RESUMEN
Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.
Asunto(s)
Manejo de la Enfermedad , Salud Global , Hepatitis C Crónica/epidemiología , Antivirales/uso terapéutico , Política de Salud , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/mortalidad , Hepatitis C Crónica/terapia , Humanos , Trasplante de Hígado , PrevalenciaRESUMEN
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 17 countries in Africa, Asia, Europe, Latin America and the Middle East, and interventions for achieving the Global Health Sector Strategy on viral hepatitis targets-"WHO Targets" (65% reduction in HCV-related deaths, 90% reduction in new infections and 90% of infections diagnosed by 2030) were considered. Scaling up treatment and diagnosis rates over time would be required to achieve these targets in all but one country, even with the introduction of high SVR therapies. The scenarios developed to achieve the WHO Targets in all countries studied assumed the implementation of national policies to prevent new infections and to diagnose current infections through screening.
Asunto(s)
Manejo de la Enfermedad , Salud Global , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/mortalidad , Viremia/epidemiología , Viremia/mortalidad , Antivirales/uso terapéutico , Política de Salud , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Incidencia , Prevalencia , Viremia/diagnóstico , Viremia/tratamiento farmacológicoRESUMEN
Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.
Asunto(s)
Salud Global , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/mortalidad , Modelos Estadísticos , Viremia/epidemiología , Viremia/mortalidad , Antivirales/uso terapéutico , Política de Salud , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Incidencia , Prevalencia , Viremia/tratamiento farmacológicoRESUMEN
The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved.
Asunto(s)
Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/virología , Modelos Estadísticos , Viremia/epidemiología , Viremia/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Femenino , Salud Global , Hepatitis C Crónica/mortalidad , Hepatitis C Crónica/terapia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Análisis de Supervivencia , Viremia/mortalidad , Viremia/terapia , Adulto JovenRESUMEN
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/prevención & control , Modelos Estadísticos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Asia/epidemiología , Niño , Preescolar , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Utilización de Medicamentos , Europa (Continente)/epidemiología , Femenino , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/terapia , Humanos , Incidencia , Lactante , Recién Nacido , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Prevalencia , Adulto JovenRESUMEN
Detailed, country-specific epidemiological data are needed to characterize the burden of chronic hepatitis C virus (HCV) infection around the world. With new treatment options available, policy makers and public health officials must reconsider national strategies for infection control. In this study of 15 countries, published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates were gathered from the literature and validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to 4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001 000 cases) and Indonesia (3 187 000 cases). Injection drug use (IDU) and a historically unsafe blood supply were major risk factors in most countries. Diagnosis, treatment and liver transplant rates varied widely between countries. However, comparison across countries was difficult as the number of cases changes over time. Access to reliable data on measures such as these is critical for the development of future strategies to manage the disease burden.
Asunto(s)
Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Niño , Preescolar , Femenino , Genotipo , Salud Global , Hepacivirus/clasificación , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/terapia , Humanos , Lactante , Recién Nacido , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
Asunto(s)
Hepatitis C Crónica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Niño , Preescolar , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Salud Global , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/cirugía , Humanos , Lactante , Recién Nacido , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
Asunto(s)
Antivirales/uso terapéutico , Costo de Enfermedad , Hepatitis C Crónica/epidemiología , Modelos Biológicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Salud Global , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6,358,000 cases in 2008 and Brazil with 2,106,000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.
Asunto(s)
Hepatitis C Crónica/epidemiología , Antivirales/uso terapéutico , Salud Global , Hepatitis C Crónica/mortalidad , Hepatitis C Crónica/terapia , Humanos , Incidencia , Trasplante de Hígado , Prevalencia , Análisis de SupervivenciaRESUMEN
The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant and (ii) increasing efficacy and treatment rate. This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV-related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3-5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.
Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Erradicación de la Enfermedad , Quimioterapia Combinada/métodos , Femenino , Salud Global , Hepatitis C Crónica/diagnóstico , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: The prevalence of hepatitis C virus (HCV) infection in Egypt is the highest in the world, yet the total economic burden has not been quantified. Improved understanding of costs and the impact of treatment strategies will provide for better allocation of resources to reduce HCV disease and economic burden. AIM: A modelling approach was used to quantify the current HCV-infected population, future disease progression and associated costs in Egypt. METHODS: Direct healthcare costs were calculated from a nationally representative hospital and a disability adjusted life year (DALY) template was used with monetary value assigned to lost life years. Three scenarios were considered: (i) Historical treatment scenario: 50% SVR; 65,000 treated annually, (ii) Current treatment scenario: 90% sustained virologic response (SVR); 65,000 treated annually, (iii) Increased treatment scenario: 90% SVR; 325,000 treated annually by 2018. RESULTS: Cumulative DALYs (2015-2030) under Scenario 1 were estimated at 7.88 million and cumulative costs estimated at $89.07 billion. Annual DALYs increased 16% during 2015-2030 while annual costs more than doubled. Scenario 2 reduced cumulative DALYs and costs by 7% and 4%, respectively. Under Scenario 3, total costs declined 73% to $1047 million during 2015-2030. As compared to Scenario 1, cumulative DALYs and costs decreased 37% and 35%, respectively. CONCLUSIONS: This is the first estimate of the total economic burden of HCV in Egypt. Extraordinary measures are necessary to substantially reduce HCV disease and cost burden. With newer therapies, strategies to reduce disease burden are feasible and cost-effective.
Asunto(s)
Gastos en Salud/estadística & datos numéricos , Hepatitis C/economía , Hepatitis C/terapia , Personas con Discapacidad , Progresión de la Enfermedad , Egipto/epidemiología , Humanos , Modelos Econométricos , Prevalencia , Años de Vida Ajustados por Calidad de VidaRESUMEN
This article examines the political agendas of public sector and organized private sector interests concerned with policies affecting uncertified home care agencies in three metropolitan areas. Using a telephone survey, the study found substantial differences across these groups in both the frequency with which they work on given issues and in some key attitudes. Overall, respondents were most likely to work on policies related to home care quality, and had particularly diverse--and at times conflicting--concerns in this area. Policymakers need to actively solicit the diverse attitudes of key interest groups towards controversial issues in order to understand less dominant perspectives, keep in mind the interconnection of policy issues, and arrive at politically viable solutions to home care policy problems.
Asunto(s)
Certificación/legislación & jurisprudencia , Agencias de Atención a Domicilio/legislación & jurisprudencia , Política Organizacional , Política , Investigación sobre Servicios de Salud , Agencias de Atención a Domicilio/normas , Agencias de Atención a Domicilio/estadística & datos numéricos , Entrevistas como Asunto , Philadelphia , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Calidad de la Atención de Salud , San Francisco , TexasRESUMEN
In order to meet its need for a current, integrated picture of the dynamic profession of dietetics, The American Dietetic Association, with assistance from American College Testing, undertook a study focusing on the roles of entry-level dietetic technicians and registered dietitians and beyond-entry-level registered dietitians. A nationwide mail survey was conducted on random samples of 3,559 dietitians who had been registered for up to 3 years, 6,647 dietitians who had been registered for more than 3 years, and all 1,226 graduates (in the previous 3 years) from the 70 ADA-approved programs preparing dietetic technicians that agreed to participate (out of the 77 ADA-approved programs). Response rates of 77.5%, 78.7%, and 68.5% were achieved for the two samples of registered dietitians and the sample of dietetic technicians, respectively. The results show that the most commonly chosen work setting for the three respondent groups was "inpatient-care, acute-care facility." There were substantial differences among the three groups in the types of activities performed and in the level of responsibility for various kinds of activities. The beyond-entry-level registered dietitians were involved in the broadest range of activities and had the most responsibility for policy setting and other administrative activities, such as preparing budgets. The results of the study provide a detailed description of dietetic practice over a broad range of practitioner-experience levels, practice settings, and client groups.
Asunto(s)
Dietética , Perfil Laboral , Administración de Personal , Personal Administrativo , Habilitación Profesional , Humanos , Encuestas y CuestionariosRESUMEN
Non-profit health and social service agencies have traditionally been an extremely important element of non-institutional community-based care for the elderly in the U.S. Policy shifts, commencing in 1981, increasingly concerned with medical cost containment are challenging private non-profit sector agencies delivering care to the elderly. At issue is the ability of communities to maintain a viable service sector predicated on service needs and service accessibility, as opposed to a highly discrete, medicalized, and fragmented service delivery system that is available primarily (or only) to those who can pay.
