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1.
Bone Joint J ; 102-B(7): 950-958, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32600136

RESUMEN

AIMS: To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. METHODS: We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. RESULTS: THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. CONCLUSION: If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950-958.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Rodilla/economía , Medición de Resultados Informados por el Paciente , Años de Vida Ajustados por Calidad de Vida , Derivación y Consulta , Anciano , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Probabilidad , Reino Unido
2.
Bone Joint J ; 102-B(7): 941-949, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32600142

RESUMEN

AIMS: To calculate how the likelihood of obtaining measurable benefit from hip or knee arthroplasty varies with preoperative patient-reported scores. METHODS: Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual's probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). A clinically meaningful improvement after arthroplasty was defined as ≥ 8 point improvement in OHS, and ≥ 7 in OKS. RESULTS: The upper preoperative score threshold, above which patients are unlikely to achieve any meaningful improvement from surgery, is 41 for knees and 40 for hips. At lower scores, the probability of improvement increased towards a maximum of 88% (knee) and 95% for (hips). CONCLUSION: By our definition of meaningful improvement, patients with preoperative scores above 41 (OKS) and 40 (OHS) should not be routinely referred to secondary care for possible arthroplasty. Using lower thresholds would incrementally increase the probability of meaningful benefit for those referred but will exclude some patients with potential to benefit. The findings are useful to support the complex shared decision-making process in primary care for referral to secondary care; and in secondary care for experienced clinicians counselling patients considering knee or hip arthroplasty, but should not be used in isolation. Cite this article: Bone Joint J 2020;102-B(7):941-949.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Medición de Resultados Informados por el Paciente , Años de Vida Ajustados por Calidad de Vida , Derivación y Consulta , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Probabilidad , Reino Unido
3.
BMJ Glob Health ; 5(7)2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32675068

RESUMEN

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others.


Asunto(s)
Infecciones por Coronavirus/economía , Salud Global , Pandemias/economía , Pandemias/ética , Neumonía Viral/economía , Salud Poblacional , Salud Pública/economía , Salud Pública/ética , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Política de Salud , Humanos , Neumonía Viral/epidemiología , Años de Vida Ajustados por Calidad de Vida
4.
Cochrane Database Syst Rev ; 6: CD009261, 2020 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-32542647

RESUMEN

BACKGROUND: Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES: To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS: In June 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA: We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. MAIN RESULTS: In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Four studies (2107 participants) reported mortality. There is low-certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.50 to 1.47; I2 = 0%). Thirty-nine studies reported SSI; 31 of these (6204 participants), were included in meta-analysis. There is moderate-certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment with standard dressings (13.0% of participants) after surgery; RR 0.66 (95% CI 0.55 to 0.80 ; I2 = 23%). Eighteen studies reported dehiscence; 14 of these (3809 participants) were included in meta-analysis. There is low-certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13; I2 = 0%). Secondary outcomes There is low-certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41; I2 = 13%; 12 trials; 3523 participants); for seroma, the RR was 0.72 (95% CI 0.50 to 1.05; I2 = 0%; seven trials; 729 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low-certainty evidence); for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59; I2 = 0%; nine trials; 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68; I2 = 69%; seven trials; 796 participants). The overall effect of NPWT on pain is uncertain (very low-certainty evidence from seven trials (2218 participants) which reported disparate measures of pain); but moderate-certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). There is also moderate-certainty evidence for women undergoing caesarean sections (one trial, 876 participants) and people having surgery for lower limb fractures (one trial, 1549 participants) that there is probably little difference in quality of life scores at 30 days or 3 or 6 months, respectively. Cost-effectiveness Five economic studies, based wholly or partially on trials included in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in four indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty and coronary artery bypass graft surgery. They calculated quality-adjusted life-years for treatment groups and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the grade of the evidence varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS: People experiencing primary wound closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSI than people treated with standard dressings (moderate-certainty evidence). There is no clear difference in number of deaths or wound dehiscence between people treated with NPWT and standard dressings (low-certainty evidence). There are also no clear differences in secondary outcomes where all evidence was low or very low-certainty. In caesarean section in obese women and surgery for lower limb fracture, there is probably little difference in quality of life scores (moderate-certainty evidence). Most evidence on pain is very low-certainty, but there is probably no difference in pain between NPWT and standard dressings after surgery for lower limb fracture (moderate-certainty evidence). Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel , Dehiscencia de la Herida Operatoria/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Cicatrización de Heridas , Vendajes , Vesícula/epidemiología , Hematoma/epidemiología , Humanos , Terapia de Presión Negativa para Heridas/economía , Terapia de Presión Negativa para Heridas/instrumentación , Terapia de Presión Negativa para Heridas/mortalidad , Procedimientos Ortopédicos , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación/estadística & datos numéricos , Seroma/epidemiología , Procedimientos Quirúrgicos Operativos/mortalidad , Dehiscencia de la Herida Operatoria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Heridas y Traumatismos/cirugía
5.
Artículo en Inglés | MEDLINE | ID: mdl-32545827

