Assessing the reliability of medical resource demand models in the context of COVID-19.

BACKGROUND: Numerous medical resource demand models have been created as tools for governments or hospitals, aiming to predict the need for crucial resources like ventilators, hospital beds, personal protective equipment (PPE), and diagnostic kits during crises such as the COVID-19 pandemic. However, the reliability of these demand models remains uncertain. METHODS: Demand models typically consist of two main components: hospital use epidemiological models that predict hospitalizations or daily admissions, and a demand calculator that translates the outputs of the epidemiological model into predictions for resource usage. We conducted separate analyses to evaluate each of these components. In the first analysis, we validated various hospital use epidemiological models using a recent validation framework designed for epidemiological models. This allowed us to quantify the accuracy of the models in predicting critical aspects such as the date and magnitude of local COVID-19 peaks, among other factors. In the second analysis, we evaluated a range of demand calculators for ventilators, medical gowns, and COVID-19 test kits. To achieve this, we decoupled these demand calculators from the underlying epidemiological models and provided ground truth data for their inputs. This approach enabled a direct comparison of the demand calculators, comparing them against each other and actual usage data when available. The code is available at https://doi.org/10.5281/zenodo.13712387 . RESULTS: Performance varied greatly across the epidemiological models, with greater variability in COVID-19 hospital use predictions than for COVID-19 deaths as analyzed previously. Some models did not have any peaks. Among those that did, the models under-estimated date of peak approximately as often as they over-estimated, but were more likely to under-estimate magnitude of peak, with typical relative errors around 50%. Regarding demand calculator predictions, there was significant variability, including five-fold differences in predictions for gown models. Validation against actual or surrogate usage data illustrated the potential value of demand models while demonstrating their limitations. CONCLUSIONS: The emerging field of demand modeling holds promise in averting medical resource shortages during future public health emergencies. However, achieving this potential necessitates focused efforts on standardization, transparency, and rigorous model validation before placing reliance on demand models in critical public health decision-making.

Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions.

BACKGROUND: Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions. METHODS: Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots-points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially-were estimated and countries in the vicinity of these knots identified. FINDINGS: Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions. INTERPRETATION: Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries-low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use. FUNDING: None.

Development and psychometric validation of an age-friendly health system assessment tool in the Iranian context.

Evaluating health system interventions for elderly care necessitates a context-specific, credible and dependable instrument. This research was dedicated to creating and validating a tool to assess the health system's age-friendliness. The study unfolded in two pivotal stages: the generation of items utilizing a hybrid model and the psychometric appraisal of the tool, encompassing both validity and reliability assessments. From an initial pool of 522 items derived from a systematic scoping review and qualitative analysis, a concise assessment tool emerged, featuring 52 items across 6 domains: governance, information, resources, service delivery, community engagement and outcomes. The 52-item tool offers a straightforward, substantiated and robust means to gauge age-friendliness, pinpoint health system deficiencies and facilitate strategic planning on the basis of its insights.

High-Sensitivity Cardiac Troponin T Reporting, Clinical Outcomes, and Health Care Resource Use.

