augustovski F. Health-Related Quality of Life in Patients with Breast Cancer in Latin America and the Caribbean: A Systematic Review and Meta-Analysis. Oncologist 2021; 26:e794-e806. [PMID: 33554426 PMCID: PMC8100549 DOI: 10.1002/onco.13709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background and Objectives Breast cancer (BC) is the most common cancer in women. It imposes a huge disease burden and a significant impact on health‐related quality of life (HRQoL). Our study focused on HRQoL of patients with BC in Latin America and the Caribbean (LAC). We conducted a systematic review to identify relevant articles published between 2008 and August 2018. We conducted several meta‐analyses and subgroup analyses by country, disease stage, and instrument used (Prospective Register Of Systematic Reviews registration number: CRD42018106835). Results From 2,265 initial references, we finally included 75 articles (8,806 participants) that assessed HRQoL. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 and B23 modules (34 studies; 8 countries; 4,866 participants) were the most used instruments, followed by the Short Form 36‐item, the abbreviated version of the World Health Organization Quality of Life instrument, and the Functional Assessment of Cancer Therapy – Breast instrument. Only four studies reported specific HRQoL data of patients with metastatic disease. Half the studies were rated as having moderate quality (38/75), and 38% (29/75) as high quality. We identified substantial heterogeneity. As expected, the meta‐analyses revealed that patients with metastatic disease reported lower HRQoL values and high symptom burden compared with patients at earlier stages. Similar results can be observed when we compared patients with early breast cancer in active treatment phases versus those in follow‐up. Conclusion This study provides a synthesis of breast cancer HRQoL reported in LAC and exposes existing evidence gaps. Patients with BC in active treatment or with metastatic disease had worse HRQoL compared with survivors during the follow‐up period. Implications for Practice This systematic review provides an exhaustive synthesis of breast cancer health‐related quality of life in women in the Latin American and Caribbean region. Patients with breast cancer in active treatment or with metastatic disease had worse health‐related quality of life compared with survivors during the different follow‐up periods. This study also shows important evidence and methods gaps that can help inform future research. This review reports the health‐related quality of life for patients with breast cancer living in Latin American countries and explores relationships with disease stage and treatment in real‐world settings.
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Affiliation(s)
- Lucas Gonzalez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Andres Pichón-Riviere
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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Alcaraz A, Hernández-Vásquez A, Palacios A, Rodríguez B, Roberti J, García-Martí S, Ciapponi A, Augustovski F, Bardach A, Pichon-Riviere A. Health and Economic Impact of Health Warnings and Plain Tobacco Packaging in Seven Latin American Countries: Results of a Simulation Model. Nicotine Tob Res 2021; 22:2032-2040. [PMID: 32531063 DOI: 10.1093/ntr/ntaa104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The burden of disease attributable to tobacco use in Latin America is very high. Our objective was to evaluate the 10-year potential impact of current legislation related to cigarette packaging and warnings and expected effects of moving to a higher level of strategies implementing cigarette plain packaging on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a microsimulation model. AIMS AND METHODS We used a probabilistic state-transition microsimulation model, considering natural history, costs, and quality of life losses associated with main tobacco-related diseases. We followed up individuals in hypothetical cohorts and calculated health outcomes annually to obtain aggregated long-term population health outcomes and costs. We performed a literature review to estimate effects and analyzed studies and information from ministries, relevant organizations, and national surveys. We calibrated the model comparing the predicted disease-specific mortality rates with local statistics. RESULTS Current graphic warnings already in place in each country could avert, during 10 years, 69 369 deaths and 638 295 disease events, adding 1.2 million years of healthy life and saving USD 5.3 billion in the seven countries. If these countries implemented plain packaging strategies, additional 155 857 premature deaths and 4 133 858 events could be averted, adding 4.1 million healthy years of life and saving USD 13.6 billion in direct health care expenses of diseases attributable to smoking. CONCLUSIONS Latin American countries should not delay the implementation of this strategy that will alleviate part of the enormous health and financial burden that tobacco poses on their economies and health care systems. IMPLICATIONS Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds evidence on the potential health effects and savings of implementing cigarette plain packaging in countries representing almost 80% of the Latin American population; findings are valuable resources for policy makers in the region.
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Affiliation(s)
- Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Belén Rodríguez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Bardach A, Rodríguez MB, Ciapponi A, Augustovski F, Andrea A, Soto N, Virgilio S, Reynales-Shigematsu LM, Roberti J, Pichón-Riviere A. Smoke-Free Air Interventions in Seven Latin American Countries: Health and Financial Impact to Inform Evidence-Based Policy Implementation. Nicotine Tob Res 2021; 22:2149-2157. [PMID: 32697824 DOI: 10.1093/ntr/ntaa133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Disease burden due to tobacco smoking in Latin America remains very high. The objective of this study was to evaluate the potential impact of implementing smoke-free air interventions on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a mathematical model. AIMS AND METHODS We built a probabilistic Monte Carlo microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths and events) and costs. To populate the model, we completed an overview and systematic review of the literature. Also, we calibrated the model comparing the predicted disease-specific mortality rates with those coming from local national statistics. RESULTS With current policies, for the next 10 years, a total of 137 121 deaths and 917 210 events could be averted, adding 3.84 million years of healthy life and saving USD 9.2 billion in these seven countries. If countries fully implemented smoke-free air strategies, it would be possible to avert nearly 180 000 premature deaths and 1.2 million events, adding 5 million healthy years of life and saving USD 13.1 billion in direct healthcare. CONCLUSIONS Implementing the smoke-free air strategy would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy. IMPLICATIONS Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds quality evidence on the potential health effects and savings of implementing smoke-free air policies in countries representing almost 80% of the Latin America and the Caribbean population.
