Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States.

Importance: Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes, disfigurement, and disability. Objective: To determine the association of varying TED severities with QoL in a non-TED population by assessing health state utility scores. Design, Setting, and Participants: This qualitative study, conducted from April 20, 2020, to April 29, 2021, assessed health states for active, moderate-severe TED, and values were elicited using time trade-off methods. Six health states of varying severity were determined from 2 placebo-controlled clinical trials (171 patients with TED and clinical activity score ≥4, ±diplopia/proptosis) and refined using interviews with US patients with TED (n = 6). Each health state description was validated by interviews with additional TED patient advocates (n = 3) and physician experts (n = 3). Health state descriptions and a QOL questionnaire were piloted and administered to a general population. Visual analog scales (VASs) were also administered to detect concurrence of the findings. Main Outcomes and Measures: TED health state utility scores and whether they differ from one another were assessed using Shapiro-Wilk, Kruskal-Wallis, pairwise Wilcoxon rank sum, and paired t tests. Results: A total of 111 participants completed time trade-off interviews. The mean (SD) utility value was 0.44 (0.34). The lowest (worse) mean utility value was observed in the most severe disease state (constant diplopia/large proptosis) with 0.30 (95% CI, 0.24-0.36), followed by constant diplopia/small proptosis (0.34; 95% CI, 0.29-0.40), intermittent or inconstant diplopia/large proptosis (0.43; 95% CI, 0.36-0.49), no diplopia/large proptosis (0.46; 95% CI, 0.40-0.52), and intermittent or inconstant diplopia/small proptosis (0.52; 95% CI, 0.45-0.58). The highest (best) mean value, 0.60 (95% CI, 0.54-0.67), was observed for the least severe disease state (no diplopia/small proptosis). Conclusions and Relevance: These findings suggest that patients with active, moderate-severe TED may have substantial disutility, with increasing severity of proptosis/diplopia more likely to have detrimental associations with QoL. These health state scores may provide a baseline for determining QoL improvement in these TED health states (utility gains) treated with new therapies.

Epidemiology and costs of dengue in Thailand: A systematic literature review.

BACKGROUND: Dengue is the fastest-spreading vector-borne viral disease worldwide. In Thailand, dengue is endemic and is associated with a high socioeconomic burden. A systematic literature review was conducted to assess and describe the epidemiological and economic burden of dengue in Thailand. METHODS: Epidemiological and economic studies published in English and Thai between 2011-2019 and 2009-2019, respectively, were searched in MEDLINE, Embase, and Evidence-Based Medicines reviews databases. Reports published by the National Ministry of Public Health (MoPH) and other grey literature sources were also reviewed. Identified studies were screened according to predefined inclusion and exclusion criteria. Extracted data were descriptively summarised and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 155 publications were included in the review (39 journal articles and 116 grey literature). Overall, dengue incidence varied yearly, with the highest rates per 100,000 population in 2013 (dengue fever (DF) 136.6, dengue haemorrhagic fever (DHF) 100.9, dengue shock syndrome (DSS) 3.58) and 2015 (DF 133.1, DHF 87.4, DSS 2.14). Peak incidence coincided with the monsoon season, and annual mortality was highest for DSS, particularly in the age group 15-24-year-olds. The highest dengue incidence rates were reported in children (10-14-year-olds) and young adults (15-24-year-olds), irrespective of dengue case definition. Economic and societal burdens are extensive, with the average cost per case ranging from USD 41 to USD 261, total cost per year estimated at USD 440.3 million, and an average of 7.6 workdays lost for DHF and 6.6 days for DF. CONCLUSIONS: The epidemiological, economic, and societal burden of dengue in Thailand is high and underreported due to gaps in national surveillance data. The use of expansion factors (EFs) is recommended to understand the true incidence of dengue and cost-benefit of control measures. Furthermore, as dengue is often self-managed and underreported, lost school and workdays result in substantial underestimation of the true economic and societal burden of dengue. The implementation of integrated strategies, including vaccination, is critical to reduce the disease burden and may help alleviate health disparities and equity challenges posed by dengue.

Epidemiology (2012-2019) and costs (2009-2019) of dengue in Malaysia: a systematic literature review.