Importance: Despite being recommended by clinical guidelines, substantial concerns remain regarding the use of high-sensitivity cardiac troponin assays and whether it is associated with increased resource use, myocardial infarction (MI) or myocardial injury diagnoses, and procedural rates. Objective: To characterize the association of reporting high-sensitivity cardiac troponin T (hs-cTnT) to the lowest limit of quantification vs conventional troponin reporting with clinical outcomes. Design, Setting, and Participants: This cohort study used a historically controlled baseline and follow-up design to compare clinical outcomes after changing hs-cTnT reporting to the lowest limit of quantification. All patients aged 18 years or older presenting to any public emergency department (ED) in the state of South Australia between February 1, 2020, and February 28, 2021, who had an hs-cTnT test in the 6 months before and after the change in troponin reporting practice were included. Outcomes were assessed after adjusting for patient characteristics using inverse probability treatment weighting. The data analysis was performed between May 1, 2022, and July 27, 2023. Exposure: hs-cTcnT reporting. Main Outcomes and Measures: The main outcomes were frequency of diagnosed MI, coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG); hospital length of stay; and ED discharge rate as measured using time-to-event Cox regression models. The secondary outcome was the composite 12-month event rate of all-cause mortality, MI, and myocardial injury. Results: A total of 40 921 patients were included, of whom 20 206 were included in the unmasked hs-cTnT reporting group (median [IQR] age, 62.0 [46.0-77.0]; 10 120 females [50.1%]) and 20 715 were included in the conventional troponin reporting group (median [IQR] age, 63.0 [47.0-77.0] years; 10 752 males [51.9%]). Unmasked hs-cTnT reporting was associated with higher ED discharge rates (45.2% vs 39.0%; P < .001) and a shorter median hospital length of stay (7.68 [IQR, 4.32-46.80] hours vs 7.92 [IQR, 4.56-49.92] hours; P < .001). There was no difference in diagnosis of MI, coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft. The composite of all-cause mortality, MI, and myocardial injury at 12 months was similar (adjusted hazard ratio, 0.95; 95% CI, 0.90-1.01; P = .09). Conclusions and Relevance: This cohort study found that unrestricted reporting of hs-cTnT results to the lowest limit of quantification was not associated with an increase in the diagnosis of MI, invasive coronary procedures, or harm at 12 months but may be associated with improved hospital resource use.

Rethinking Scale-Up of Rehabilitation for Chronic Disease in Low-Resource Settings: Embracing Complexity for Contextual Impact.

As the burden of chronic disease and multiple long-term conditions is increasing globally, disproportionally affecting those in low-resourced settings, there is an increasing call to action to scale effective models of care that can assist in mitigating the impact of chronic disease on functioning, activity, societal participation, and health-related quality of life. The aim of this paper is to unpack the contextual factors that have been implicitly and explicitly voiced by researchers reporting on rehabilitation interventions used to manage chronic disease in low-resourced settings. We systematically engaged the literature and applied a reflexive qualitative and systems thinking lens to unpack the contextual factors and their interplay. A total of 40 different contextual factors were derived through an iterative analysis of 144 eligible articles. The identified factors could be packaged into nine system elements or subsystems relevant to the scale-up of rehabilitation for people with chronic disease. The complexity identified encourages a focus on innovative and intersectoral approaches to address the rehabilitation needs in low-resourced settings.

Management of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Germany: a single-center study on hospital resources and healthcare economics.

Background: Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) present as a main feature ≤50% stenosis upon angiography despite clinical symptoms and biomarker elevation related to acute coronary syndrome. Due to broad availability of high sensitivity troponin testing as well as invasive and non-invasive imaging, this clinical entity receives increasing clinical awareness. Objective: We aimed to investigate the in-hospital work flow and economic impact of MINOCA vs. MICAD (myocardial infarction with obstructive coronary artery disease) patients and related clinical outcomes in a single-center patient collective of a large university heart center in Germany. Methods: We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017-2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography for acute coronary syndrome. Associated in-hospital costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained. Results: After screening of 3,021 patients, we included 660 patients with acute coronary syndrome. Of those, 118 patients were attributed to the MINOCA-group. 542 patients presented with a "classical" myocardial infarction (MICAD group). MINOCA patients were less frail, more likely female, but showed no relevant difference in age or other selected comorbidities except for fewer cases of diabetes. In-hospital mortality (11% vs. 0%; p < 0.001) and 30-day mortality (17.3% vs. 4.2%; p < 0.001) after the index event were significantly higher in the "classical" myocardial infarction group (MICAD)- Despite a shorter overall length of hospital stay (9.5 ± 8.7 days vs. 12.3 ± 10.5 days, p < 0.01) with a significantly shorter duration of high care monitoring (intensive/intermediate care or chest pain units) (2.4 ± 2.1 days vs. 4.7 ± 3.3 days, p < 0.01) MINOCA patients consumed a relevant contingent of hospital resources. Thus, in a 12-months period a total sum of almost 300 days was attributed to high care monitoring for MINOCA patients with a mean difference of approximately 50% compared to patients with classical myocardial infarction. With average and median costs of 50% less per index, MINOCA treatment costs were lower compared to the MICAD group in the hospital reimbursement system of Germany. Consequently, MINOCA treatment was not associated with a relevant profit for these expanses and a relevant share of nearly 40% of the total costs was generated due to high care monitoring. Conclusion: In light of lower mortality than MICAD and growing scarcity of staff, financial and capacity resources the clinical symptom complex of MINOCA should be put under particular consideration for refining care concepts and resource allocation.