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Affiliation(s)
- Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - María Belén Rodríguez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Alcaraz Andrea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Natalie Soto
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Sacha Virgilio
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Javier Roberti
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Ciapponi A, Donato M, Gülmezoglu AM, Alconada T, Bardach A. Mobile apps for detecting falsified and substandard drugs: A systematic review. PLoS One 2021; 16:e0246061. [PMID: 33539433 PMCID: PMC7861418 DOI: 10.1371/journal.pone.0246061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
The use of substandard and counterfeit medicines (SCM) leads to significant health and economic consequences, like treatment failure, rise of antimicrobial resistance, extra expenditures of individuals or households and serious adverse drug reactions including death. Our objective was to systematically search, identify and compare relevant available mobile applications (apps) for smartphones and tablets, which use could potentially affect clinical and public health outcomes. We carried out a systematic review of the literature in January 2020, including major medical databases, and app stores. We used the validated Mobile App Rating Scale (MARS) to assess the quality of apps, (1 worst score, 3 acceptable score, and 5 best score). We planned to evaluate the accuracy of the mobile apps to detect SCM. We retrieved 335 references through medical databases and 42 from Apple, Google stores and Google Scholar. We finally included two studies of the medical database, 25 apps (eight from the App Store, eight from Google Play, eight from both stores, and one from Google Scholar), and 16 websites. We only found one report on the accuracy of a mobile apps detecting SCMs. Most apps use the imprint, color or shape for pill identification, and only a few offer pill detection through photographs or bar code. The MARS mean score for the apps was 3.17 (acceptable), with a maximum of 4.9 and a minimum of 1.1. The 'functionality' dimension resulted in the highest mean score (3.4), while the 'engagement' and 'information' dimensions showed the lowest one (3.0). In conclusion, we found a remarkable evidence gap about the accuracy of mobile apps in detecting SCMs. However, mobile apps could potentially be useful to screen for SCM by assessing the physical characteristics of pills, although this should still be assessed in properly designed research studies.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
- * E-mail:
| | - Manuel Donato
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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Cormick G, Betran AP, Romero IB, Cormick MS, Belizán JM, Bardach A, Ciapponi A. Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:316. [PMID: 33499250 PMCID: PMC7911363 DOI: 10.3390/nu13020316] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
Calcium supplementation and fortification are strategies widely used to prevent adverse outcome in population with low-calcium intake which is highly frequent in low-income settings. We aimed to determine the effectiveness and cost-effectiveness of calcium fortified foods on calcium intake and related health, or economic outcomes. We performed a systematic review and meta-analysis involving participants of any age or gender, drawn from the general population. We searched PubMed, Agricola, EMBASE, CINAHL, Global Health, EconLit, the FAO website and Google until June 2019, without language restrictions. Pair of reviewers independently selected, extracted data and assessed the risk of bias of included studies using Covidence software. Disagreements were resolved by consensus. We performed meta-analyses using RevMan 5.4 and subgroup analyses by study design, age group, and fortification levels. We included 20 studies of which 15 were randomized controlled trials (RCTs), three were non-randomised studies and two were economic evaluations. Most RCTs had high risk of bias on randomization or blinding. Most represented groups were women and children from 1 to 72 months, most common intervention vehicles were milk and bakery products with a fortification levels between 96 and 1200 mg per 100 g of food. Calcium intake increased in the intervention groups between 460 mg (children) and 1200 mg (postmenopausal women). Most marked effects were seen in children. Compared to controls, height increased 0.83 cm (95% CI 0.00; 1.65), plasma parathyroid hormone decreased -1.51 pmol/L, (-2.37; -0.65), urine:calcium creatinine ratio decreased -0.05, (-0.07; -0.03), femoral neck and hip bone mineral density increased 0.02 g/cm2 (0.01; 0.04) and 0.03 g/cm2 (0.00; 0.06), respectively. The largest cost savings (43%) reported from calcium fortification programs came from prevented hip fractures in older women from Germany. Our study highlights that calcium fortification leads to a higher calcium intake, small benefits in children's height and bone health and also important evidence gaps for other outcomes and populations that could be solved with high quality experimental or quasi-experimental studies in relevant groups, especially as some evidence of calcium supplementation show controversial results on the bone health benefit on older adults.
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Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina;
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Departament de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo 1903, Argentina;
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland;
| | - Iris Beatriz Romero
- Departament de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo 1903, Argentina;
| | - Maria Sol Cormick
- Departament de Diagnóstico por Imágenes, Fleni, Montañeses 2325, Ciudad de Buenos Aires C1428, Argentina;
| | - José M. Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina;
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
| | - Ariel Bardach
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Centro Cochrane Argentino-Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina
| | - Agustín Ciapponi
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Centro Cochrane Argentino-Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina
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Pichon-Riviere A, Alcaraz A, Palacios A, Rodríguez B, Reynales-Shigematsu LM, Pinto M, Castillo-Riquelme M, Peña Torres E, Osorio DI, Huayanay L, Loza Munarriz C, de Miera-Juárez BS, Gallegos-Rivero V, De La Puente C, del Pilar Navia-Bueno M, Caporale J, Roberti J, Virgilio SA, Augustovski F, Bardach A. The health and economic burden of smoking in 12 Latin American countries and the potential effect of increasing tobacco taxes: an economic modelling study. The Lancet Global Health 2020; 8:e1282-e1294. [DOI: 10.1016/s2214-109x(20)30311-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 02/05/2023]
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