The cost effectiveness of treating Burkitt lymphoma in Uganda.

BACKGROUND: Perceptions of high cost and resource intensity remain political barriers to the prioritization of childhood cancer treatment programs in many low- and middle-income countries (LMICs). Little knowledge exists of the actual cost and cost-effectiveness of such programs. To improve outcomes for children with Burkitt lymphoma (BL), the most common childhood cancer in Africa, the Uganda Cancer Institute implemented a comprehensive BL treatment program in 2012. We undertook an economic evaluation of the program to ascertain the cost-effectiveness of BL therapy in a specific LIC setting. METHODS: We compared the treatment of BL to usual care in a cohort of 122 patients treated between 2012 and 2014. Costs included variable, fixed, and family costs. Our primary measure of effectiveness was overall survival (OS). Patient outcomes were determined through prospective capture and retrospective chart abstraction. The cost per disability-adjusted life-year (DALY) averted was calculated using the World Health Organization's Choosing Interventions That Are Cost-Effective (WHO-CHOICE) methodology. RESULTS: The 2-year OS with treatment was 55% (95% CI, 45% to 64%). The cost per DALY averted in the treatment group was US$97 (Int$301). Cumulative estimate of national DALYs averted through treatment was 8607 years, and the total national annual cost of treatment was US$834,879 (Int$2,590,845). The cost of BL treatment fell well within WHO-CHOICE cost-effectiveness thresholds. The ratio of cost per DALY averted to per capita gross domestic product was 0.14, reflecting a very cost-effective intervention. CONCLUSION: This study demonstrates that treating BL with locally tailored protocols is very cost-effective by international standards. Studies of this kind will furnish crucial evidence to help policymakers prioritize the allocation of LMIC health system resources among noncommunicable diseases, including childhood cancer.

The Biopsychosocial Impact of COVID-19 on Older Adults.

COVID-19 has spread rapidly around the world and taken over 2.6 million lives. Older adults experience disproportionate morbidity and mortality from the disease because increasing age and the presence of comorbidities are important predictors of negative outcomes. Lasting effects of COVID-19 have been described after recovery from the acute illness despite eradication of the virus from the body. The impact of COVID-19 on a person's biological health post-infection is observed in multiple systems including respiratory, cardiac, renal, haematological, and neurological. Psychological dysfunction following recovery is also prevalent. Social factors such as distancing and stay at home measures leave older adults isolated and food insecure; they also face intertwined financial and health risks due to the resulting economic shutdown. This study examines the effects of COVID-19 on older adults using the biopsychosocial model framework.

Family fIRST, an Interactive Risk Screening Tool for Families in a School-Based Pediatric Clinic.

The purpose of this study was to create a tablet-based, social history screening tool called Family fIRST and evaluate its feasibility and usability in a school-based medical clinic. A mixed methods study design was used to examine quantitative and qualitative outcomes of a survey and semi-structured interview completed by families and physicians. The majority (87%) found the survey easy to understand. Themes for improvement included more free-form space and increased sensitivity around question wording. Clinic physicians felt Family fIRST increased discussion around social history and suggested the tool should help link to suggested resources. Demographic results showed that 12 of 29 (43%) parents had income less than $15 000 and 19 of 29 (65%) were unemployed. Family fIRST was a well-received and feasible tool to implement at the school-based medical clinic. Preliminary results show that families attending the clinic have increased prevalence of negative determinants of health; social history should therefore represent a key area of focus at the medical visit in order to optimize clinic support of families.