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Bloom DE, Canning D, Kotschy R, Prettner K, Schünemann J. Health and Economic Growth: Reconciling the Micro and Macro Evidence. World Dev 2024; 178:106575. [PMID: 38463754 PMCID: PMC10921999 DOI: 10.1016/j.worlddev.2024.106575] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Economists use micro-based and macro-based approaches to assess the macroeconomic return to population health. The macro-based approach tends to yield estimates that are either negative and close to zero or positive and an order of magnitude larger than the range of estimates derived from the micro-based approach. This presents a micro-macro puzzle regarding the macroeconomic return to health. We reconcile the two approaches by controlling for the indirect effects of health on income per capita, which macro-based approaches usually include but micro-based approaches deliberately omit when isolating the direct income effects of health. Our results show that the macroeconomic return to health lies in the range of plausible microeconomic estimates, demonstrating that both approaches are in fact consistent with one another.
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Bloom DE, Titball RW, Carapetis J. Strep A: challenges, opportunities, vaccine-based solutions and economics. NPJ Vaccines 2024; 9:81. [PMID: 38641630 PMCID: PMC11031572 DOI: 10.1038/s41541-024-00864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Affiliation(s)
- David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
- Perth Children's Hospital, Perth, WA, Australia.
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Bloom DE, Carapetis J. Strep A: challenges, opportunities, vaccine-based solutions, and economics. NPJ Vaccines 2024; 9:80. [PMID: 38641634 PMCID: PMC11031564 DOI: 10.1038/s41541-024-00863-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/11/2024] [Indexed: 04/21/2024] Open
Abstract
This collection of articles focuses on Streptococcus pyogenes (Strep A) vaccine research and innovation, with a focus on emerging efforts to understand and estimate the full societal value of Strep A vaccination.
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Affiliation(s)
- David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Perth Children's Hospital, Perth, WA, Australia
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Nandi A, Counts N, Bröker J, Malik S, Chen S, Han R, Klusty J, Seligman B, Tortorice D, Vigo D, Bloom DE. Cost of care for Alzheimer's disease and related dementias in the United States: 2016 to 2060. NPJ Aging 2024; 10:13. [PMID: 38331952 PMCID: PMC10853249 DOI: 10.1038/s41514-024-00136-6] [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] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Medical and long-term care for Alzheimer's disease and related dementias (ADRDs) can impose a large economic burden on individuals and societies. We estimated the per capita cost of ADRDs care in the in the United States in 2016 and projected future aggregate care costs during 2020-2060. Based on a previously published methodology, we used U.S. Health and Retirement Survey (2010-2016) longitudinal data to estimate formal and informal care costs. In 2016, the estimated per patient cost of formal care was $28,078 (95% confidence interval [CI]: $25,893-$30,433), and informal care cost valued in terms of replacement cost and forgone wages was $36,667 ($34,025-$39,473) and $15,792 ($12,980-$18,713), respectively. Aggregate formal care cost and formal plus informal care cost using replacement cost and forgone wage methods were $196 billion (95% uncertainty range [UR]: $179-$213 billion), $450 billion ($424-$478 billion), and $305 billion ($278-$333 billion), respectively, in 2020. These were projected to increase to $1.4 trillion ($837 billion-$2.2 trillion), $3.3 trillion ($1.9-$5.1 trillion), and $2.2 trillion ($1.3-$3.5 trillion), respectively, in 2060.
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Affiliation(s)
- Arindam Nandi
- The Population Council, 1 Dag Hammarskjold Plaza, New York, NY, 10017, USA.
- One Health Trust, Washington, DC, USA.
| | - Nathaniel Counts
- Office of the Commissioner of Health & Mental Hygiene for the City of New York, New York, NY, USA
| | | | | | - Simiao Chen
- University of Heidelberg, Heidelberg, Germany
| | - Rachael Han
- Department of Molecular and Cellular Biology and The Center for Brain Science, Harvard University, Cambridge, MA, USA
| | | | - Benjamin Seligman
- Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Geriatrics Research, Education, and Clinical Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA
| | | | - Daniel Vigo
- University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nichols E, Petrosyan S, Khobragade P, Banerjee J, Angrisani M, Dey S, Bloom DE, Schaner S, Dey AB, Lee J. Trajectories and correlates of poor mental health in India over the course of the COVID-19 pandemic: a nationwide survey. BMJ Glob Health 2024; 9:e013365. [PMID: 38286516 PMCID: PMC10826618 DOI: 10.1136/bmjgh-2023-013365] [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] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic had large impacts on mental health; however, most existing evidence is focused on the initial lockdown period and high-income contexts. By assessing trajectories of mental health symptoms in India over 2 years, we aim to understand the effect of later time periods and pandemic characteristics on mental health in a lower-middle income context. METHODS We used data from the Real-Time Insights of COVID-19 in India cohort study (N=3709). We used covariate-adjusted linear regression models with generalised estimating equations to assess associations between mental health (Patient Health Questionnaire (PHQ-4) score; range 0-12) and pandemic periods as well as pandemic characteristics (COVID-19 cases and deaths, government stringency, self-reported financial impact, COVID-19 infection in the household) and explored effect modification by age, gender and rural/urban residence. RESULTS Mental health symptoms dropped immediately following the lockdown period but rose again during the delta and omicron waves. Associations between mental health and later pandemic stages were stronger for adults 45 years of age and older (p<0.001). PHQ-4 scores were significantly associated with all pandemic characteristics considered, including estimated COVID-19 deaths (PHQ-4 difference of 0.10 units; 95% CI 0.06 to 0.13), government stringency index (0.14 units; 95% CI 0.11 to 0.18), self-reported major financial impacts (1.20 units; 95% CI 1.09 to 1.32) and COVID-19 infection in the household (0.36 units; 95% CI 0.23 to 0.50). CONCLUSION While the lockdown period and associated financial stress had the largest mental health impacts on Indian adults, the effects of the pandemic on mental health persisted over time, especially among middle-aged and older adults. Results highlight the importance of investments in mental health supports and services to address the consequences of cyclical waves of infections and disease burden due to COVID-19 or other emerging pandemics.
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Affiliation(s)
- Emma Nichols
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Sarah Petrosyan
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Pranali Khobragade
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Joyita Banerjee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Sharmistha Dey
- All India Institute of Medical Sciences, New Delhi, India
| | - David E Bloom
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Simone Schaner
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Aparajit B Dey
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
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Sevilla JP, Tortorice D, Kantor D, Regan J, Meszaros KH, Beck EC, Begum N, Bloom DE. Lifecycle model-based evaluation of infant 4CMenB vaccination in the UK. Eur J Health Econ 2024:10.1007/s10198-023-01654-y. [PMID: 38182698 DOI: 10.1007/s10198-023-01654-y] [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] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/22/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Invasive meningococcal disease, an uncommon but severe disease, imposes catastrophic health and economic burdens. Cost-utility analysis (CUA) assumes separability in lifetime health and economic variables and cannot capture the full value of preventing such burdens. We overcome these limitations with a retrospective societal perspective cost-benefit analysis (CBA) of meningococcal serogroup B vaccination (4CMenB) of one infant cohort in the United Kingdom using a health-augmented lifecycle model (HALM) incorporating health's interactions with consumption, earnings, non-market time and financial risk. METHODS We used a static Markov model of vaccination's health impact and an HALM to estimate the private willingness to pay (PWTP) for the intrinsic and instrumental value of health under perfect capital markets, financial risk protection in the absence of insurance against permanent disability, parental spillovers, and acute phase disability. We estimated social WTP (SWTP) incorporating social severity preferences. We estimated rates of return that inform health payer reimbursement decisions, finance ministry budgeting decisions, and legislature taxation decisions. An expert Advisory Board investigated the validity of applying the HALM to infant 4CMenB. RESULTS The PWTP for a 2 + 1 vaccination schedule is £395, comprising £166 of disability insurance value, £79 of positive parental spillover value, £28 in the value of averting acute phase disability, and £122 in residual intrinsic and instrumental value of health. SWTP is £969. CONCLUSIONS HALM-based CBA provides an empirically richer, more utility-theoretically grounded approach to vaccine evaluation than CUA, demonstrating good value for money for legislatures (based on private values) and for all decision-makers (based on social values).
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Affiliation(s)
- J P Sevilla
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA.
| | - Daniel Tortorice
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | - David Kantor
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | - John Regan
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | | | | | | | - David E Bloom
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
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Bloom DE, Bonanni P, Martinón-Torres F, Richmond PC, Safadi MAP, Salisbury DM, Charos A, Schley K, Findlow J, Balmer P. Meningococcal Disease in the Post-COVID-19 Era: A Time to Prepare. Infect Dis Ther 2023; 12:2649-2663. [PMID: 38048020 PMCID: PMC10746601 DOI: 10.1007/s40121-023-00888-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
The global invasive meningococcal disease (IMD) landscape changed considerably during the COVID-19 pandemic, as evidenced by decreased incidence rates due to COVID-19 mitigation measures, such as limited social contact, physical distancing, mask wearing, and hand washing. Vaccination rates were also lower during the pandemic relative to pre-pandemic levels. Although policymakers may have shifted their focus away from IMD vaccination programs to COVID-19 vaccination programs, strong arguments support implementation and prioritization of IMD vaccination programs; IMD cases have increased in some countries and IMD rates may even have exceeded pre-pandemic levels. Additional concerns include increased susceptibility due to vaccination coverage gaps, increased incidence of other respiratory pathogens, immunity debt from lockdown restrictions, and increased IMD epidemiologic variability. The full range of benefits of widely available and effective meningococcal vaccines needs to be considered, especially in health technology assessments, where the broad benefits of these vaccines are neither accurately quantified nor captured in implementation policy decisions. Importantly, implementation of meningococcal vaccination programs in the current IMD climate also appeals to broader healthcare principles, including preparedness rather than reactive approaches, generally accepted benefit-risk approaches to vaccination, historical precedent, and the World Health Organization's goal of defeating meningitis by 2030. Countries should therefore act swiftly to bolster existing meningococcal vaccination strategies to provide broad coverage across age groups and serogroups given the recent increases in IMD incidence.