Access of Low-Resource Areas to ASCO Quality Initiatives: Initial Experience and Lessons Learned.

With the aim of improving the quality of cancer care globally, ASCO began to offer its quality improvement programs to interested international oncology practices. In this manuscript, we describe the experiences with ASCO quality initiatives in low- and middle-income countries (LMICs). The experience acquired from different practices in Latin America and Africa was reviewed and various action steps were summarized. Encountered challenges and implemented solutions to mitigate these challenges were identified to list as lessons learned for oncology practices in LMICs or low-resource settings to use in their future quality improvement initiatives and providing a proactive approach for those practices considering starting quality improvement programs. Having programs tailored to LMICs may facilitate the participation of more practices and help them take advantage of these programs to enhance patient care. The preliminary data and learning are promising and demonstrate that participation in quality improvement activities can have a positive effect. Although this early experience is encouraging, each country and resource-limited practice will have its own unique challenges as highlighted in this article. Having more practices participate will further enhance the knowledge base, build experience in addressing challenges, and enable oncology patients to reap the benefits worldwide.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

The economic burden of recurrence in elderly patients with completely resected, stage IIB/IIC or III melanoma: an analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database.

AIMS: To compare healthcare resource utilization (HRU) and costs between patients with or without melanoma recurrence and between patients with distant or locoregional melanoma recurrence. METHODS: Patients aged ≥65 years with completely resected, stage IIB/IIC or III melanoma were identified from Surveillance, Epidemiology, and End Results-Medicare data and stratified based on whether they experienced a recurrence, and whether it was distant or locoregional (separately for each stage). The index date was the date of recurrence (recurrence group) or a randomly assigned date (non-recurrence group). Patients in the recurrence and non-recurrence groups were propensity score-matched 1:1 based on patient characteristics; HRU and healthcare costs were compared between the 2 groups and between patients with distant or locoregional recurrence during the ≤24 months following index. RESULTS: After matching, 507 pairs of patients with recurrent or non-recurrent stage IIB/IIC melanoma (236 patients with distant recurrence, 271 with locoregional) and 141 pairs of patients with recurrent or non-recurrent stage III melanoma (50 patients with distant recurrence, 91 with locoregional) were included. During the first year following recurrence, unadjusted HRU was generally higher in patients with versus without recurrence and patients with distant versus locoregional recurrence among both stage IIB/IIC and III cohorts. Patients who experienced recurrence incurred $6,474 (stage IIB/IIC) or $6,112 (stage III) per patient per month (PPPM) more in unadjusted, all-cause, total healthcare costs than patients without recurrence (both p < 0.001). Patients with distant recurrence incurred $7,292 (stage IIB/IIC) or $5,436 (stage III) PPPM more in unadjusted, all-cause, total healthcare costs than patients with locoregional recurrence (both p < 0.05). LIMITATIONS: Melanoma recurrence was identified using a claims-based algorithm. CONCLUSIONS: Economic burden is higher in patients with versus without melanoma recurrence and patients with distant versus locoregional recurrence. There is a high unmet need for adjuvant therapies that may help to prevent or delay recurrence.

Consensus statements for the establishment of medical intensive care in low-resource settings: international study using modified Delphi methodology.