OBJECTIVES: A systematic literature review was conducted to assess the epidemiology and economic burden of dengue in Malaysia. METHODS: Embase, MEDLINE, Evidence-Based Reviews databases, and gray literature sources were searched for English and Malay studies and surveillance reports on the epidemiology (between 2012 and 2019) and costs (between 2009 and 2019) of dengue in Malaysia. Independent screening of titles/abstracts, followed by full texts was performed using prespecified criteria. RESULTS: A total of 198 publications were included (55 peer-reviewed and 143 gray literature). Dengue incidence has been increasing in recent years, with 130,101 cases (dengue fever 129,578 cases; dengue hemorrhagic fever 523 cases) reported in 2019, which is the highest since 2012. All dengue virus serotypes co-circulated between 2004 and 2017, and major outbreaks occurred in a cyclical pattern, often associated with a change in the predominant circulating serotype. Economic impacts are substantial, including the societal impact of lost work (7.2-8.8 days) and school days (3.2-4.1 days) due to dengue. CONCLUSION: The rising incidence and high cost of dengue, coupled with overlapping diseases, will likely result in further pressures on the healthcare system. To appropriately mitigate and control dengue, it is critical to implement integrated strategies, including vaccination, to reduce the burden of dengue.

Epidemiology and costs of dengue in Brazil: a systematic literature review.

OBJECTIVES: Dengue infection is a growing public health problem, with the number of reported cases increasing in the Americas and worldwide. This review characterized the epidemiological and economic burden of dengue in Brazil. METHODS: Embase, MEDLINE, evidence-based review databases, and gray literature sources were searched for published literature and surveillance reports on epidemiology (between 2000 and 2019) and costs (between 2009 and 2019) of dengue in Brazil. Studies were included if they reported data on incidence, seroprevalence, serotype distribution, expansion factors, hospitalization, mortality, or costs. Data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 344 publications were included (167 peer-reviewed and 177 gray literature). Dengue outbreaks increased in incidence and frequency, with the highest incidence observed in 2015 at 807 cases per 100,000 population. Outbreaks were related to alternating predominant serotypes. Dengue was more frequent in young adults (aged 20-39 years) and in the Midwest. Cost and societal impacts are substantial and varied across regions, age, and public/private delivery of healthcare services. CONCLUSION: The burden of dengue in Brazil is increasing and likely underestimated. Therefore, developing and implementing new strategies, including vaccination, is essential to reduce the disease burden.

Understanding the Economic Burden of Treating Low-Grade Upper Tract Urothelial Cancer in the United States.

INTRODUCTION: Low grade upper tract urothelial cancer is an uncommon urothelial tumor for which treatment involves multiple ureteroscopic interventions and potentially radical nephroureterectomy. Given the burden of these procedures, there is growing interest in determining how the utilization, complications and morbidities associated with treatment contribute to the burden of care for upper tract urothelial cancer. The aim of this study was to conduct a systematic literature review to understand the economic burden of treating low grade upper tract urothelial cancer. METHODS: The systematic literature review captured publications from January 1, 2009 to March 11, 2019 in MEDLINE®, Embase®, Evidence-Based Medicine Reviews, PsycINFO and EconLit. Conference proceedings from 7 different conferences were also searched. RESULTS: We identified 15 studies that reported on the economic burden associated with treatment interventions in upper tract urothelial cancer. Treatment costs associated with radical nephroureterectomy were the greatest cost component contributing to expenditures including initial procedural costs (ranging from $11,793 to $23,235 per patient), readmission/retreatment costs ($31,697 per patient) and long-terms costs up to 5 years associated with end stage renal disease and chronic kidney disease ($41,474 to $385,464 per patient). Kidney-sparing management was identified as a cost saving alternative to radical nephroureterectomy, with $252,272 per patient saved through 5 years. CONCLUSIONS: The economic burden of low grade upper tract urothelial cancer is high due to costs incurred by patient comorbidities, multiple episodes of care and complications associated with radical nephroureterectomy. Therefore, there is a need for a paradigm shift towards cost-effective, minimally invasive, kidney-sparing treatments.