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Affiliation(s)
- David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago, de Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Peter C Richmond
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | - Marco A P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - David M Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London, UK
| | | | | | - Jamie Findlow
- Vaccines, Antivirals and Evidence Generation, Pfizer Ltd, Tadworth, UK
| | - Paul Balmer
- Vaccines, Antivirals and Evidence Generation, Pfizer Inc, Collegeville, PA, USA
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Miller KM, Barnett TC, Cadarette D, Bloom DE, Carapetis JR, Cannon JW. Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study. EBioMedicine 2023; 98:104864. [PMID: 37950997 PMCID: PMC10663680 DOI: 10.1016/j.ebiom.2023.104864] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A). METHODS We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines. FINDINGS We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing. INTERPRETATION A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours. FUNDING The Wellcome Trust, grant agreement number 215490/Z/19/Z.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Daniel Cadarette
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Centre for Child Health Research, Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
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Ehrlich JR, Agarwal A, Young C, Lee J, Bloom DE. Author Correction: The prevalence of vision impairment and blindness among older adults in India: findings from the Longitudinal Ageing Study in India. Nat Aging 2023; 3:1602. [PMID: 38001313 DOI: 10.1038/s43587-023-00541-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- Joshua R Ehrlich
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Arunika Agarwal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Codi Young
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jinkook Lee
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Cadarette D, Ferranna M, Cannon JW, Abbas K, Giannini F, Zucker L, Bloom DE. The full health, economic, and social benefits of prospective Strep A vaccination. NPJ Vaccines 2023; 8:166. [PMID: 37903813 PMCID: PMC10616198 DOI: 10.1038/s41541-023-00758-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/09/2023] [Indexed: 11/01/2023] Open
Abstract
Recent research has documented a wide range of health, economic, and social benefits conferred by vaccination, beyond the direct reductions in morbidity, mortality, and future healthcare costs traditionally captured in economic evaluations. In this paper, we describe the societal benefits that would likely stem from widespread administration of safe and effective vaccines against Streptococcus pyogenes (Strep A), which was estimated to be the fifth-leading cause of infectious disease deaths globally prior to the COVID-19 pandemic. We then estimate the global societal gains from prospective Strep A vaccination through a value-per-statistical-life approach. Estimated aggregate lifetime benefits for 30 global birth cohorts range from $1.7 to $5.1 trillion, depending on the age at which vaccination is administered and other factors. These results suggest that the benefits of Strep A vaccination would be large and justify substantial investment in the vaccines' development, manufacture, and delivery.
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Affiliation(s)
| | - Maddalena Ferranna
- University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Leo Zucker
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ferranna M, Cadarette D, Chen S, Ghazi P, Ross F, Zucker L, Bloom DE. The macroeconomic burden of noncommunicable diseases and mental health conditions in South America. PLoS One 2023; 18:e0293144. [PMID: 37862345 PMCID: PMC10588886 DOI: 10.1371/journal.pone.0293144] [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: 06/11/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
Noncommunicable diseases and mental health conditions (referred to collectively as NMHs) are the greatest cause of preventable death, illness, and disability in South America and negatively affect countries' economic performance through their detrimental impacts on labor supply and capital investments. Sound, evidence-based policy-making requires a deep understanding of the macroeconomic costs of NMHs and of their distribution across countries and diseases. The paper estimates and projects the macroeconomic burden of NMHs over the period 2020-2050 in 10 South American countries. We estimate the impact of NMHs on gross domestic product (GDP) through a human capital-augmented production function approach, accounting for mortality and morbidity effects of NMHs on labor supply, for the impact of treatment costs on physical capital accumulation, and for variations in human capital by age. Our central estimates suggest that the overall burden of NMHs in these countries amounts to $7.3 trillion (2022 international $, 3% discount rate, 95% confidence interval: $6.8-$7.8 trillion). Overall, the macroeconomic burden of NMHs is around 4% of total GDP over 2020-2050, with little variation across countries (from 3.2% in Peru to 4.5% in Brazil). In other words, without NMHs, annual GDP over 2020-2050 would be about 4% larger. In most countries, the largest macroeconomic burden is associated with cancers. Results from the paper point to a significant macroeconomic burden of NMHs in South America and provide a strong justification for investment in NMH prevention, early detection, treatment, and formal and informal care.
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Affiliation(s)
- Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, United States of America
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, United States of America
| | - Daniel Cadarette
- Harvard Kennedy School, Cambridge, Massachusetts, United States of America
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Parastou Ghazi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Faith Ross
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Leo Zucker
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Connolly MP, Kotsopoulos N, Roberts C, Kotlikoff L, Bloom DE, Hu T, Nyaku M. Public economic gains from tax-financed investments in childhood immunization in the United States. PLOS Glob Public Health 2023; 3:e0002461. [PMID: 37851624 PMCID: PMC10584131 DOI: 10.1371/journal.pgph.0002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/15/2023] [Indexed: 10/20/2023]
Abstract
The emergence of COVID-19 has displayed the importance of immunization and the need for continued public investment in vaccination programs. Globally, national vaccination programs rely heavily on tax-financed expenditure, requiring upfront investments and ongoing financial commitments. To evaluate annual public investments, we conducted a fiscal analysis that quantifies the public economic consequences to government in the United States attributable to childhood vaccination. To estimate the change in net government revenue, we developed a decision-analytic model that quantifies lifetime tax revenues and transfers based on changes in morbidity and mortality arising from vaccination of the 2017 U.S. birth cohort. Reductions in deaths and comorbid conditions attributed to pediatric vaccines were used to derive gross lifetime earnings gains, tax revenue gains attributed to averted morbidity and mortality avoided, disability transfer cost savings, and averted special education costs associated with each vaccine. Our analysis indicates a fiscal dividend of $41.7 billion from vaccinating this cohort. The bulk of this gain for government reflects avoiding the loss of $30.6 billion in present-value tax revenues. All pediatric vaccines raise tax revenues by reducing vaccine-preventable morbidity and mortality in amounts ranging from $7.3 million (hepatitis A) to $20.3 billion (diphtheria) over the life course. Based on public investments in pediatric vaccines, a benefit-cost ratio of 17.8 was calculated for each dollar invested in childhood immunization. The public economic yield attributed to childhood vaccination in the U.S. is significant from a government perspective, providing fiscal justification for ongoing investment.
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Affiliation(s)
- Mark P. Connolly
- Health Economics, Global Market Access Solutions LLC, Mooresville, North Carolina, United States of America
- University Medical Center Groningen, Groningen, Netherlands
| | - Nikolaos Kotsopoulos
- Health Economics, Global Market Access Solutions LLC, Mooresville, North Carolina, United States of America
- Department of Economics, University of Athens, Athens, Greece
| | - Craig Roberts
- Merck & Co., Inc., Center for Observational and Real-World Evidence, Kenilworth, New Jersey, United States of America
| | - Laurence Kotlikoff
- Department of Economics, Boston University, Boston, Massachusetts, United States of America
| | - David E. Bloom
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tianyan Hu
- Merck & Co., Inc., Center for Observational and Real-World Evidence, Kenilworth, New Jersey, United States of America
| | - Mawuli Nyaku
- Merck & Co., Inc., Center for Observational and Real-World Evidence, Kenilworth, New Jersey, United States of America
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Ferranna M, Robinson LA, Cadarette D, Eber MR, Bloom DE. The benefits and costs of U.S. employer COVID-19 vaccine mandates. Risk Anal 2023; 43:2053-2068. [PMID: 36649917 DOI: 10.1111/risa.14090] [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: 08/02/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
In 2021, the Biden Administration issued mandates requiring COVID-19 vaccinations for U.S. federal employees and contractors and for some healthcare and private sector workers. These mandates have been challenged in court; some have been halted or delayed. However, their costs and benefits have not been rigorously appraised. This study helps fill that gap. We estimate the direct costs and health-related benefits that would have accrued if these vaccination requirements had been implemented as intended. Compared with the January 2022 vaccination rates, we find that the mandates could have led to 15 million additional vaccinated individuals, increasing the overall proportion of the fully vaccinated U.S. population from 64% to 68%. The associated net benefits depend on the subsequent evolution of the pandemic-information unavailable ex ante to analysts or policymakers. In scenarios involving the emergence of a novel, more transmissible variant, against which vaccination and previous infection offer moderate protection, the estimated net benefits are potentially large. They reach almost $20,000 per additional vaccinated individual, with more than 20,000 total deaths averted over the 6-month period assessed. In scenarios involving a fading pandemic, existing vaccination-acquired or infection-acquired immunity provides sufficient protection, and the mandates' benefits are unlikely to exceed their costs. Thus, mandates may be most useful when the consequences of inaction are catastrophic. However, we do not compare the effects of mandates with alternative policies for increasing vaccination rates or for promoting other protective measures, which may receive stronger public support and be less likely to be overturned by litigation.
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Affiliation(s)
- Maddalena Ferranna
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
| | - Lisa A Robinson
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Michael R Eber
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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14
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Nichols E, Petrosyan S, Khobragade P, Banerjee J, Angrisani M, Dey S, Bloom DE, Schaner S, Dey AB, Lee J. Trajectories and correlates of poor mental health in India over the course of the COVID-19 pandemic: a nation-wide survey. medRxiv 2023:2023.09.13.23295513. [PMID: 37745425 PMCID: PMC10516061 DOI: 10.1101/2023.09.13.23295513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Introduction The COVID-19 pandemic had large impacts on mental health; however, most existing evidence is focused on the initial lockdown period and high-income contexts. By assessing trajectories of mental health symptoms in India over two years, we aim to understand the effect of later time periods and pandemic characteristics on mental health in a lower-middle income context. Methods We used data from the Real-Time Insights of COVID-19 in India (RTI COVID-India) cohort study (N=3,662). We used covariate-adjusted linear regression models with generalized estimating equations to assess associations between mental health (PHQ-4 score) and pandemic periods as well as pandemic characteristics (COVID-19 cases and deaths, government stringency, self-reported financial impact, COVID-19 infection in the household) and explored effect modification by age, gender, and rural/urban residence. Results Mental health symptoms dropped immediately following the lockdown period but rose again during the delta and omicron waves. Associations between mental health and later pandemic stages were stronger for adults 45 years of age and older (p<0.001). PHQ-4 scores were significantly and independently associated with all pandemic characteristics considered, including estimated COVID-19 deaths (PHQ-4 difference of 0.041 SD units; 95% Confidence Interval 0.030 - 0.053), government stringency index (0.060 SD units; 0.048 - 0.072), self-reported major financial impacts (0.45 SD units; 0.41-0.49), and COVID-19 infection in the household (0.11 SD units; 0.07-0.16). Conclusion While the lockdown period and associated financial stress had the largest mental health impacts on Indian adults, the effects of the pandemic on mental health persisted over time, especially among middle-age and older adults. Results highlight the importance of investments in mental health supports and services to address the consequences of cyclical waves of infections and disease burden due to COVID-19 or other emerging pandemics.