Asunto(s)
Servicios de Salud Comunitaria , Servicios de Salud para Ancianos , Anciano , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/tendencias , Servicios de Salud para Ancianos/economía , Servicios de Salud para Ancianos/tendencias , Humanos , Organizaciones sin Fines de Lucro , Justicia Social , Servicio Social , Estados UnidosRESUMEN
This paper examines the medicalization of community-based services for the elderly; a process of restructuring to provide more highly medical services to a frail older population at the expense of providing a broader range of social and supportive services to older persons with varying levels of need. Medicalization is tied to changes in government policy (particularly Medicare reimbursement) which have led to increased competition within the health and social service sector. The paper utilizes data on services, policy impact and staffing from the DRG Impact Study conducted at the Institute for Health and Aging (UCSF), a 3-year study of the impacts of federal policy on 7 types of community providers of services to the elderly. Data are presented from telephone interviews conducted at two points in time (1986 and 1987) with directors of a representative sample of home health agencies (HHAs). Findings include: HHAs were more likely to report adding highly medical services and cited social/supportive services (as opposed to highly medical and/or highly technical services) as the most commonly requested services they cannot provide. Policy effects and societal implications of the medicalization of home care are considered.
Asunto(s)
Servicios de Salud Comunitaria/tendencias , Política de Salud , Servicios de Salud para Ancianos/tendencias , Servicio Social/tendencias , Anciano , Servicios de Salud Comunitaria/economía , Servicios de Salud para Ancianos/economía , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Sistema de Pago Prospectivo , Cambio Social , Percepción Social , Servicio Social/economía , Estados UnidosRESUMEN
Medicine, with its focus on individual organic pathology and interventions, has become a powerful and pervasive force in the definition and treatment of aging. The resulting "biomedicalization of aging" socially constructs old age as a process of decremental physical decline and places aging under the domain and control of biomedicine. This paper examines the effects of medicalization on the scientific enterprise and development of the knowledge base in aging, the status and work of the professions, policy, and public perception.
Asunto(s)
Envejecimiento/fisiología , Política de Salud , Humanos , Investigación , Apoyo a la Investigación como Asunto , Estados UnidosRESUMEN
Support for gerontological education and research is analyzed from 1976 through 1986 for five federal agencies: the Administration on Aging, the Bureau of Health Professions, the National Institute on Aging, the National Institute of Mental Health, and the Veterans Administration. It was determined that total federal allocations varied greatly between the social/behavioral and biomedical components of the aging field, with biomedical education and research receiving an increasingly larger percentage of support.
Asunto(s)
Financiación Gubernamental/tendencias , Geriatría/educación , Apoyo a la Investigación como Asunto/tendencias , Humanos , Estados UnidosRESUMEN
OBJECTIVE: To determine the best method of cervical ripening to prevent postdate inductions in women with an unfavorable cervix at 41 weeks' gestation. STUDY DESIGN: Women presenting at 41 weeks' gestation with a Bishop score of < or = 4 received daily dinoprostone (Cervidil) vaginal inserts (group I) or daily membrane sweeping (group II). RESULTS: One-hundred and eighty-two women were prospectively randomized with 91 women in each arm. The women in group II, membrane sweeping, had Bishop scores significantly greater on admission for delivery (p < 0.001), had less time elapsed from admission to delivery (p = 0.018), and had fewer labor inductions at 42 weeks (p = 0.04) than the women in group I, the dinoprostone group. In addition, a greater number of women in group II were admitted in spontaneous labor (p = 0.006) than in group I. Total antenatal costs for the membrane sweeping group was $15,120 versus $59,540 for the dinoprostone group. CONCLUSION: Daily membrane sweeping was more effective than dinoprostone administration with fewer postdate inductions at one-fourth the cost.
Asunto(s)
Maduración Cervical , Dinoprostona/uso terapéutico , Oxitócicos/uso terapéutico , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Estudios Prospectivos , SupositoriosRESUMEN
This article examines changes in clients served by home health agencies, and how changes are related to recent health care trends and local market structure. Two types of explanatory factors are examined: organizational measures and market factors. A theoretical model of isomorphism is tested, considering the effects of privatization within the context of the growth of chains and multifacility systems. Findings show that (a) system members are more likely than nonmembers to show increases in clients of all ages; (b) for-profits that are not system members are more likely to have increases in total clientele and in clients age 65-74, whereas for-profits' changes in clientele age 85 or over depends on their system membership--increasing among nonmembers, decreasing among members; and (c) agencies in states with home health "certificate of need" (CON) are more likely to have increases in clients age 65-74 and 85 and over. The results for total clientele and those age 65-74 support an isomorphism hypothesis.