BACKGROUND: The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS. METHODS: In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement. RESULTS: Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education. CONCLUSION: Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.

Enhancing the implementation and integration of mHealth interventions in resource-limited settings: a scoping review.

BACKGROUND: Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions. METHODS: We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions. RESULTS: We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged. CONCLUSION: The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.

Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study.

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease. METHODS: This retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV. RESULTS: Out of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 - 1,261) and full-term infants ($ 606; 95% CI: 583-630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk-shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics. CONCLUSION: Our findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.

[Comparison and analysis of ophthalmic resources and service ability in Shanxi Province in 2014 and 2021].

Objective: To compare and analyze the ophthalmic resources and service ability in Shanxi Province in 2014 and 2021, and to provide reference for the development planning of ophthalmology and eye care. Methods: In this cross-sectional study, a questionnaire survey was conducted among all ophthalmic institutions registered in the health administrative department in 11 cities of Shanxi Province by the end of 2014 and 2021 by using the National Ophthalmology Competency Resource Questionnaire (compiled by the Medical Administration and Hospital Authority of the National Health and Wellness Commission). The basic situations of ophthalmic institutions in 2014 and 2021, as well as the human resources, ophthalmic equipment configuration, technology and medical service capabilities, were recorded and compared. The chi-square test was used for statistical analysis. Results: A total of 270 questionnaires for 2014 were collected from 270 ophthalmic institutions, and 292 questionnaires for 2021 from 292 ophthalmic institutions. The institution categories in 2014 (197 general hospitals, 31 eye hospitals and 42 others) were statistically different from those in 2021 (182 general hospitals, 45 eye hospitals and 65 others) (P<0.05). The proportion of doctors with senior titles in ophthalmic institutions increased from 25.5% (346/1 358) in 2014 to 41.7% (580/1 391) in 2021, the proportion of senior technicians increased from 9.4% (14/148) to 25.3% (110/435), the proportion of doctors with junior titles decreased from 42.1% (572/1 358) to 26.5% (369/1 391), and the proportion of junior technicians decreased from 45.3% (67/148) to 39.1% (170/435). There was a significant difference in the distribution of professional titles between doctors and technicians in ophthalmic institutions (P<0.05). The number of doctors (130 to 28), nurses (152 to 50), technicians (33 to 11) and full-time optometrists (44 to 12) in the first-class ophthalmic institutions decreased, the increase of equipment with the ophthalmic A-ultrasound scan system, fundus camera and coherent optical tomography system (35.1%, 28.9% and 25.4%; P<0.05) ranked the top three, and the increase of performing the phacoemulsification procedure, intraocular lens implantation, intravitreal injection and iris surgery (30.2%, 24.7% and 20.7%; P<0.05) ranked the top three in 2021 as compared to 2014. Conclusions: The resources and service ability of ophthalmology in Shanxi Province developed in 2021 in comparison with 2014. However, there were some problems, such as changes in the type and structure of eye institutions, unreasonable proportions of professional titles, insufficient human resources in primary ophthalmic institutions, and slow improvement in the allocation of ophthalmology equipment and technical capabilities.

Barriers to Implementing a Quality Improvement Program in Low- and Middle-Income Countries: Adequacy of Resources.

Low- and middle-income countries (LMICs) report disproportionally worse cancer mortality. Current global cancer control efforts focus predominantly on expanding access to multimodality treatment for patients, whereas less attention has been spent on implementing strategies to ensure sustained quality assessment and improvement across the cancer care continuum. The goal of this focused review was to examine specific resource barriers to the development and implementation of quality improvement programs in LMICs. In this article, we use a nonsystematic review process to discuss the existing literature on four resource barriers within the context of cancer care delivery in LMICs, focusing on staff, time allocated for quality improvement work, research infrastructure, and funding. We provide possible solutions to address these barriers and share examples of specific quality improvement initiatives implemented across different world regions. Possible solutions to address these resource barriers include investment in human resources by increasing recruitment and training of the workforce, engagement of medical trainees and patients in quality improvement work, establishment of cancer registries and electronic medical records, and prioritization by large international funding agencies to invest in quality improvement research in LMICs. This review highlights four prevalent resources barriers to quality improvement in LMICs. Using examples from Botswana, Colombia, India, and Rwanda, we demonstrate solutions that may help overcome these barriers.