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Affiliation(s)
- Emma Nichols
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Sarah Petrosyan
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Pranali Khobragade
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Joyita Banerjee
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Sharmistha Dey
- All India Institute of Medical Sciences, New Delhi, India
| | - David E. Bloom
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Simone Schaner
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - AB Dey
- Venu Geriatric Institute, New Delhi, India
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
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15
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Gibson E, Ollendorf DA, Simoens S, Bloom DE, Martinón-Torres F, Salisbury D, Severens JL, Toumi M, Molnar D, Meszaros K, Sohn WY, Begum N. Rule of Prevention: a potential framework to evaluate preventive interventions for rare diseases. J Mark Access Health Policy 2023; 11:2239557. [PMID: 37583879 PMCID: PMC10424616 DOI: 10.1080/20016689.2023.2239557] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
Background: The benefits of preventive interventions lack comprehensive evaluation in standard health technology assessments (HTA), particularly for rare and transmissible diseases. Objective: To identify possible considerations for future HTA using analogies between the treatment and prevention of rare diseases. Study design: An Expert panel meeting assessed whether one HTA assessment framework can be applied to assess both rare disease treatments and preventive interventions. Experts also evaluated the range of value elements currently included in HTAs and their applicability to rare, transmissible, and/or preventable diseases. Results: A broad range of value should be considered when assessing rare, transmissible disease prevention. Although standard HTA can be applied to transmissible diseases, the risk of local outbreaks and the need for large-scale prevention programs suggest a modified assessment framework, capable of incorporating prevention-specific value elements in HTAs. A 'Rule of Prevention' framework was proposed to allow broader value considerations anchored to severity, equity, and prevention benefits in decision-making for preventive interventions for rare transmissible diseases. Conclusion: The proposed prevention framework introduces an explicit initial approach to consistently assess rare transmissible diseases, and to incorporate the broader value of preventive interventions compared with treatment.
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Affiliation(s)
| | - Daniel A. Ollendorf
- Institute for Clinical Research and Health Policy Studies (ICRHPS), Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA, USA
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Federico Martinón-Torres
- Department of Pediatrics, Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - David Salisbury
- Royal Institute of International Affairs, Chatham House, London, UK
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16
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Chen S, Kuhn M, Prettner K, Yu F, Yang T, Bärnighausen T, Bloom DE, Wang C. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health 2023; 11:e1183-e1193. [PMID: 37474226 PMCID: PMC10369014 DOI: 10.1016/s2214-109x(23)00217-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and imposes a substantial economic burden. Gaining a thorough understanding of the economic implications of COPD is an important prerequisite for sound, evidence-based policy making. We aimed to estimate the macroeconomic burden of COPD for each country and establish its distribution across world regions. METHODS In this health-augmented macroeconomic modelling study we estimated the macroeconomic burden of COPD for 204 countries and territories over the period 2020-50. The model accounted for (1) the effect of COPD mortality and morbidity on labour supply, (2) age and sex specific differences in education and work experience among those affected by COPD, and (3) the impact of COPD treatment costs on physical capital accumulation. We obtained data from various public sources including the Global Burden of Disease Study 2019, the World Bank database, and the literature. The macroeconomic burden of COPD was assessed by comparing gross domestic product (GDP) between a scenario projecting disease prevalence based on current estimates and a counterfactual scenario with zero COPD prevalence from 2020 to 2050. FINDINGS Our findings suggest that COPD will cost the world economy INT$4·326 trillion (uncertainty interval 3·327-5·516; at constant 2017 prices) in 2020-50. This economic effect is equivalent to a yearly tax of 0·111% (0·085-0·141) on global GDP. China and the USA face the largest economic burdens from COPD, accounting for INT$1·363 trillion (uncertainty interval 1·034-1·801) and INT$1·037 trillion (0·868-1·175), respectively. INTERPRETATION The macroeconomic burden of COPD is large and unequally distributed across countries, world regions, and income levels. Our study stresses the urgent need to invest in global efforts to curb the health and economic burdens of COPD. Investments in effective interventions against COPD do not represent a burden but could instead provide substantial economic returns in the foreseeable future. FUNDING Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, Chinese Academy of Medical Sciences and Peking Union Medical College project, and Horizon Europe. TRANSLATIONS For the Chinese and German translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Michael Kuhn
- International Institute for Applied Systems Analysis, Laxenburg, Austria; Wittgenstein Centre, Vienna, Austria
| | - Klaus Prettner
- Vienna University of Economics and Business, Department of Economics, Vienna, Austria
| | - Fengyun Yu
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Chinese Academy of Engineering, Beijing, China.
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17
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Giannini F, Cannon JW, Cadarette D, Bloom DE, Moore HC, Carapetis J, Abbas K. Author Correction: Modeling the potential health impact of prospective Strep A vaccines. NPJ Vaccines 2023; 8:104. [PMID: 37454195 DOI: 10.1038/s41541-023-00704-z] [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: 07/18/2023] Open
Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, UK
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18
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Lee J, Meijer E, Langa KM, Ganguli M, Varghese M, Banerjee J, Khobragade P, Angrisani M, Kurup R, Chakrabarti SS, Gambhir IS, Koul PA, Goswami D, Talukdar A, Mohanty RR, Yadati RS, Padmaja M, Sankhe L, Rajguru C, Gupta M, Kumar G, Dhar M, Chatterjee P, Singhal S, Bansal R, Bajpai S, Desai G, Rao AR, Sivakumar PT, Muliyala KP, Bhatankar S, Chattopadhyay A, Govil D, Pedgaonkar S, Sekher TV, Bloom DE, Crimmins EM, Dey AB. Prevalence of dementia in India: National and state estimates from a nationwide study. Alzheimers Dement 2023; 19:2898-2912. [PMID: 36637034 PMCID: PMC10338640 DOI: 10.1002/alz.12928] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Prior estimates of dementia prevalence in India were based on samples from selected communities, inadequately representing the national and state populations. METHODS From the Longitudinal Aging Study in India (LASI) we recruited a sample of adults ages 60+ and administered a rich battery of neuropsychological tests and an informant interview in 2018 through 2020. We obtained a clinical consensus rating of dementia status for a subsample (N = 2528), fitted a logistic model for dementia status on this subsample, and then imputed dementia status for all other LASI respondents aged 60+ (N = 28,949). RESULTS The estimated dementia prevalence for adults ages 60+ in India is 7.4%, with significant age and education gradients, sex and urban/rural differences, and cross-state variation. DISCUSSION An estimated 8.8 million Indians older than 60 years have dementia. The burden of dementia cases is unevenly distributed across states and subpopulations and may therefore require different levels of local planning and support. HIGHLIGHTS The estimated dementia prevalence for adults ages 60+ in India is 7.4%. About 8.8 million Indians older than 60 years live with dementia. Dementia is more prevalent among females than males and in rural than urban areas. Significant cross-state variation exists in dementia prevalence.
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Affiliation(s)
- Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Veterans Affairs, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Joyita Banerjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pranali Khobragade
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Ravi Kurup
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Indrajeet Singh Gambhir
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Parvaiz A. Koul
- Department of Internal and Pulmonary Medicine, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | - Rashmi Ranjan Mohanty
- Department of Medicine, All India Institute of Medical Sciences, Bhubaneshwar, India
| | | | - Mekala Padmaja
- Department of Medicine, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Lalit Sankhe
- Department of Community Medicine, Grant Medical College and J.J. Hospital, Mumbai, India
| | - Chhaya Rajguru
- Department of Community Medicine, Grant Medical College and J.J. Hospital, Mumbai, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Govind Kumar
- Department of Medicine, Indira Gandhi Institute of Medical Science, Patna, India
| | - Minakshi Dhar
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunny Singhal
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rishav Bansal
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Bajpai
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Desai
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhijith R. Rao
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Palanimuthu T. Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Dipti Govil
- International Institute for Population Sciences, Mumbai, India
| | | | - T. V. Sekher
- International Institute for Population Sciences, Mumbai, India
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eileen M. Crimmins
- School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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19
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Giannini F, Cannon JW, Cadarette D, Bloom DE, Moore HC, Carapetis J, Abbas K. Modeling the potential health impact of prospective Strep A vaccines. NPJ Vaccines 2023; 8:90. [PMID: 37301930 DOI: 10.1038/s41541-023-00668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
The World Health Organization published the preferred product characteristics for a Group A Streptococcus (Strep A) vaccine in 2018. Based on these parameters for the age of vaccination, vaccine efficacy, duration of protection from vaccine-derived immunity, and vaccination coverage, we developed a static cohort model to estimate the projected health impact of Strep A vaccination at the global, regional, and national levels and by country-income category. We used the model to analyse six strategic scenarios. Based on Strep A vaccine introduction between 2022 and 2034 for the primary scenario, we estimated vaccination at birth for 30 vaccinated cohorts could avert 2.5 billion episodes of pharyngitis, 354 million episodes of impetigo, 1.4 million episodes of invasive disease, 24 million episodes of cellulitis, and 6 million cases of rheumatic heart disease globally. Vaccination impact in terms of burden averted per fully vaccinated individual is highest in North America for cellulitis and in Sub-Saharan Africa for rheumatic heart disease.
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Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, UK
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20
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Tortorice D, Ferranna M, Bloom DE. Optimal global spending for group A Streptococcus vaccine research and development. NPJ Vaccines 2023; 8:62. [PMID: 37185380 PMCID: PMC10125865 DOI: 10.1038/s41541-023-00646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/29/2022] [Accepted: 03/13/2023] [Indexed: 05/17/2023] Open
Abstract
Group A Streptococcus (Strep A) leads to 600,000 deaths and 600 million cases of pharyngitis annually. Although long a promising target for vaccine development, how much funding should be allocated to develop a Strep A vaccine is unclear. We aim to calculate the optimal amount of global spending for Strep A vaccine development, the resulting benefits, and the social rate of return on this spending. We develop a model of optimal spending, from a global societal perspective, on research and development (R&D) for vaccines and treatments. The model takes as inputs total harm from the disease, the probability an R&D project succeeds, the cost of a project, and the fraction of total harm a success alleviates. Based on these inputs the model outputs an optimal amount of spending and a rate of return. We calibrate the model for Strep A. Optimal spending is estimated to be 2020 USD33 billion. This spending leads to 2020 USD1.63 trillion in benefits and a real return of 22.3% per year for thirty years. Sensitivity shows an optimal spending range of 15.9 billion to 58.5 billion, a benefits range of 1.6 trillion to 37.9 trillion, and a return range of 18.0-48.2%. Investment in a Strep A vaccine could create enormous benefits for comparatively little cost. It represents one of the highest return uses of public spending. Policy can promote Strep A vaccine development through direct funding of projects and by promoting financial mechanisms that allow the private sector to diversify its R&D investment.
