Increasing prevalence of mental disorders in smokers seeking treatment of tobacco dependence: a retrospective observational study.

BACKGROUND: There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS: We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS: In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS: Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.

Comparison of Elicitation Approaches in Early Stage HTA Applied on Artificial Thymus for Patients with DiGeorge Syndrome.

This paper focuses on research in expert elicitation as a part of the early stage health technology assessment (eHTA). The current state of affairs is analysed and two elicitation approaches are compared-the four fixed intervals method and the histogram method-as applied to an example of early assessment of clinical effectiveness of artificial thymus for patients with DiGeorge syndrome. A survey was carried out consisting of four questions concerning the topic, with the aim to apply the elicitation methods. Eight experts answered the questions using both elicitation methods. Based on their answers, the methods were compared visually and by means of statistical tests. In order to compare the perception of the two elicitation methods, the survey also included questions regarding the experts' subjective preferences. The results of the comparison of the two elicitation approaches did not clearly confirm which method was more beneficial and better; however, it was possible to indicate which of the two methods is better suited for different types of experts. Before selecting an elicitation method as a part of eHTA, it is advisable to effectively consider the technology to be assessed and the type of experts to be invited to share their opinion.

Factors Affecting Young Adults' Decision Making to Undergo COVID-19 Vaccination: A Patient Preference Study.

Young adults are a substantial driver of lagging vaccination against COVID-19 worldwide. We aimed to understand what vaccine or vaccination environment attributes may affect young adults' vaccine inclination. We contacted a convenience sample of 1415 students to recruit a minimum of 150 individuals for a web-based discrete choice experiment. The respondents were asked to choose one of two hypothetical vaccines, defined by six attributes-vaccine efficacy, risk of mild side effects, protection duration, administration route, recommender, and travel time to the vaccination site. Individual preferences were calculated with the Markov chain Monte Carlo hierarchical Bayes estimation. A total of 445 individuals (mean age 24.4 years, 272 (61.1%) women) completed the survey between 22 March and 3 May 2021. Vaccine protection duration (28.3 (95% CI, 27.0-29.6)) and vaccine efficacy in preventing COVID-19 (27.5 (95% CI, 26.3-28.8)) were the most important, followed by the risk of vaccine side effects (17.3 (95% CI, 16.2-18.4)). Individuals reluctant or unsure about vaccination (21.1%) prioritized the potential for mild side effects higher and vaccine efficacy lower than the vaccine-inclined individuals. New vaccination programs that target young adults should emphasize the protection duration, low risk of vaccine side effects, and high efficacy.

Discrete Event Simulation Model for Cost-Effectiveness Evaluation of Screening for Asymptomatic Patients with Lower Extremity Arterial Disease.

Lower limb ischemic disease (LEAD) affects a significant portion of the population, with most patients being asymptomatic. Patient screening is necessary because LEAD patients have an increased risk of occurrence of other cardiovascular events and manifestations of disease, in terms of leg symptoms such as intermittent claudication, critical limb ischemia, or amputation. The aim of this work was to evaluate the cost-effectiveness of screening using ABI diagnostics in asymptomatic patients and its impact on limb symptoms associated with LEAD. A discrete event simulation model was created to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as QALYs. A cost-effectiveness analysis was performed to compare ABI screening examination and the situation without such screening. A probabilistic sensitivity analysis and scenario analysis were carried out to evaluate the robustness of the results. In the basic setting, the screening intervention was a more expensive intervention, at a cost of CZK 174,010, compared to CZK 70,177 for the strategy without screening. The benefits of screening were estimated at 14.73 QALYs, with 14.46 QALYs without screening. The final ICER value of CZK 389,738 per QALY is below the willingness to pay threshold. Likewise, the results of the probabilistic sensitivity analysis and of the scenario analysis were below the threshold of willingness to pay, thus confirming the robustness of the results. In conclusion, ABI screening appears to be a cost-effective strategy for asymptomatic patients aged 50 years when compared to the no-screening option.

The invisible costs of obstructive sleep apnea (OSA): Systematic review and cost-of-illness analysis.