RESUMEN

The WHO declared the novel coronavirus disease a pandemic, with severe consequences for health and global economic activity and Italy is one of the hardest hit countries. This study aims to assess the socio-economic burden of COVID-19 pandemic in Italy through the estimation of Disability-Adjusted Life Years (DALYs) and productivity loss. The observational study was based on data from official governmental sources collected since the inception of epidemic until 28 April 2020. DALYs for a disease combines the years of life lost due to premature mortality in the population and the years lost due to disability of the disease. In addition to DALYs, temporary productivity loss due to absenteeism from work and permanent productivity loss due to premature mortality were estimated using the Human Capital Approach. The total DALYs amount to 2.01 per 1000 persons. The total permanent productivity loss was around EUR 300 million while the temporary productivity loss was around EUR 100 million. This evaluation does not consider other economic aspects related to lockdown, quarantine of contacts, healthcare direct costs etc. The burden of disease methodology is functional metric for steering choices of health policy and allowing the government to be accountable for the utilization of resources.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Costo de Enfermedad , Mortalidad Prematura , Neumonía Viral/epidemiología , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Niño , Preescolar , Costos y Análisis de Costo , Eficiencia , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Adulto Joven
6.
Rev Saude Publica ; 54: 58, 2020.
Artículo en Español, Inglés | MEDLINE | ID: mdl-32555978

RESUMEN

OBJECTIVE To describe the human resources for health and analyze the inequality in its distribution in Mexico. METHODS Cross-sectional study based on the National Occupation and Employment Survey (ENOE in Spanish) for the fourth quarter of 2018 in Mexico. Graduated physicians and nurses, and auxiliary/technician nurses with completed studies were considered as human resources for health. States were grouped by degree of marginalization. Densities of human resources for health per 1,000 inhabitants, Index of Dissimilarity (DI) and Concentration Indices (CI) were estimated as measures of unequal distribution. RESULTS The density of human resources for health was 4.6 per 1,000 inhabitants. We found heterogeneity among states with densities from 2.3 to 10.5 per 1,000 inhabitants. Inequality was higher in the states with a very low degree of marginalization (CI = 0.4) than those with high marginalization (CI = 0.1), and the inequality in the distribution of physicians (CI = 0.5) was greater than in graduated nurses (CI = 0.3) among states. In addition, 17 states showed a density above the threshold of 4.5 per 1,000 inhabitants proposed in the Global Strategy on Human Resources for Health. That implies a deficit of nearly 60,000 human resources for health among the 15 states below the threshold. For all states, to reach a density equal to the national density of 4.6, about 12.6% of human health resources would have to be distributed among states that were below national density. CONCLUSIONS In Mexico, there is inequality in the distribution of human resources for health, with state differences. Government mechanisms could support the balance in the labor market of physicians and nurses through a human resources policy.