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Affiliation(s)
- Daniel Tortorice
- Department of Economics and Accounting, College of the Holy Cross, Worcester, MA, USA.
| | - Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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21
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Zhang J, Prettner K, Chen S, Bloom DE. Beyond GDP: Using healthy lifetime income to trace well-being over time with estimates for 193 countries. Soc Sci Med 2023; 320:115674. [PMID: 36681057 DOI: 10.1016/j.socscimed.2023.115674] [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: 11/01/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
We measure well-being across 193 countries from 1990 to 2019 using a new indicator: healthy lifetime income (HLI). Apart from the income component as captured by standard per capita gross domestic product, HLI incorporates health as a second important component. Overall, HLI can be interpreted as the income of the average person in an economy during the years in which the person is in good health. We show that HLI has particular strengths as compared with other measures such as the Human Development Index. These include requiring only easily accessible data for its construction, having an immediate economic interpretation and unit of measurement, not needing the application of arbitrary weights of subcomponents, and not being bounded from above. As compared with using per capita gross domestic product as a metric for well-being, we find that countries with better population health tend to fare better in the rankings. This provides a rationale for investments in health and helps shift the focus from material well-being (as an instrumental indicator of well-being) toward health (as an intrinsic goal).
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Affiliation(s)
- Junlai Zhang
- Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria; Jiangxi University of Finance and Economics, School of Statistics, Nanchang, China
| | - Klaus Prettner
- Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria.
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Nandi A, Pecetta S, Bloom DE. Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceutical sales data from 71 countries, 2020-2022. EClinicalMedicine 2023; 57:101848. [PMID: 36776504 PMCID: PMC9900305 DOI: 10.1016/j.eclinm.2023.101848] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [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: 10/31/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Despite bacterial coinfection rates of less than 10%, antibiotics are prescribed to an estimated 75% of patients with COVID-19, potentially exacerbating antimicrobial resistance. We estimated the associations of COVID-19 cases and vaccinations with global antibiotic sales during the first two years of the COVID-19 pandemic. METHODS We obtained monthly data on broad-spectrum antibiotic sales volumes (cephalosporins, penicillins, macrolides, and tetracyclines) in 71 countries during March 2020-May 2022 from the IQVIA MIDAS® database. These data were combined with country-month-level COVID-19 case and vaccination data from Our World in Data. We used least squares (pooled) and fixed-effects panel data regression models, accounting for country characteristics, to estimate the associations between antibiotic sales volumes and COVID-19 cases and vaccinations per 1000 people. FINDINGS Sales of all four antibiotics fell sharply during April and May 2020, followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.2%-0.3% higher sales of cephalosporins, 0.2%-0.3% higher sales of penicillins, 0.4%-0.6% higher sales of macrolides, and 0.3% higher sales of all four antibiotics combined per 1000 people. Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.8%, 1.3%, and 1.5% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continent were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations. Results from pooled regression analysis were similar to those from the fixed-effects models. INTERPRETATION Antibiotic sales were positively associated with COVID-19 cases globally during 2020-2022. Our findings underline that antibiotic stewardship in the context of COVID-19 remains essential. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Arindam Nandi
- The Population Council, New York, USA
- One Health Trust, Washington DC, USA
- Corresponding author. Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Simone Pecetta
- Research and Development Center, GlaxoSmithKline, Siena, Italy
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Pecetta S, Nandi A, Weller C, Harris V, Fletcher H, Berlanda Scorza F, Pizza M, Salisbury D, Moxon R, Black S, Bloom DE, Rappuoli R. Vaccines for a sustainable planet. Sci Transl Med 2023; 15:eadf1093. [PMID: 36857432 DOI: 10.1126/scitranslmed.adf1093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The health of the planet is one objective of the United Nations' Sustainable Development Goals. Vaccines can affect not only human health but also planet health by reducing poverty, preserving microbial diversity, reducing antimicrobial resistance, and preventing an increase in pandemics that is fueled partly by climate change.
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Affiliation(s)
| | - Arindam Nandi
- Population Council, New York, NY, USA.,One Health Trust, Washington, DC, USA
| | | | - Vanessa Harris
- Amsterdam University Medical Center, Department of Internal Medicine, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Helen Fletcher
- Janssen Pharmaceutical Companies of Johnson & Johnson, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Richard Moxon
- Department of Paediatrics, Oxford University, Oxford, UK
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - David E Bloom
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
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24
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Chen S, Cao Z, Prettner K, Kuhn M, Yang J, Jiao L, Wang Z, Li W, Geldsetzer P, Bärnighausen T, Bloom DE, Wang C. Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050. JAMA Oncol 2023; 9:465-472. [PMID: 36821107 PMCID: PMC9951101 DOI: 10.1001/jamaoncol.2022.7826] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Importance Cancers are a leading cause of mortality, accounting for nearly 10 million annual deaths worldwide, or 1 in 6 deaths. Cancers also negatively affect countries' economic growth. However, the global economic cost of cancers and its worldwide distribution have yet to be studied. Objective To estimate and project the economic cost of 29 cancers in 204 countries and territories. Design, Setting, and Participants A decision analytical model that incorporates economic feedback in assessing health outcomes associated with the labor force and investment. A macroeconomic model was used to account for (1) the association of cancer-related mortality and morbidity with labor supply; (2) age-sex-specific differences in education, experience, and labor market participation of those who are affected by cancers; and (3) the diversion of cancer treatment expenses from savings and investments. Data were collected on April 25, 2022. Main Outcomes and Measures Economic cost of 29 cancers across countries and territories. Costs are presented in international dollars at constant 2017 prices. Results The estimated global economic cost of cancers from 2020 to 2050 is $25.2 trillion in international dollars (at constant 2017 prices), equivalent to an annual tax of 0.55% on global gross domestic product. The 5 cancers with the highest economic costs are tracheal, bronchus, and lung cancer (15.4%); colon and rectum cancer (10.9%); breast cancer (7.7%); liver cancer (6.5%); and leukemia (6.3%). China and the US face the largest economic costs of cancers in absolute terms, accounting for 24.1% and 20.8% of the total global burden, respectively. Although 75.1% of cancer deaths occur in low- and middle-income countries, their share of the economic cost of cancers is lower at 49.5%. The relative contribution of treatment costs to the total economic cost of cancers is greater in high-income countries than in low-income countries. Conclusions and Relevance In this decision analytical modeling study, the macroeconomic cost of cancers was found to be substantial and distributed heterogeneously across cancer types, countries, and world regions. The findings suggest that global efforts to curb the ongoing burden of cancers are warranted.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhong Cao
- Institute for Artificial Intelligence, Tsinghua University, Beijing, China,State Key Lab of Intelligent Technologies and Systems, Beijing National Research Center for Information Science and Technology, Department of Automation, Tsinghua University, Beijing, China
| | - Klaus Prettner
- Vienna Institute of Demography, Wittgenstein Centre, International Institute for Applied Systems Analysis, OeAW, University of Vienna, Vienna, Austria,Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria
| | - Michael Kuhn
- Vienna Institute of Demography, Wittgenstein Centre, International Institute for Applied Systems Analysis, OeAW, University of Vienna, Vienna, Austria,International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lirui Jiao
- Columbia Mailman School of Public Health, New York, New York
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China,Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan, China
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David E. Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,National Clinical Research Center for Respiratory Diseases, Beijing, China,Chinese Academy of Engineering, Beijing, China
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25
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Banerjee J, Petrosyan S, Rao AR, Jacob S, Khobragade PY, Weerman B, Chien S, Angrisani M, Agarwal A, Madan N, Sethi T, Dey S, Schaner S, Bloom DE, Lee J, Dey AB. Cohort Profile: Real-Time Insights of COVID-19 in India (RTI COVID-India). BMC Public Health 2023; 23:292. [PMID: 36759802 PMCID: PMC9909130 DOI: 10.1186/s12889-023-15084-1] [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] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID) pandemic caused disruption globally and was particularly distressing in low- and middle-income countries such as India. This study aimed to provide population representative estimates of COVID-related outcomes in India over time and characterize how COVID-related changes and impacts differ by key socioeconomic groups across the life course. METHODS The sample was leveraged from an existing nationally representative study on cognition and dementia in India: Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). The wave-1 of LASI-DAD enrolled 4096 older adults aged 60 years and older in 3316 households from 18 states and union territories of India. Out of the 3316 LASI-DAD households, 2704 with valid phone numbers were contacted and invited to participate in the Real-Time Insights COVID-19 in India (RTI COVID-India) study. RTI COVID-India was a bi-monthly phone survey that provided insight into the individual's knowledge, attitudes, and behaviour towards COVID-19 and changes in the household's economic and health conditions throughout the pandemic. The survey was started in May 2020 and 9 rounds of data have been collected. FINDINGS TILL DATE Out of the 2704 LASI-DAD households with valid phone numbers, 1766 households participated in the RTI COVID-India survey at least once. Participants were in the age range of 18-102 years, 49% were female, 66% resided in rural area. Across all rounds, there was a higher report of infection among respondents aged 60-69 years. There was a greater prevalence of COVID-19 diagnosis reported in urban (23.0%) compared to rural areas (9.8%). Respondents with higher education had a greater prevalence of COVID-19 diagnosis compared to those with lower or no formal education. Highest prevalence of COVID-19 diagnosis was reported from high economic status compared to middle and low economic status households. Comparing education gradients in experiencing COVID-19 symptoms and being diagnosed, we observe an opposite pattern: respondents with no formal schooling reported the highest level of experiencing COVID-19 symptoms, whereas the greatest proportion of the respondents with secondary school or higher education reported being diagnosed with COVID-19. FUTURE PLANS The study group will analyse the data collected showing the real-time changes throughout the pandemic and will make the data widely available for researchers to conduct further studies.