BACKGROUND: Obstructive sleep apnea (OSA) is a risk factor for several diseases and is correlated with other non-medical consequences that increase the disease's clinical and economic burden. However, OSA's impact is highly underestimated, also due to substantial diagnosis gaps. OBJECTIVE: This study aims at assessing the economic burden of OSA in the adult population in Italy by performing a cost-of-illness analysis with a societal perspective. In particular, we aimed at estimating the magnitude of the burden caused by conditions for which OSA is a proven risk factor. METHODS: A systematic literature review on systematic reviews and meta-analyses, integrated by expert opinion, was performed to identify all clinical and non-clinical conditions significantly influenced by OSA. Using the Population Attributable Fraction methodology, a portion of their prevalence and costs was attributed to OSA. The total economic burden of OSA for the society was estimated by summing the costs of each condition influenced by the disease, the costs due to OSA's diagnosis and treatment and the economic value of quality of life lost due to OSA's undertreatment. RESULTS: Twenty-six clinical (e.g., diabetes) and non-clinical (e.g., car accidents) conditions were found to be significantly influenced by OSA, contributing to an economic burden ranging from €10.7 to €32.0 billion/year in Italy. The cost of impaired quality of life due to OSA undertreatment is between €2.8 and €9.0 billion/year. These costs are substantially higher than those currently borne to diagnose and treat OSA (€234 million/year). CONCLUSIONS: This study demonstrates that the economic burden due to OSA is substantial, also due to low diagnosis and treatment rates. Providing reliable estimates of the economic impact of OSA at a societal level may increase awareness of the disease burden and help to guide evidence-based policies and prioritisation for healthcare, ultimately ensuring appropriate diagnostic and therapeutic pathways for patients.

Cost-Utility Analysis of Home Mechanical Ventilation in Patients with Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost-utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost-utility analysis was carried out at the end of the study and results are presented in incremental cost-utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective.

Clinical Utility of Body Surface Potential Mapping in CRT Patients.

This paper reviews the current status of the knowledge on body surface potential mapping (BSPM) and ECG imaging (ECGI) methods for patient selection, left ventricular (LV) lead positioning, and optimisation of CRT programming, to indicate the major trends and future perspectives for the application of these methods in CRT patients. A systematic literature review using PubMed, Scopus, and Web of Science was conducted to evaluate the available clinical evidence regarding the usage of BSPM and ECGI methods in CRT patients. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used as a basis for this review. BSPM and ECGI methods applied in CRT patients were assessed, and quantitative parameters of ventricular depolarisation delivered from BSPM and ECGI were extracted and summarised. BSPM and ECGI methods can be used in CRT in several ways, namely in predicting CRT outcome, in individualised optimisation of CRT device programming, and the guiding of LV electrode placement, however, further prospective or randomised trials are necessary to verify the utility of BSPM for routine clinical practice.

Cost-benefit Analysis in Health Care: The Case of Bariatric Surgery Compared With Diet.

PURPOSE: The aim of the present study was to assess, by using a cost-benefit analysis, the net monetary benefit (NMB) of bariatric surgery compared with diet (including physical exercise) for obese patients, from both an Italian payer perspective and the broader societal perspective. METHODS: The study considered the following groups of patients: (1) patients with a body mass index (BMI) ≥40 kg/m2 without complications + patients with BMI ≥35 kg/m2 with complications; (2) patients with BMI ≥35 kg/m2 and diabetes; and (3) patients with BMI ranging from 30 to 35 kg/m2 and diabetes. A Markov model was developed to project the lifetime health outcomes (life years and quality-adjusted life years [QALYs]) and costs associated with bariatric surgery and diet for the considered groups of patients. The clinical effectiveness of each strategy was based on the likelihood of experiencing cardiovascular events or events related to the presence of diabetes. Data on clinical effectiveness, quality of life, productivity losses, and out-of-pocket costs were mainly derived from the literature; direct costs were obtained from official tariffs or the literature. Different scenarios were considered for the analyses in addition to the base case. According to both perspectives considered, the NMB was calculated by first assuming a willingness-to-pay threshold (30,000€ per QALY), then converting health benefits (QALYs) into the common monetary metric (ie, the euro). NMB was calculated as follows: (incremental benefit × willingness-to-pay - incremental cost). FINDINGS: For all the scenarios and groups of patients considered, the NMB of bariatric surgery versus diet, on a lifetime horizon, from the payer perspective was positive and ranged from 54,647€ to 122,960€; it varied between 141,192€ and 380,286€ from the societal perspective. In the former case, the NMB turns positive after 3-4 years, indicating that bariatric surgery may be a worthy investment also in the short run for the National Health Service; in the latter case, for a time horizon longer than 2-3 years, the surgical option begins to show advantages for the whole society. IMPLICATIONS: Despite its defined cost-effectiveness, bariatric surgery is under-diffused because the initial investment for the technology is often considered a barrier. The cost-benefit analysis showed that bariatric surgery, compared with diet, may be a worthwhile technology for obese patients in Italy from both a payer perspective and the broader societal perspective.