Asunto(s)
Fuerza Laboral en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Enfermeras y Enfermeros/provisión & distribución , Médicos/provisión & distribución , Adulto , Distribución por Edad , Anciano , Estudios Transversales , Femenino , Geografía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , México , Persona de Mediana Edad , Densidad de Población , Años de Vida Ajustados por Calidad de Vida , Factores Socioeconómicos , Adulto Joven
7.
J Korean Med Sci ; 35(21): e199, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32476305

RESUMEN

BACKGROUND: The world is currently experiencing a pandemic of coronavirus disease 2019 (COVID-19). In Korea, as in other countries, the number of confirmed cases and deaths due to COVID-19 have been rising. This study aimed to calculate the burden of disease due to COVID-19 in Korea. METHODS: We used data on confirmed cases and deaths due to COVID-19 between January 20 and April 24, 2020 provided by the Korea Centers for Disease Control and Prevention, the local governments and the public media to determine disability-adjusted life years (DALYs) by sex and age. Morbidity was estimated directly among the confirmed, cured, and fatal cases. Disability weights were adopted from previous similar causes on the severity of COVID-19 for the years of life lived with disability (YLDs). The years of life lost (YLLs) were calculated using the standard life expectancy from the 2018 life tables for each sex and age. RESULTS: The YLDs were higher in females (155.2) than in males (105.1), but the YLLs were higher in males (1,274.3) than in females (996.4). The total disease burden attributable to COVID-19 in Korea during the study period, was estimated to be 2,531.0 DALYs, and 4.930 DALYs per 100,000 population. The YLDs and the YLLs constituted 10.3% and 89.7% of the total DALYs, respectively. The DALYs per 100,000 population were highest in people aged ≥ 80 years, followed by those aged 70-79, 60-69, and 50-59 years, but the incidence was the highest in individuals aged 20-29 years. CONCLUSION: This study provided the estimates of DALYs due to COVID-19 in Korea. Most of the disease burden from COVID-19 was derived from YLL; this indicates that decision-makers should focus and make an effort on reducing fatality for preparing the second wave of COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/economía , Costo de Enfermedad , Evaluación de la Discapacidad , Pandemias/economía , Neumonía Viral/economía , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , República de Corea , Factores de Tiempo , Adulto Joven
8.
PLoS One ; 15(4): e0232245, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32353011

RESUMEN

BACKGROUND: Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of interventions for adults with PTSD. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of 10 interventions and no treatment for adults with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS: Eye movement desensitisation and reprocessing (EMDR) appeared to be the most cost-effective intervention for adults with PTSD (with a probability of 0.34 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by combined somatic/cognitive therapies, self-help with support, psychoeducation, selective serotonin reuptake inhibitors (SSRIs), trauma-focused cognitive behavioural therapy (TF-CBT), self-help without support, non-TF-CBT and combined TF-CBT/SSRIs. Counselling appeared to be less cost-effective than no treatment. TF-CBT had the largest evidence base. CONCLUSIONS: A number of interventions appear to be cost-effective for the management of PTSD in adults. EMDR appears to be the most cost-effective amongst them. TF-CBT has the largest evidence base. There remains a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of treatments for adults with PTSD.


Asunto(s)
Trastornos por Estrés Postraumático/tratamiento farmacológico , Trastornos por Estrés Postraumático/psicología , Adulto , Terapia Cognitivo-Conductual/métodos , Análisis Costo-Beneficio , Inglaterra , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Femenino , Humanos , Masculino , Psicoterapia/métodos , Años de Vida Ajustados por Calidad de Vida , Inhibidores de la Captación de Serotonina/uso terapéutico , Medicina Estatal
9.
PLoS One ; 15(5): e0232951, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32401782

