Cost-effectiveness analysis of isolation strategies for asymptomatic and mild symptom COVID-19 patients.

BACKGROUND: Management of COVID-19 patients with mild and moderate symptoms could be isolated at home isolation (HI), community isolation (CI) or hospitel. However, it was still unclear which strategy was more cost-effective. Therefore, this study was conducted to evaluate this. METHODS: This study used data from patients who initially stayed at HI, CI, and hospitel under supervision of Ramathibodi Hospital between April and October 2021. Outcomes of interest were hospitalisation and mortality. An incremental cost-effectiveness ratios (ICER) was calculated based on hospital perspective using home isolation as the reference. RESULTS: From 7,077 patients, 4,349 2,356, and 372 were admitted at hospitel, HI, and CI, respectively. Most patients were females (57.04%) and the mean age was 40.42 (SD = 16.15). Average durations of stay were 4.47, 3.35, and 3.91 days for HI, CI, and hospitel, respectively. The average cost per day for staying in these corresponding places were 24.22, 63.69, and 65.23 US$. For hospitalisation, the ICER for hospitel was at 41.93 US$ to avoid one hospitalisation in 1,000 patients when compared to HI, while CI had more cost, but less cases avoided. The ICER for hospitel and CI were at 46.21 and 866.17 US$ to avoid one death in 1,000 patients. CONCLUSIONS: HI may be cost-effective isolated strategy for preventing hospitalisation and death in developing countries with limited resources.

Efficacy of Time-Restricted Eating and Behavioral Economic Intervention in Reducing Fasting Plasma Glucose, HbA1c, and Cardiometabolic Risk Factors in Patients with Impaired Fasting Glucose: A Randomized Controlled Trial.

This randomized controlled trial is aimed at assessing the efficacy of combining time-restricted eating (TRE) with behavioral economic (BE) interventions and comparing it to TRE alone and to the usual care for reducing fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and other cardiometabolic risk factors among patients with impaired fasting glucose (IFG). Seventy-two IFG patients aged 18-65 years were randomly allocated for TRE with BE interventions (26 patients), TRE alone (24 patients), or usual care (22 patients). Mean FPG, HbA1c, and other cardiometabolic risk factors among the three groups were compared using a mixed-effect linear regression analysis. Mean body weight, FPG, HbA1c, fasting insulin, and lipid profiles did not significantly differ among the three groups. When considering only patients who were able to comply with the TRE protocol, the TRE group showed significantly lower mean FPG, HbA1c, and fasting insulin levels compared to the usual care group. Our results did not show significant differences in body weight, blood sugar, fasting insulin, or lipid profiles between TRE plus BE interventions, TRE alone, and usual care groups. However, TRE might be an effective intervention in lowering blood sugar levels for IFG patients who were able to adhere to the TRE protocol.

Efficacy of time-restricted eating and behavioural economic interventions in reducing fasting plasma glucose, HbA1c and cardiometabolic risk factors compared with time-restricted eating alone or usual care in patients with impaired fasting glucose: protocol for an open-label randomised controlled trial.

INTRODUCTION: Impaired fasting glucose (IFG) is a significant risk factor for diabetes mellitus. Time-restricted eating (TRE) is one type of diet showing positive effects on metabolic signal pathways. However, effects of TRE on cardiometabolic risk factors in humans are limited. Additionally, compliance with TRE remains problematic despite having intention to follow the diet control. Therefore, this study aims to investigate the efficacy of TRE with behavioural economic interventions or TRE alone relative to usual care, in reducing fasting plasma glucose (FPG), haemoglobin A1c (HbA1c) and other cardiometabolic risk factors in patients with IFG. METHODS AND ANALYSIS: This parallel-group, open-label randomised controlled trial will be conducted at the outpatient clinic of the Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. Patients aged 18-65 years with IFG defined as FPG 100-125 mg/dL and body mass index ≥25 kg/m2 will be recruited between October 2021 and October 2022. Patients will be randomly allocated to three groups (1:1:1 ratio) as (1) TRE with behavioural economic interventions including financial incentives and text reminders, (2) TRE alone or (3) usual care. The number of participants will be 38 per group (a total of 114). The duration of the intervention will be 12 weeks. Primary outcome is FPG levels measured at 12 weeks after randomisation. Secondary outcomes are HbA1c, body weight, systolic and diastolic blood pressure, fasting insulin, serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and high-sensitivity C reactive protein. P value of <0.05 of two-sided test will be considered as statistical significance. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University (MURA2021/389). All patients will be informed about the details of the study and sign written informed consent before enrollment in the study. Results from this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: TCTR20210520002.