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Affiliation(s)
- Joyita Banerjee
- Venu Geriatric Care Centre, Venu Charitable Society, Sheikh Sarai, New Delhi, 110017 India
| | - Sarah Petrosyan
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Abhijith R. Rao
- grid.410871.b0000 0004 1769 5793Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Steffi Jacob
- Venu Geriatric Care Centre, Venu Charitable Society, Sheikh Sarai, New Delhi, 110017 India
| | - Pranali Yogiraj Khobragade
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Bas Weerman
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Sandy Chien
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Marco Angrisani
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Arunika Agarwal
- grid.38142.3c000000041936754XDepartment of Global Health and Population Research, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Nirupam Madan
- grid.413618.90000 0004 1767 6103Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Tanya Sethi
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA
| | - Sharmistha Dey
- grid.413618.90000 0004 1767 6103Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Simone Schaner
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA ,grid.42505.360000 0001 2156 6853Department of Economics, University of Southern California, Los Angeles, CA 90089 USA
| | - David E. Bloom
- grid.38142.3c000000041936754XDepartment of Global Health and Population Research, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Jinkook Lee
- grid.42505.360000 0001 2156 6853Centre for Economic and Social Research, University of Southern California, Los Angeles, CA 90089 USA ,grid.42505.360000 0001 2156 6853Department of Economics, University of Southern California, Los Angeles, CA 90089 USA
| | - A. B. Dey
- Venu Geriatric Care Centre, Venu Charitable Society, Sheikh Sarai, New Delhi, 110017 India
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26
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Di Fusco M, Mendes D, Steuten L, Bloom DE, Drummond M, Hauck K, Pearson-Stuttard J, Power R, Salisbury D, Towse A, Roiz J, Szabo G, Yang J, Marczell K. The Societal Value of Vaccines: Expert-Based Conceptual Framework and Methods Using COVID-19 Vaccines as a Case Study. Vaccines (Basel) 2023; 11:234. [PMID: 36851112 PMCID: PMC9961127 DOI: 10.3390/vaccines11020234] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
Health technology assessments (HTAs) of vaccines typically focus on the direct health benefits to individuals and healthcare systems. COVID-19 highlighted the widespread societal impact of infectious diseases and the value of vaccines in averting adverse clinical consequences and in maintaining or resuming social and economic activities. Using COVID-19 as a case study, this research work aimed to set forth a conceptual framework capturing the broader value elements of vaccines and to identify appropriate methods to quantify value elements not routinely considered in HTAs. A two-step approach was adopted, combining a targeted literature review and three rounds of expert elicitation based on a modified Delphi method, leading to a conceptual framework of 30 value elements related to broader health effects, societal and economic impact, public finances, and uncertainty value. When applying the framework to COVID-19 vaccines in post-pandemic settings, 13 value elements were consensually rated highly important by the experts for consideration in HTAs. The experts reviewed over 10 methods that could be leveraged to quantify broader value elements and provided technical forward-looking recommendations. Limitations of the framework and the identified methods were discussed. This study supplements ongoing efforts aimed towards a broader recognition of the full societal value of vaccines.
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Affiliation(s)
- Manuela Di Fusco
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
| | - Diana Mendes
- Health & Value, Pfizer Co., Ltd., Tadworth KT20 7NS, UK
| | | | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Michael Drummond
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Health Analytics, Lane Clark & Peacock, London W1U 1DQ, UK
| | - Rachel Power
- The Patients Association, PO Box 935, Harrow HA1 3YJ, UK
| | - David Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London SW1Y 4LE, UK
| | | | - Julie Roiz
- Evidence, Value and Access by PPD, Evidera, London W6 8BJ, UK
| | - Gabor Szabo
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
| | - Jingyan Yang
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
- Institute for Social and Economic Research and Policy, Graduate School of Arts and Science, Columbia University, New York, NY 10027, USA
| | - Kinga Marczell
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
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27
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Lee J, Petrosyan S, Khobragade P, Banerjee J, Chien S, Weerman B, Gross A, Hu P, Smith JA, Zhao W, Aksman L, Jain U, Shanthi GS, Kurup R, Raman A, Chakrabarti SS, Gambhir IS, Varghese M, John JP, Joshi H, Koul PA, Goswami D, Talukdar A, Mohanty RR, Yadati YSR, Padmaja M, Sankhe L, Rajguru C, Gupta M, Kumar G, Dhar M, Jovicich J, Ganna A, Ganguli M, Chatterjee P, Singhal S, Bansal R, Bajpai S, Desai G, Bhatankar S, Rao AR, Sivakumar PT, Muliyala KP, Sinha P, Loganathan S, Meijer E, Angrisani M, Kim JK, Dey S, Arokiasamy P, Bloom DE, Toga AW, Kardia SLR, Langa K, Crimmins EM, Dey AB. Deep phenotyping and genomic data from a nationally representative study on dementia in India. Sci Data 2023; 10:45. [PMID: 36670106 PMCID: PMC9852797 DOI: 10.1038/s41597-023-01941-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) is a nationally representative in-depth study of cognitive aging and dementia. We present a publicly available dataset of harmonized cognitive measures of 4,096 adults 60 years of age and older in India, collected across 18 states and union territories. Blood samples were obtained to carry out whole blood and serum-based assays. Results are included in a venous blood specimen datafile that can be linked to the Harmonized LASI-DAD dataset. A global screening array of 960 LASI-DAD respondents is also publicly available for download, in addition to neuroimaging data on 137 LASI-DAD participants. Altogether, these datasets provide comprehensive information on older adults in India that allow researchers to further understand risk factors associated with cognitive impairment and dementia.
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Affiliation(s)
- Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
| | - Sarah Petrosyan
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Pranali Khobragade
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Joyita Banerjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandy Chien
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Bas Weerman
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Alden Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peifeng Hu
- Division of Geriatric Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Leon Aksman
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Urvashi Jain
- Department of Economics, Finance and Real Estate, University of South Alabama, Mobile, USA
| | - G S Shanthi
- Department of Geriatric Medicine, Madras Medical College, Chennai, India
| | - Ravi Kurup
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Aruna Raman
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Indrajeet Singh Gambhir
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - John P John
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Himanshu Joshi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | - Rashmi Ranjan Mohanty
- Department of Medicine, All India Institute of Medical Sciences, Bhubaneshwar, India
| | | | - Mekala Padmaja
- Department of Medicine, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Lalit Sankhe
- Department of Community Medicine, Grant Medical College and J.J. Hospital, Mumbai, India
| | - Chhaya Rajguru
- Department of Community Medicine, Grant Medical College and J.J. Hospital, Mumbai, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Govind Kumar
- Department of Medicine Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Minakshi Dhar
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Jorge Jovicich
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Andrea Ganna
- Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunny Singhal
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rishav Bansal
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Bajpai
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Desai
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Abhijith R Rao
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Palanimuthu T Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jung Ki Kim
- School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Sharmistha Dey
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Perianayagam Arokiasamy
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eileen M Crimmins
- School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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28
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Dhaliwal BK, Rattani A, Chandrashekhar R, Bloom DE, Shet A, Seth R. Caregiver perceptions of the broader societal benefits of vaccination: A path toward sustainable vaccine advocacy in India. SSM Qual Res Health 2022; 2:None. [PMID: 36531293 PMCID: PMC9748304 DOI: 10.1016/j.ssmqr.2022.100156] [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] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last decade growing public health evidence suggests that, in addition to health-related benefits, there are also social and economic benefits of vaccination. Research to understand how caregivers in low-and-middle-income countries perceive these social and economic benefits, or if these benefits factor into their vaccination decisions for their children, has been limited. Leveraging qualitative strategies to gain more nuanced insights into caregiver perceptions of vaccination benefits has also been significantly underexplored. We conducted in-depth interviews with 13 caregivers of children, at which point we reached saturation, in Mewat District, Haryana, an area in India with low vaccination coverage. Interview results suggest that caregivers of children associate positive health outcomes with vaccination programs, and some additional social and economic benefits beyond improved health outcomes. Caregivers also shared how local advocacy and gaps in vaccination programs can affect their perceptions of vaccination benefits. Qualitatively exploring the perceived benefits provides a unique understanding of the value that caregivers assign to vaccination and complements existing knowledge on factors that dissuade caregivers from vaccination. These insights will allow researchers to better identify and design context-specific advocacy strategies to strengthen vaccination programs in communities with low vaccine uptake and acceptance.
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Affiliation(s)
- Baldeep K. Dhaliwal
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Ananya Rattani
- Bal Umang Drishya Sanstha, E-10, Green Park Main, New Delhi, India
| | | | - David E. Bloom
- Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Rajeev Seth
- Bal Umang Drishya Sanstha, E-10, Green Park Main, New Delhi, India
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29
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Pease AJ, Zoungas S, Callander E, Jones TW, Johnson SR, Holmes-Walker DJ, Bloom DE, Davis EA, Zomer E. Nationally Subsidized Continuous Glucose Monitoring: A Cost-effectiveness Analysis. Diabetes Care 2022; 45:2611-2619. [PMID: 36162008 DOI: 10.2337/dc22-0951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Continuous Glucose Monitoring (CGM) Initiative recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age-groups. RESEARCH DESIGN AND METHODS We used a patient-level Markov model to simulate disease progression for young people with type 1 diabetes and compared government-subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian health care system's perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses. RESULTS Government-subsidized CGM funding for young people with type 1 diabetes compared with a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD 39,518 per quality-adjusted life-year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, though strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD 34,890 per QALY gained. CONCLUSIONS Providing subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared with a completely user-funded model in Australia.
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Affiliation(s)
- Anthony J Pease
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephanie R Johnson
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - D Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ehrlich JR, Agarwal A, Young C, Lee J, Bloom DE. The prevalence of vision impairment and blindness among older adults in India: findings from the Longitudinal Ageing Study in India. Nat Aging 2022; 2:1000-1007. [PMID: 37118083 PMCID: PMC10148950 DOI: 10.1038/s43587-022-00298-6] [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] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/23/2022] [Indexed: 04/30/2023]
Abstract
Vision impairment and blindness are strongly associated with aging and late-life disability. While home to about 17% of the world's population, an estimated 25% of visually impaired people globally live in India. This proportion is expected to increase as India's population rapidly ages and continues to grow. There is a need for up-to-date epidemiologic data on the prevalence of vision impairment and blindness in India and on the socioeconomic determinants of poor vision, especially among older adults, to promote visual and overall health and well-being in later life. This paper uses newly available data from Wave 1 (2017-2019) of the population-based Longitudinal Ageing Study in India to estimate the overall and sex-specific prevalence of presenting visual acuity impairment and blindness among individuals aged 45 and older at the national level and for all constituent states and union territories. Overall, 33.8% (95% confidence interval: 33.31%, 34.26%) of the Indian population aged 45 and older had distance visual acuity impairment or was blind (visual acuity in the better-seeing eye < 20/40). The age-standardized prevalence varied considerably among states (22.3-54.6%), and women were more likely than men to be visually impaired or blind in all states. Near visual acuity impairment was also highly prevalent (43.0%, 95% confidence interval: 42.45%, 43.46%). Vision impairment and blindness were more common among marginalized groups and were associated with lower socioeconomic status. Findings from this study are relevant for surveillance of vision health, design of targeted eye care policies and programs and efforts to promote human and economic development.