Establishing Vitreoretinal Surgery Capacity in Sierra Leone: Challenges and Opportunities to Address Retinal Health Disparities in Resource-limited Settings.

A range of challenges exists regarding vitreoretinal (VR) surgical services in resource-limited settings, including Sierra Leone. As a result, retinal pathologies may contribute to vision loss and blindness. In the wake of the 2013 to 2016 outbreak of Ebola virus disease in West Africa, gaps in ophthalmic care were underscored as survivors were experiencing a constellation of sequelae, including uveitis and VR disease. Given the unmet needs in addressing VR disease, systems for retinal surgical care were required. To further understand long-term ocular complications in Ebola survivors and molecular and immunologic factors associated with this, research infrastructure was developed for retinal evaluation and surgery. The 5 "S'" framework was implemented and considered staff, space, stuff, systems, and social support. The ongoing development of retinal health infrastructure has helped to address challenges related to program implementation, development of surgical capacity, and alignment with local stakeholders and collaborator objectives. VR surgical services have been established in Sierra Leone through multidisciplinary partnerships and collaboration and serve patients in-country, as well as others in West Africa who have traveled for care. Continued engagement across stakeholders can aim to address challenges and promote effective care delivery.

Real world data on cervical cancer treatment patterns, healthcare access and resource utilization in the Brazilian public healthcare system.

The aim of the study is to evaluate the treatment patterns, time to start treatment, and healthcare resources utilization (HCRU) of cervical cancer (CC) patients within the Brazilian public health system (SUS). This is an observational retrospective study using SUS administrative database (DATASUS). Data from January-2014 to December-2020 was gathered from patients with the ICD-10 C53 codes. From 2014 to 2020, 206,861 women were included, among whom 90,073 (43.5%) had stage information. Of staged patients, 60.7% (54,719) had advanced disease (stages III and IV) and the most performed treatments were chemoradiotherapy (CRT) (41.6%), surgery + CRT (19.1%), radiotherapy (RT) only (16.8%) and chemotherapy (CT) only (13.3%). The proportion of patients submitted to CT in advanced stages was higher than in non-advanced stages (I and II), in contrast to RT, which was more frequent in stage I than stage IV. Median time to initiate treatment surpassed two months in approximately 30% of the cases, regardless of stage. Conization was the most performed surgical procedure. The hospitalization rate per patient per month for stage IV was twice as high as stage I (0.05 [95%CI 0.05-0.05] and 0.11 [0.11-0.11], respectively). The same trend was observed for outpatient visits (0.54 [95%CI 0.53-0.55] and 0.96 [0.93-0.98], respectively). This study demonstrated a high proportion of advanced CC at diagnosis in Brazil. The treatment pattern showed that chemoradiotherapy was the most frequent regimen overall and the use of chemotherapy and HCRU increased with staging. These results could provide information to improve public policies towards access to prevention, diagnosis, and treatment of CC in Brazil.

Health care resource utilization and costs across stages of amyotrophic lateral sclerosis in the United States.

