Comparing methods for handling missing cost and quality of life data in the Early Endovenous Ablation in Venous Ulceration trial.

OBJECTIVES: This study compares methods for handling missing data to conduct cost-effectiveness analysis in the context of a clinical study. METHODS: Patients in the Early Endovenous Ablation in Venous Ulceration (EVRA) trial had between 1 year and 5.5 years (median 3 years) of follow-up under early or deferred endovenous ablation. This study compares complete-case-analysis (CCA), multiple imputation using linear regression (MILR) and using predictive mean matching (MIPMM), Bayesian parametric approach using the R package missingHE (BPA), repeated measures fixed effect (RMFE) and repeated measures mixed model (RMM). The outcomes were total mean costs and total mean quality-adjusted life years (QALYs) at different time horizons (1 year, 3 years and 5 years). RESULTS: All methods found no statistically significant difference in cost at the 5% level in all time horizons, and all methods found statistically significantly greater mean QALY at year 1. By year 3, only BPA showed a statistically significant difference in QALY between treatments. Standard errors differed substantially between the methods employed. CONCLUSION: CCA can be biased if data are MAR and is wasteful of the data. Hence the results for CCA are likely to be inaccurate. Other methods coincide in suggesting that early intervention is cost-effective at a threshold of £30,000 per QALY 1, 3 and 5 years. However, the variation in the results across the methods does generate some additional methodological uncertainty, underlining the importance of conducting sensitivity analyses using alternative approaches.

High electrochemical performance of nickel cobaltite@biomass carbon composite (NiCoO@BC) derived from the bark of Anacardium occidentale for supercapacitor application.

Biomass carbon-based materials are highly promising for supercapacitor (SC) electrodes due to their availability, environment-friendliness, and low cost. Herein, an easy energy-saving hydrothermal process was used to produce NiCo2O4/NiOOH (NiCoO) composites with biomass carbon (BC) derived from the bark of Anacardium occidentale (AO) at different synthesis time durations (2 h, 4 h, 8 h, 16 h). The structural and morphological properties of the samples were analysed using XRD, Raman spectroscopy, XPS, SEM, TEM and BET, and the results exhibit the presence of carbon inserted into the nickel-cobalt hydroxide matrix. The NiCoO@BC composite synthesized in 4 h (NiCoO@BC(4 h)) displays a good specific capacitance of 475 F g-1 at 0.5 A g-1 and a low equivalent series resistance (ESR) value of 0.36 Ω. It shows a good coulombic efficiency of 98% and retains 86% of the capacitance after 4000 cycles. The asymmetric supercapacitor (ASC) device (NiCoO@BC(4 h)//AC) assembled using activated carbon (AC) as a negative electrode displays 20 W h kg-1 energy density and 900 W kg-1 power density at 1 A g-1. The stability test shows a good coulombic efficiency of 99% and 78% capacitance retention after 15 000 cycles. These findings imply that NiCoO@BC composites have outstanding electrochemical properties, making them suitable as SC electrode materials.

Influence of personality traits, gender, and socio-economic factors in obesity in the English Longitudinal Study of Ageing.

Obesity is a chronic disorder associated with high mortality rates and high morbidity. The risk of obesity is associated with certain personality traits (PTs). Some studies have found correlations among some PTs and gender. Additionally, obesity implies higher costs in daily living. The aim of this paper is to overcome this problem in the literature and estimate the association between PTs and obesity by taking into account the economic situation of the individual. This study employs data from the English Longitudinal Study of Ageing (ELSA). We focus on waves 5 and 6 of the ELSA with a sample of 6562 individuals. The results suggests that the traits of agreeableness ( ß = 0.071 , se = 0.016 , p < 0.001 ) and openness ( ß = 0.028 , se : 0.014 , p < 0.001 ) are positively and significantly associated with obesity. On the other hand, consciousness has a negative and statistically significant effect on obesity ß = 0.072 , se : 0.017 , p < 0.001 . Results are robust to the inclusion/exclusion of different regressors.

[Healthcare access through community-based health insurance among Senegalese migrants]. / Acceso a la atención sanitaria mediante seguros de salud comunitarios entre migrantes de Senegal.

OBJECTIVE: To evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants. METHOD: Data were retrieved through qualitative techniques, semi-structured interviews (n=14) and discussion group (n=10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine. RESULTS: The lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance. CONCLUSIONS: This study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.

Cost-effectiveness analysis of current varicose veins treatments.

OBJECTIVE: To analyze the effectiveness and cost effectiveness of technologies for treatment of varicose veins over 5 years-conservative care, surgery (high ligation and stripping), ultrasound-guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA), and cyanoacrylate glue occlusion (CAE). METHODS: A systematic review was updated and used to construct a Markov decision model. Outcomes were reintervention on the truncal vein, retreatment of residual varicosities and quality-adjusted life years (QALY) and costs over 5 years. RESULTS: UGFS has a significantly greater reintervention rate than other procedures; there is no significant difference between the other procedures. The cost per QALY of EVLA vs UGFS in our base-case model is £16,966 ($23,700) per QALY, which is considered cost effective in the UK. RFA, MOCA, and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS: EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, conservative care, and high ligation and stripping are not cost effective at current prices in the UK National Health Service. MOCA and CAE seem to be promising, but further evidence on the effectiveness, reinterventions, and health-related quality of life is needed, as well as how cost effectiveness may vary across settings and reimbursement systems.

Acceso a la atención sanitaria mediante seguros de salud comunitarios entre migrantes de Senegal / Healthcare access through community-based health insurance among Senegalese migrants

Objetivo: Evaluar los determinantes en la financiación del acceso a la atención médica y el papel de una clase particular de financiación informal propia, denminada tontina, para el acceso a la atención médica en la población de migrantes de origen senegalés. Método: Los datos fueron recogidos mediante técnicas cualitativas, entrevistas semiestructuradas (n = 14) y grupo de discusión (n = 10) en una población de migrantes senegaleses residentes en Granada, entre octubre y noviembre de 2019. Los participantes clave provenían de una tontina. Resultados: La falta de trabajo o de recursos económicos, así como la condición de migrante indocumentado, constituyen barreras para la adhesión a los seguros de salud públicos y privados. Asimismo, los participantes consideran que la asistencia sanitaria pública no tiene en cuenta la importancia que puede tener para ellos seguir un tratamiento cerca de sus familiares o tener la alternativa de las medicinas tradicionales. La tontina permite proteger a las personas más vulnerables, como las indocumentadas, y financiar las prácticas de importancia cultural para las personas migrantes senegalesas. Conclusiones: Este estudio es el primero en proporcionar una comprensión de un mecanismo de financiación propio de un colectivo de migrantes bastante desconocido por la sociedad española. Las tontinas continúan una larga tradición en la que las comunidades desfavorecidas y vulnerables resisten múltiples fuentes de discriminación y desigualdad mediante la autoayuda, la confianza y la solidaridad. (AU)

Objective: To evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants. Method: Data were retrieved through qualitative techniques, semi-structured interviews (n = 14) and discussion group (n = 10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine. Results: The lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance. Conclusions: This study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity. (AU)