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Affiliation(s)
- Joshua R Ehrlich
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Arunika Agarwal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Codi Young
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jinkook Lee
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Bennett NG, Bloom DE, Ferranna M. Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption. PLoS One 2022; 17:e0274529. [PMID: 36136997 PMCID: PMC9498968 DOI: 10.1371/journal.pone.0274529] [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: 05/08/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
The paper investigates the factors underlying COVID-19 vaccine and booster hesitancy in the United States, and the efficacy of various incentives or disincentives to expand uptake. We use cross-sectional, national survey data on 3,497 U.S. adults collected online from September 10, 2021 to October 20, 2021 through the Qualtrics platform. Results from a multinomial logistic regression reveal that hesitancy and refusal were greatest among those who expressed a lack of trust either in government or in the vaccine’s efficacy (hesitancy relative risk ratio, or RRR: 2.86, 95% CI: 2.13–3.83, p<0.001). Hesitancy and refusal were lowest among those who typically get a flu vaccine (hesitancy RRR: 0.28, 95% CI: 0.21–0.36, p<0.001; refusal RRR: 0.08, 95% CI: 0.05–0.13, p<0.001). Similar results hold for the intention to get a booster shot among the fully vaccinated. Monetary rewards (i.e., lottery ticket and gift cards) fared poorly in moving people toward vaccination. In contrast, the prospect of job loss or increased health insurance premiums was found to significantly increase vaccine uptake, by 8.7 percentage points (p<0.001) and 9.4 percentage points (p<0.001), respectively. We also show that the motivations underlying individuals’ hesitancy or refusal to get vaccinated vary, which, in turn, suggests that messaging must be refined and directed accordingly. Also, moving forward, it may be fruitful to more deeply study the intriguing possibility that expanding flu vaccine uptake may also enhance willingness to vaccinate in times of pandemics. Last, disincentives such as work-based vaccination mandates that would result in job loss or higher health insurance premiums for those who refuse vaccination should be strongly considered to improve vaccine uptake in the effort to address the common good.
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Affiliation(s)
- Neil G. Bennett
- CUNY Institute for Demographic Research, City University of New York, New York, New York, United States of America
- Austin W. Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York, United States of America
- PhD Program in Sociology, CUNY Graduate Center, City University of New York, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, City University of New York, New York, New York, United States of America
- * E-mail:
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maddalena Ferranna
- Department of Pharmaceutical and Health Economics, USC School of Pharmacy, Los Angeles, California, United States of America
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Nandi A, Counts N, Chen S, Seligman B, Tortorice D, Vigo D, Bloom DE. Global and regional projections of the economic burden of Alzheimer's disease and related dementias from 2019 to 2050: A value of statistical life approach. EClinicalMedicine 2022; 51:101580. [PMID: 35898316 PMCID: PMC9310134 DOI: 10.1016/j.eclinm.2022.101580] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The burden of Alzheimer's disease and related dementias (ADRDs) is expected to grow rapidly with population aging, especially in low- and middle-income countries, in the next few decades. We used a willingness-to-pay approach to project the global, regional, and national economic burden of ADRDs from 2019 to 2050 under status quo. METHODS We projected age group and country-specific disability-adjusted life years (DALYs) lost to ADRDs in future years based on historical growth in disease burden and available population projections. We used country-specific extrapolations of the value of a statistical life (VSL) year and its future projections based on historical income growth to estimate the economic burden - measured in terms of the value of lost DALYs - of ADRDs. A probabilistic uncertainty analysis was used to calculate point estimates and 95% uncertainty bounds of the economic burden. FINDINGS In 2019, the global VSL-based economic burden of ADRDs was an estimated $2.8 trillion. The burden was projected to increase to $4.7 trillion (95% uncertainty bound: $4 trillion-$5.5 trillion) in 2030, $8.5 trillion ($6.8 trillion-$10.8 trillion) in 2040, and $16.9 trillion ($11.3 trillion-$27.3 trillion) in 2050. Low- and middle-income countries (LMICs) would account for 65% of the global VSL-based economic burden in 2050, as compared with only 18% in 2019. Within LMICs, upper-middle income countries would carry the largest VSL-based economic burden by 2050 (92% of LMICs burden and 60% of global burden). INTERPRETATION ADRDs have a large and inequitable projected future VSL-based economic burden. FUNDING The Davos Alzheimer's Collaborative.
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Affiliation(s)
- Arindam Nandi
- The Population Council, New York, NY, USA
- One Health Trust, Washington DC, USA
- Corresponding author.
| | - Nathaniel Counts
- Mental Health America, New York, NY, USA
- Albert Einstein Medical College, New York, NY, USA
| | | | - Benjamin Seligman
- Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Geriatrics Research, Education, and Clinical Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA
| | | | - Daniel Vigo
- University of British Columbia, Vancouver, BC, Canada
| | - David E. Bloom
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, Bloom DE, Cannon JW. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. EClinicalMedicine 2022; 48:101458. [PMID: 35706486 PMCID: PMC9124702 DOI: 10.1016/j.eclinm.2022.101458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/21/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Contemporary data for the global burden of sore throat and group A Streptococcus (Strep A) pharyngitis are required to understand the frequency of disease and develop value propositions for Strep A vaccines. METHODS We used Clarivate Analytics' Web of Science platform to search WoS core collection, PubMed, Medline, data citation index, KCI-Korean Journal Database, Russian Science Citation Index, and the SciELO Citation Index for articles published between Jan 1, 2000, and Feb 15, 2021, from any country and in any language. The risk of bias was assessed using the JBI critical appraisal checklist. We used random-effects meta-analyses to pool sore throat and Strep A sore throat incidence rates from community-based studies. Our study was registered with PROSPERO (CRD42020181103). FINDINGS Of 5,529 articles identified by the search strategy, 26 studies met the inclusion criteria, but only two included data to determine incidence among adults. The pooled incidence rate, calculated for children only, was 82.2 episodes per 100 child-years (95% CI 25.2-286.3, I2 = 100%) for sore throat (7 studies; 7,964 person years) and 22.1 episodes per 100 child-years (95% CI 14.7-33.1, I2 = 98%) for Strep A sore throat (9 studies; 15,696 person years). The pooled cumulative incidence rate of sore throat from five studies was 31.9 per 100 children. There was significant methodological and statistical heterogeneity among studies, and five of 26 studies had a risk of bias score less than five (range: nine [maximum score] to one). INTERPRETATION Strep A sore throat has a considerable global burden. However, methodologically standardised studies are required to quantify that burden, analyse differences in rates between populations, and evaluate the likely impact of future Strep A vaccines. FUNDING This study was funded by Wellcome Trust 215,490/Z/19/Z.
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Affiliation(s)
- Kate M. Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Corresponding author.
| | - Jonathan R. Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Daniel Cadarette
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica N. Daw
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey W. Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wang Y, Fu Y, Ghazi P, Gao Q, Tian T, Kong F, Zhan S, Liu C, Bloom DE, Qiao J. Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Global Health 2022; 10:e820-e830. [PMID: 35561719 PMCID: PMC9115867 DOI: 10.1016/s2214-109x(22)00098-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Abstract
Background Infertility and intimate partner violence (IPV) are of serious concern globally, yet the prevalence of IPV against infertile women has not been quantified at the regional or global level. We aimed to estimate the prevalence of IPV against infertile women and its variation in low-income and middle-income countries (LMICs). Methods We did a systematic literature search of 11 databases for articles published between database inception and Sept 30, 2021, and performed meta-analyses to estimate the pooled prevalence and 95% CI of IPV against infertile women in LMICs. We used subgroup analyses and meta-regressions to explore variation in the prevalence by study period (2010 and before vs after 2010), study region (Africa, west Asia, south Asia, and east Asia), type of infertility (primary or secondary), risk of bias (high, moderate, or low), sample size (continuous variable), and measuring tools (the modified Abuse Assessment Screen, the WHO Violence Against Women instrument, or the revised Conflict Tactics Scales). This study is registered with PROSPERO, CRD42021248448. Findings Of 2661 references identified (2637 via database searches and 24 via secondary searches), 120 full-text articles were reviewed, and we identified 30 relevant studies conducted in nine LMICs between 2000 and 2019. 25 studies met the inclusion criteria for meta-analysis, with a total sample size of 7164 participants. The 12-month prevalence of IPV among infertile women was 36·0% (95% CI 20·4–55·2), compared with a lifetime prevalence of 47·2% (31·7–63·3). The most common type of IPV was psychological violence, with a prevalence of 24·6% (11·3–45·6) over 12 months and 51·5% (38·8–64·0) over a lifetime (slightly higher than the pooled overall rate due to different data sources), respectively; followed by physical violence (11·9% [5·2–25·1] and 20·2% [12·1–31·7]); sexual violence (8·7% [2·6–25·0] and 11·5% [6·1–20·7]); and economic coercion (2·6% [0·4–13·7] and 9·8% [5·7–16·5]). Significant variations of lifetime prevalence estimates were presented by study period (R2=39·46%), region (R2=50·95%), and measuring tools (R2=54·27%). Interpretation A high prevalence of IPV against infertile women is evident despite heterogeneity across studies. IPV screening, counselling, and structural interventions should be tailored to address this urgent issue at multiple levels of society. Funding China Medical Board and WHO.
