Estimating the Health-Related Quality of Life Benefit of Prophylactic Treatment for COVID-19 in Immunocompromised People: A Multimethod Valuation Study.

Background: Pre-exposure prophylaxis (PrEP) for COVID-19 provides additional protection, beyond vaccines alone, for individuals who are immunocompromised (IC). This may reduce the need for preventative behavioral modification, such as shielding-a behavioral restriction limiting an IC individual to minimize face-to-face interactions and/or crowded places. Therefore, PrEP may improve psychosocial well-being and health-related quality of life (HRQoL) for individuals with IC conditions. Objective: To estimate the potential HRQoL and utility benefit of PrEP for prevention of COVID-19 in individuals with IC conditions who may not have an adequate response of full vaccination (and therefore are at "highest risk" of severe COVID-19) that can be used in future economic evaluations of preventative therapies against COVID-19. Methods: Vignettes describing HRQoL associated with 2 pre-PrEP states (shielding and semi-shielding behavioral restrictions) and a post-PrEP state were developed from a literature review and tested through interviews with clinicians (n = 4) and individuals with IC conditions (n = 10). Vignettes were valued by a general population sample (N = 100) using a visual analog scale (VAS), time trade-off (TTO), and EQ-5D-5L. A sample of individuals with IC conditions (n = 48) valued their current HRQoL and a post-PrEP vignette using VAS and EQ-5D-5L. Results: Individuals with IC conditions reported a mean current EQ-5D-5L score of 0.574, and 0.656 for post-PrEP based on the vignette. PrEP would lead to behavior changes for 75% (30/40) of individuals with IC conditions and an emotional benefit for 93% (37/40) of individuals with IC conditions. Mean values from the general population valuation based on EQ-5D-5L ranged from 0.606 ("shielding") to 0.932 ("post-PrEP"). Conclusion: This study quantified the expected health state utility benefit of reduced psychosocial burden and behavioral restriction. PrEP would potentially result in a utility gain between 0.082 and 0.326, dependent on valuation approach and expected change in behavioral restrictions, leading to improvements in daily activities and emotional well-being.

Patient preferences for investigating cancer-related symptoms in Australian general practice: a discrete-choice experiment.

BACKGROUND: Striking the right balance between early cancer diagnosis and the risk of excessive testing for low-risk symptoms is of paramount importance. Patient-centred care must also consider patient preferences for testing. AIM: To investigate the diagnostic testing preferences of the Australian public for symptoms associated with oesophagogastric (OG), bowel, or lung cancer. DESIGN AND SETTING: One of three discrete-choice experiments (DCEs) related to either OG, bowel, or lung cancer were administered to a nationally representative sample of Australians aged ≥40 years. METHOD: Each DCE comprised three scenarios with symptom positive predictive values (PPVs) for undiagnosed cancer ranging from 1% to 3%. The numerical risk was concealed from participants. DCE attributes encompassed the testing strategy, GP familiarity, test and result waiting times, travel duration, and test cost. Preferences were estimated using conditional and mixed logit models. RESULTS: A total of 3013 individuals participated in one of three DCEs: OG (n = 1004), bowel (n = 1006), and lung (n = 1003). Preferences were chiefly driven by waiting time and test cost, followed by the test type. There was a preference for more invasive tests. When confronted with symptoms carrying an extremely low risk (symptom PPV of ≤1%), participants were more inclined to abstain from testing. CONCLUSION: Access-related factors, particularly waiting times and testing costs, emerged as the most pivotal elements influencing preferences, underscoring the substantial impact of these systemic factors on patient choices regarding investigations.

Fitness effects of a demography-dispersal trade-off in expandingSaccharomyces cerevisiaemats.

Fungi expand in space and time to form complex multicellular communities. The mechanisms by which they do so can vary dramatically and determine the life-history and dispersal traits of expanding populations. These traits influence deterministic and stochastic components of evolution, resulting in complex eco-evolutionary dynamics during colony expansion. We perform experiments on budding yeast strains genetically engineered to display rough-surface and smooth-surface phenotypes in colony-like structures called 'mats'. Previously, it was shown that the rough-surface strain has a competitive advantage over the smooth-surface strain when grown on semi-solid media. We experimentally observe the emergence and expansion of segments with a distinct smooth-surface phenotype during rough-surface mat development. We propose a trade-off between dispersal and local carrying capacity to explain the relative fitness of these two phenotypes. Using a modified stepping-stone model, we demonstrate that this trade-off gives the high-dispersing, rough-surface phenotype a competitive advantage from standing variation, but that it inhibits this phenotype's ability to invade a resident smooth-surface population via mutation. However, the trade-off improves the ability of the smooth-surface phenotype to invade in rough-surface mats, replicating the frequent emergence of smooth-surface segments in experiments. Together, these computational and experimental findings advance our understanding of the complex eco-evolutionary dynamics of fungal mat expansion.