BACKGROUND: People living with ALS (plwALS) experience motor control loss, speech/swallowing difficulties, respiratory insufficiency, and early death. Advancing disease stage is typically associated with a greater burden on the health care system, and delays in diagnosis can result in substantial health care resource utilization (HCRU). OBJECTIVE: To estimate HCRU and cost burden of plwALS across disease stages from a US payer perspective we assessed HCRU and costs in early-, mid-, and late-stage ALS. METHODS: Using insurance claims data from the IBM MarketScan Databases between January 2013 and December 2019, we identified plwALS as having at least 2 claims at least 27 days apart with an ALS International Classification of Diseases, Ninth or Tenth Revision diagnosis code (335.20/G12.21) or at least 1 ALS diagnosis code and prescription filled for riluzole/edaravone. Eligible plwALS were aged at least 18 years and had at least 12 months of enrollment data before and at least 6 months after the index date (date diagnosis criteria met). plwALS were grouped into disease stages using an ALS severity-based staging algorithm developed using ALS symptom and staging survey data from 142 neurologists reporting on 880 plwALS. The starting date of each severity stage was defined as the first date of an ALS symptom within the early-, mid-, and late-stage categories, respectively. The ending date for a severity stage was defined as the day before the first date of an ALS symptom from a more severe category. plwALS could transition to more severe stages, with reverse transition of severity excluded. Mixed regression modeling was used to assess differences in HCRU and costs per person-year between severity stages, adjusted for age and sex. RESULTS: 2,273 plwALS were included in the total ALS study sample, with 1,215 early-stage, 1,511 midstage, and 1,186 late-stage plwALS. 90% of early-stage plwALS had ALS symptoms before diagnosis, and 27% of late-stage plwALS had a late-stage symptom before diagnosis. In the evaluation period, later-stage ALS groups had more overall hospital admissions (early = 0.15, middle = 0.23, and late = 0.74; P < 0.01), outpatient visits/service (early = 26.81, middle = 32.78, and late = 48.54; P < 0.01), emergency department visits (early = 0.46, middle = 0.69, and late = 1.03; P < 0.01), and total prescription count (early = 9.23, middle = 11.37, and late = 12.72; P < 0.01) over 12 months. Annualized costs increased as ALS progressed (early = $31,411, middle = $51,481, and late = $121,903; P < 0.01), which was primarily driven by higher frequency of and cost per hospital admission. CONCLUSIONS: HCRU and costs increased with ALS progression, with diagnosis frequently occurring even after experiencing late-stage symptoms. These findings highlight the potential value of delaying progression into a more resource-intensive stage by diagnosing and adequately treating plwALS earlier in the disease course.

Comorbid depression and anxiety and their association with health care resource utilization among individuals with type 1 diabetes in the United States.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking. OBJECTIVE: To assess health care resource utilization (HCRU) among adults with T1DM and comorbid depression or anxiety. METHODS: We identified individuals aged 18 to 64 with a T1DM diagnosis from January 1, 2017, to December 31, 2021, using a 25% random sample of the IQVIA PharMetrics Plus for Academics database. The index date was the date of the first medical claim with a T1DM diagnosis. Eligibility required continuous medical and prescription coverage for 12 months before (baseline) and after (follow-up) the index date. Comorbid depression/anxiety and baseline characteristics were assessed during the baseline period. The following 2 mutually exclusive groups were created: individuals with T1DM and comorbid depression/anxiety, and those with only T1DM. To balance baseline demographic and clinical characteristics between the groups, we implemented 1:1 propensity-score matching. We assessed all-cause, diabetes-related, and major adverse cardiovascular event-related HCRU during the follow-up period. Logistic (binary) and negative binomial (count) regression models examined the association between comorbid depression/anxiety and HCRU across types of health care settings. RESULTS: Out of 6,491 eligible individuals with T1DM, 1,168 (18%) had either depression or anxiety. In the matched cohort of 2,314 individuals, those with T1DM and comorbid depression/anxiety had significantly higher odds of all-cause emergency department visits (odds ratio = 1.67; 95% CI = 1.39-2.00) and higher rates of physician office visits (incidence rate ratio = 1.37; 95% CI = 1.27-1.47) and other outpatient encounters (incidence rate ratio = 1.23; 95% CI = 1.13-1.34) than those with only T1DM. Findings were similar for diabetes-related and major adverse cardiovascular event-related HCRU. CONCLUSIONS: Comorbid depression/anxiety among individuals with T1DM results in significantly higher HCRU than T1DM alone. The findings underscore the importance of effective management of comorbid depression/anxiety in the T1DM population.