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Nadareishvili I, Zhulina A, Tskitishvili A, Togonidze G, Bloom DE, Lunze K. The Approach to the COVID-19 Pandemic in Georgia-A Health Policy Analysis. Int J Public Health 2022; 67:1604410. [PMID: 35592028 PMCID: PMC9110664 DOI: 10.3389/ijph.2022.1604410] [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] [Received: 08/14/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to analyze key COVID-19 pandemic-related policies and national strategic responses in light of Georgia’s political, socioeconomic and cultural backgrounds. Methods: We applied a policy triangle framework for policy analysis, performed document and media content analysis, and described pandemic trends statistically. Results: Early introduction of stringent restrictive measures largely prevented a first wave in March–May 2020. This was communicated as a success story, prompting a public success perception. With unpopular restrictions lifted and hesitancy to embrace evidence-informed policymaking ahead of nationwide parliamentary elections, SARS-CoV-2 infection spread rapidly and was met with an insufficiently coordinated effort. Facing health system capacity saturation an almost complete lockdown was re-introduced in late 2020. Factors as delayed immunization campaign, insufficient coordination and, again, little evidence-informed policymaking eventually led to another devastating COVID-19 wave in summer of 2021. Conclusion: Georgia’s pandemic health policy response was adversely impacted by a volatile political environment. National pandemic preparedness and response might benefit from an independent body with appointment procedures and operations shielded from political influences to effectively inform and communicate evidence-based pandemic policy.
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Affiliation(s)
| | | | | | | | - David E Bloom
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
| | - Karsten Lunze
- School of Medicine, Boston University, Boston, MA, United States.,Boston Medical Center, Boston, MA, United States
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Srinivasan V, Bloom DE, Khoury A. Forecasting the Incremental Value to Society Created by a Class of New Prescription Drugs: A Proposed Methodology and Its Application to Treating Chronic Hepatitis C in India. Appl Health Econ Health Policy 2022; 20:371-381. [PMID: 35275389 DOI: 10.1007/s40258-022-00725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For low- and middle-income countries, the forecasted incremental value to society created by a class of new prescription drugs would be a useful criterion to prioritize the licensing, subsidization, and provision of new drugs. OBJECTIVES We provide a methodology to forecast the value of a new class of drugs, defined as the incremental value obtained in the scenario in which the new class of drugs is available along with existing drugs compared with the scenario of existing drugs only. We forecasted the value created by direct-acting antiviral drugs to treat chronic hepatitis C in India. METHOD We conducted a physician survey together with an aggregate multinomial logit model to forecast for each patient type the fraction of physicians who would prescribe the new drug under different scenarios. Value was determined by the monetary equivalent of increased life expectancy, reduced disability, and decreased future infection of others, minus drug cost, all treatment-related costs, and the cost of side effects. RESULTS We forecasted that the introduction of direct-acting antiviral drugs is likely to create USD11.5 billion of value in India over a 5-year period, based on a 'realistic' assumption about the growth rate of India's per capita GDP. Under 'pessimistic' and 'optimistic' assumptions about the growth rate, the value changes to USD6.5 and 22.5 billion, respectively. CONCLUSIONS There is major value likely to be created by the new direct-acting antiviral drugs in treating hepatitis C in India; this is consistent with the Indian Government's decision to provide the drugs free of cost.
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Affiliation(s)
- V Srinivasan
- Graduate School of Business, Stanford University, Stanford, CA, 94305, USA.
| | - David E Bloom
- Department of Global Health and Population, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Alex Khoury
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Abstract
New technologies and unprecedented public investment have transformed vaccine development and allowed fast delivery of safe and efficacious COVID-19 vaccines, mitigating the impact of the pandemic on health and the economy. A quantum change in public investment for vaccine development and widespread vaccine distribution are necessary to achieve global pandemic preparedness.
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Affiliation(s)
- Simone Pecetta
- Research and Development Center, GlaxoSmithKline (GSK), Siena, Italy
| | | | | | | | | | - Richard Hatchett
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Steve Black
- University of Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David E Bloom
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rino Rappuoli
- Research and Development Center, GlaxoSmithKline (GSK), Siena, Italy
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Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Hu P. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study. PLoS Med 2022; 19:e1003855. [PMID: 34982770 PMCID: PMC8726460 DOI: 10.1371/journal.pmed.1003855] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. METHODS AND FINDINGS We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017-2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%-46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%-56.5%) had been diagnosed, 38.9% (95% CI 38.1%-39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%-32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14-1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61-0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68-1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86-1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00-1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10-1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017-2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. CONCLUSIONS Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.
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Affiliation(s)
- Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Jenny Wilkens
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, United States of America
| | - T. V. Sekher
- International Institute for Population Sciences, Mumbai, India
| | - David E. Bloom
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Peifeng Hu
- Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
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Sevilla JP, Klusty JM, Song Y, Russo MJ, Thompson CA, Jiao X, Clancy SJ, Bloom DE. Cost-utility and cost-benefit analysis of TAVR availability in the US severe symptomatic aortic stenosis patient population. J Med Econ 2022; 25:1051-1060. [PMID: 35983718 DOI: 10.1080/13696998.2022.2112442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIMS We evaluated the availability of transcatheter aortic valve replacement (TAVR) to determine its value across all severe symptomatic aortic stenosis (SSAS) patients, especially those untreated because of concerns regarding invasive surgical AVR (SAVR) and its impact on active aging. METHODS We performed payer perspective cost-utility analysis (CUA) and societal perspective cost-benefit analysis (CBA). The CBA's benefit measure is active time: salaried labor, unpaid work, and active leisure. The study population is a cohort of US elderly SSAS patients. We compared a "TAVR available" scenario in which SSAS patients distribute themselves across TAVR, SAVR, and medical management (MM); and a "TAVR not available" scenario with only SAVR and MM. We structured each scenario with a decision-tree model of SSAS patient treatment allocation. We measured the association between health and active time in the US Health and Retirement Study and used this association to impute active time to SSAS patients given their health. RESULTS The incremental cost-effectiveness ratio (ICER) and rate of return (RoR) of TAVR availability were $8,533 and 395%, respectively. CUA net monetary benefits (NMB) were $212,199 per patient and $43.4 billion population-wide. CBA NMB were $50,530 per patient and $10.3 billion population-wide. LIMITATIONS Among study limitations were scarcity of evidence regarding key parameters and the lack of long-term survival, health utility, and treatment cost data. Our analysis did not account for TAVR durability, retreatments, and valve-in-valve treatments. CONCLUSION Across risk-, age-, and treatment-eligibility groups, TAVR is the economically optimal treatment choice. It represents strong value-for-money per patient and population-wide. The vast majority of TAVR value involves raising treatment uptake among the untreated.
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Affiliation(s)
- J P Sevilla
- Life Sciences Group, Data for Decisions, LLC, Waltham, MA, USA
| | | | - Younghwan Song
- Department of Economics, Union College, Schenectady, NY, USA
| | - Mark J Russo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Kleinman A, Chen H, Levkoff SE, Forsyth A, Bloom DE, Yip W, Khanna T, Walsh CJ, Perry D, Seely EW, Kleinman AS, Zhang Y, Wang Y, Jing J, Pan T, An N, Bai Z, Wang J, Liu Q, Habbal F. Social Technology: An Interdisciplinary Approach to Improving Care for Older Adults. Front Public Health 2021; 9:729149. [PMID: 35004562 PMCID: PMC8733256 DOI: 10.3389/fpubh.2021.729149] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Population aging is a defining demographic reality of our era. It is associated with an increase in the societal burden of delivering care to older adults with chronic conditions or frailty. How to integrate global population aging and technology development to help address the growing demands for care facing many aging societies is both a challenge and an opportunity for innovation. We propose a social technology approach that promotes use of technologies to assist individuals, families, and communities to cope more effectively with the disabilities of older adults who can no longer live independently due to dementia, serious mental illness, and multiple chronic health problems. The main contributions of the social technology approach include: (1) fostering multidisciplinary collaboration among social scientists, engineers, and healthcare experts; (2) including ethical and humanistic standards in creating and evaluating innovations; (3) improving social systems through working with those who deliver, manage, and design older adult care services; (4) promoting social justice through social policy research and innovation, particularly for disadvantaged groups; (5) fostering social integration by creating age-friendly and intergenerational programs; and (6) seeking global benefit by identifying and generalizing best practices. As an emergent, experimental approach, social technology requires systematic evaluation in an iterative process to refine its relevance and uses in different local settings. By linking technological interventions to the social and cultural systems of older people, we aim to help technological advances become an organic part of the complex social world that supports and sustains care delivery to older adults in need.
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Affiliation(s)
- Arthur Kleinman
- Department of Anthropology, Harvard University, Cambridge, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- *Correspondence: Arthur Kleinman
| | - Hongtu Chen
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sue E. Levkoff
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- School of Social Work, University of South Carolina, Columbia, MO, United States
| | - Ann Forsyth
- Graduate School of Design, Harvard University, Cambridge, MA, United States
| | - David E. Bloom
- School of Public Health, Harvard University, Boston, MA, United States
| | - Winnie Yip
- School of Public Health, Harvard University, Boston, MA, United States
| | - Tarun Khanna
- Harvard Business School, Boston, MA, United States
| | - Conor J. Walsh
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
| | - David Perry
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
| | - Ellen W. Seely
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Yan Zhang
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Yuan Wang
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jun Jing
- Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, China
| | - Tianshu Pan
- Institute of Anthropology and Ethnology, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Ning An
- School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Zhenggang Bai
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Jiexiu Wang
- Policy Research Center, Ministry of Civil Affairs, Beijing, China
| | - Qing Liu
- Jiangsu Industrial Technology Research Institute, Nanjing, China
| | - Fawwaz Habbal
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
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Affiliation(s)
- David E Bloom
- Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - T V Sekher
- International Institute for Population Sciences, Mumbai, India
| | - Jinkook Lee
- University of Southern California, Los Angeles, CA, USA
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Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1003490.].
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Dhaliwal BK, Chandrashekhar R, Rattani A, Seth R, Closser S, Jain A, Bloom DE, Shet A. Community perceptions of vaccination among influential stakeholders: qualitative research in rural India. BMC Public Health 2021; 21:2122. [PMID: 34794415 PMCID: PMC8600485 DOI: 10.1186/s12889-021-12188-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background In India and other low- and middle-income countries, multiple family and community members are influential in caregivers’ perceptions of vaccination. Existing literature indicates the primary caregiver, typically the mother, is instrumental in vaccine decision-making, but this may vary in contexts. We investigated the role of stakeholders in India who influence caregivers’ vaccination perceptions, as this is essential to developing strategies to promote vaccine acceptance and improve uptake. Methods This research was conducted in 2019 in Mewat District in Haryana, an area in India with extremely low vaccination coverage. We conducted six focus group discussions with 60 participants in the following categories: fathers of children under-5 years old, expectant mothers, mothers-in-law, community health workers, and community influencers such as locally elected officials and religious leaders. Results Our results highlighted four themes that influence vaccine uptake. First, while caregivers associated vaccination with reductions in specific diseases, they also noted that vaccination services brought broad health gains, including improved nutrition, antenatal guidance, and social support. Second, community health workers critically influenced, positively or negatively, caregivers’ vaccination perceptions. Third, community health workers faced gaps in their education such as limited training on vaccine side-effects, placing them at a disadvantage when dealing with families. Finally, we found that mothers-in-law, fathers, and religious leaders influence caregivers’ perceptions of vaccination. Conclusions Communication of broader benefits of vaccines and vaccination services by community health workers could be impactful in increasing vaccine acceptance. Vaccine uptake could potentially be improved by facilitating community health workers’ ownership over vaccine acceptance and uptake by involving them in the design and implementation of interventions to target mothers and mothers-in-law. A ‘bottom-up’ approach, leveraging community health workers’ knowledge to design interventions, and giving a voice to key members of the household and society beyond mothers alone, may sustain health improvement in low vaccine coverage areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12188-4.
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Affiliation(s)
- Baldeep K Dhaliwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA. .,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD, USA.
| | - Riti Chandrashekhar
- Bal Umang Drishya Sanstha, E-10, Block X, Green Park Extension, New Delhi, India
| | - Ananya Rattani
- Bal Umang Drishya Sanstha, E-10, Block X, Green Park Extension, New Delhi, India
| | - Rajeev Seth
- Bal Umang Drishya Sanstha, E-10, Block X, Green Park Extension, New Delhi, India
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Anika Jain
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Anita Shet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD, USA
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Chen S, Kuhn M, Prettner K, Bloom DE, Wang C. Macro-level efficiency of health expenditure: Estimates for 15 major economies. Soc Sci Med 2021; 287:114270. [PMID: 34482274 PMCID: PMC8412416 DOI: 10.1016/j.socscimed.2021.114270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/25/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic highlights the importance of strong and resilient health systems. Yet how much a society should spend on healthcare is difficult to determine because additional health expenditures imply lower expenditures on other types of consumption. Furthermore, the welfare-maximizing ("efficient") aggregate amount and composition of health expenditures depend on efficiency concepts at three levels that often get blurred in the debate. While the understanding of efficiency is good at the micro- and meso-levels-that is, relating to minimal spending for a given bundle of treatments and to the optimal mix of different treatments, respectively-this understanding rarely links to the efficiency of aggregate health expenditure at the macroeconomic level. While micro- and meso-efficiency are necessary for macro-efficiency, they are not sufficient. We propose a novel framework of a macro-efficiency score to assess welfare-maximizing aggregate health expenditure. This allows us to assess the extent to which selected major economies underspend or overspend on health relative to their gross domestic products per capita. We find that all economies under consideration underspend on healthcare with the exception of the United States. Underspending is particularly severe in China, India, and the Russian Federation. Our study emphasizes that the major and urgent issue in many countries is underspending on health at the macroeconomic level, rather than containing costs at the microeconomic level.
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Affiliation(s)
- Simiao Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Michael Kuhn
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria
| | - Klaus Prettner
- Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria; Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Chinese Academy of Engineering, Beijing, China.
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45
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Chen S, Prettner K, Kuhn M, Bloom DE. The economic burden of COVID-19 in the United States: Estimates and projections under an infection-based herd immunity approach. J Econ Ageing 2021; 20:100328. [PMID: 34123719 PMCID: PMC8186726 DOI: 10.1016/j.jeoa.2021.100328] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To assess the economic burden of COVID-19 that would arise absent behavioral or policy responses under the herd immunity approach in the United States and compare it to the total burden that also accounts for estimates of the value of lives lost. METHODS We use the trajectories of age-specific human and physical capital in the production process to calculate output changes based on a human capital-augmented production function. We also calculate the total burden that results when including the value of lives lost as calculated from mortality rates of COVID-19 and estimates for the value of a statistical life in the United States based on studies assessing individual's willingness to pay to avoid risks. RESULTS Our results indicate that the GDP loss associated with unmitigated COVID-19 would amount to a cumulative US$1.4 trillion by 2030 assuming that 60 percent of the population is infected over three years. This is equivalent to around 7.7 percent of GDP in 2019 (in constant 2010 US$) or an average tax on yearly output of 0.6 percent. After applying the value of a statistical life to account for the value of lives lost, our analyses show that the total burden can mount to between US$17 and 94 trillion over the next decade, which is equivalent to an annual tax burden between 8 and 43 percent. CONCLUSION Our results show that the United States would incur a sizeable burden if it adopted a non-interventionist herd immunity approach. FUNDING Research reported in this paper was supported by the Alexander von Humboldt Foundation, the Bill & Melinda Gates Foundation (Project INV-006261), and the Sino-German Center for Research Promotion (Project C-0048), which is funded by the German Research Foundation (DFG) and the National Natural Science Foundation of China (NSFC). Preparation of this article was also supported by the Value of Vaccination Research Network (VoVRN) through a grant from the Bill & Melinda Gates Foundation (Grant OPP1158136). The content is solely the responsibility of the authors.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Klaus Prettner
- Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria
- Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria
| | - Michael Kuhn
- Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Affiliation(s)
- John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - David E Bloom
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Andrew J Scott
- London Business School and Centre for Economic Policy Research, London, UK
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Subbaraman R, Ganapathi L, Mukherjee B, Bloom DE, Solomon SS. Humane shelter at home: a call to reimagine a core pandemic intervention. BMJ Glob Health 2021; 6:e006614. [PMID: 34353818 PMCID: PMC8349640 DOI: 10.1136/bmjgh-2021-006614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bhramar Mukherjee
- Departments of Biostatistics, Epidemiology, and Global Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sunil Suhas Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, Tamil Nadu, India
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Bloom DE, Khoury A, Srinivasan V. Estimating the net value of treating hepatitis C virus using sofosbuvir-velpatasvir in India. PLoS One 2021; 16:e0252764. [PMID: 34292958 PMCID: PMC8297876 DOI: 10.1371/journal.pone.0252764] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Recently developed direct-acting antiviral (DAA) treatments for hepatitis C virus (HCV) have been groundbreaking for their high efficacy across disease genotypes and lack of severe side effects. This study uses a cost-of-illness (COI) approach to estimate the net value conferred by this class of drugs using the cost and efficacy of one of these novel drug combinations, sofosbuvir and velpatasvir (SOF/VEL), recently licensed for generic manufacture in India. This study considers COI of lifetime earnings lost by patients and potential secondarily infected individuals due to disability and premature death from HCV infection. Expected net benefits of treatment are substantial for non-cirrhotic (NC) and compensated cirrhotic (CC) patients (ranging from 5,98,003 INR for NC women to 1,05,25,504 INR for CC men). Increased earnings are not sufficient to fully offset cost of treatment for decompensated cirrhotic individuals but treatment may still be justified on the basis of the intrinsic value of health improvements and other treatment benefits.
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Affiliation(s)
- David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Alexander Khoury
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - V. Srinivasan
- Stanford Graduate School of Business, Stanford, California, United States of America
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Ferranna M, Cadarette D, Bloom DE. COVID-19 Vaccine Allocation: Modeling Health Outcomes and Equity Implications of Alternative Strategies. Engineering (Beijing) 2021; 7:924-935. [PMID: 33968462 PMCID: PMC8089031 DOI: 10.1016/j.eng.2021.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 05/03/2023]
Abstract
Given the scarcity of safe and effective COVID-19 vaccines, a chief policy question is how to allocate them among different sociodemographic groups. This paper evaluates COVID-19 vaccine prioritization strategies proposed to date, focusing on their stated goals; the mechanisms through which the selected allocations affect the course and burden of the pandemic; and the main epidemiological, economic, logistical, and political issues that arise when setting the prioritization strategy. The paper uses a simple, age-stratified susceptible-exposed-infectious-recovered model applied to the United States to quantitatively assess the performance of alternative prioritization strategies with respect to avoided deaths, avoided infections, and life-years gained. We demonstrate that prioritizing essential workers is a viable strategy for reducing the number of cases and years of life lost, while the largest reduction in deaths is achieved by prioritizing older adults in most scenarios, even if the vaccine is effective at blocking viral transmission. Uncertainty regarding this property and potential delays in dose delivery reinforce the call for prioritizing older adults. Additionally, we investigate the strength of the equity motive that would support an allocation strategy attaching absolute priority to essential workers for a vaccine that reduces infection-fatality risk.
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Affiliation(s)
| | - Daniel Cadarette
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Heenan RC, Parks T, Bärnighausen T, Kado J, Bloom DE, Steer AC. The cost-of-illness due to rheumatic heart disease: national estimates for Fiji. Trans R Soc Trop Med Hyg 2021; 114:483-491. [PMID: 32232393 DOI: 10.1093/trstmh/trz118] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a chronic valvular heart disease that is responsible for a heavy burden of premature mortality in low- and middle-income countries. The total costs of RHD are important to health policy and research investment decisions. We estimate for the first time the total cost of RHD for Fiji (2008-2012) using a cost-of-illness approach and novel primary data on RHD disease burden and costs. METHODS RHD cases were identified using probabilistic record linkage across four routine data sources: (1) the Fiji RHD Control Program, (2) national hospital admissions records, (3) the Ministry of Health database of cause-specific deaths and (4) hospital ECG clinic registers. For each individual with RHD, we obtained information on RHD hospital admissions, treatment and death. We conducted a prevalence-based cost-of-illness analysis, including bottom-up assessment of indirect and direct (healthcare) costs. RESULTS The estimated cost of RHD in Fiji for 2008-2012 was year-2010 $FJ91.6 million (approximately US$47.7 million). Productivity losses from premature mortality constituted the majority of costs (71.4%). Indirect costs were 27-fold larger than the direct costs. CONCLUSIONS RHD leads to a heavy economic burden in Fiji. Improved prevention strategies for RHD will likely confer substantial economic benefits to the country.
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Affiliation(s)
- Rachel C Heenan
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia.,Department of General Medicine, Royal Children's Hospital Melbourne, Parkville 3052, Australia
| | - Tom Parks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.,Wellcome Centre for Human Genetics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, USA.,Africa Health Research Institute, KwaZulu-Natal 4013, South Africa.,Institute of Public Health, Heidelberg University, Heidelberg 69120, Germany
| | - Joseph Kado
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.,Telethon Kids Institute, Nedlands 6009, Australia
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Andrew C Steer
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia.,Department of General Medicine, Royal Children's Hospital Melbourne, Parkville 3052, Australia.,Tropical Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville 3052, Australia
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