RESUMEN

OBJECTIVE: This paper introduces a novel method to evaluate the local impact of behavioral scenarios on disease prevalence and burden with representative individual level data while ensuring that the model is in agreement with the qualitative patterns of global relative risk (RR) estimates. The method is used to estimate the impact of behavioral scenarios on the burden of disease due to ischemic heart disease (IHD) and diabetes in the Turkish adult population. METHODS: Disease specific Hierarchical Bayes (HB) models estimate the individual disease probability as a function of behaviors, demographics, socio-economics and other controls, where constraints are specified based on the global RR estimates. The simulator combines the counterfactual disease probability estimates with disability adjusted life year (DALY)-per-prevalent-case estimates and rolls up to the targeted population level, thus reflecting the local joint distribution of exposures. The Global Burden of Disease (GBD) 2016 study meta-analysis results guide the analysis of the Turkish National Health Surveys (2008 to 2016) that contain more than 90 thousand observations. FINDINGS: The proposed Qualitative Informative HB models do not sacrifice predictive accuracy versus benchmarks (logistic regression and HB models with non-informative and numerical informative priors) while agreeing with the global patterns. In the Turkish adult population, Increasing Physical Activity reduces the DALYs substantially for both IHD by 8.6% (6.4% 11.2%), and Diabetes by 8.1% (5.8% 10.6%), (90% uncertainty intervals). Eliminating Smoking and Second-hand Smoke predominantly decreases the IHD burden 13.1% (10.4% 15.8%) versus Diabetes 2.8% (1.1% 4.6%). Increasing Fruit and Vegetable Consumption, on the other hand, reduces IHD DALYs by 4.1% (2.8% 5.4%) while not improving the Diabetes burden 0.1% (0% 0.1%). CONCLUSION: While the national RR estimates are in qualitative agreement with the global patterns, the scenario impact estimates are markedly different than the attributable risk estimates from the GBD analysis and allow evaluation of practical scenarios with multiple behaviors.


Asunto(s)
Diabetes Mellitus/epidemiología , Carga Global de Enfermedades/estadística & datos numéricos , Isquemia Miocárdica/epidemiología , Femenino , Humanos , Estilo de Vida , Masculino , Modelos Teóricos , Programas Nacionales de Salud , Prevalencia , Investigación Cualitativa , Años de Vida Ajustados por Calidad de Vida , Turquia/epidemiología
10.
PLoS One ; 15(5): e0232240, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32379763

RESUMEN

AIM: That clinical trial (RAINBOW) showed that a 7.4 months overall survival benefit with the combination therapy with ramucirumab (RAM) and paclitaxel (PAC) as second-line therapy for patients with recurrent or metastatic gastric or gastro-oesophageal junction adenocarcinoma, compared with placebo (PLA) plus paclitaxel. We performed an analysis to assess the cost-effectiveness of RAM from a Chinese perspective and recognized the range of drug costs. METHODS: By building a Markov model to estimate quality-adjusted life-years (QALYs), life-years (LYs) and lifetime costs. Transition probabilities, costs and utilities were estimated for the published literature, Chinese health care system and local price setting. We performed threshold analyses and probabilistic sensitivity analyses to evaluate the uncertainty of the model. RESULTS: Compared with PLA strategy, RAM strategy provided an incremental survival benefit of 1.22 LYs and 0.64 QALYs. The probabilistic sensitivity analysis showed that when RAM costs less than $151 or $753 per 4 weeks, the incremental cost-effectiveness ratio (ICER) approximated the willingness-to-pay threshold (WTP), suggesting that there was 50% likelihood that the ICER for RAM + PAC would be less than $44528.4 per QALY or $48121 per QALY, respectively. CONCLUSIONS: For patients with advanced gastric or gastro-oesophageal junction adenocarcinoma who fail first-line chemotherapy, our results are conducive to the multilateral drug price guidance negotiations of RAM in China.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/economía , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Adenocarcinoma/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Grupo de Ascendencia Continental Asiática , China , Análisis Costo-Beneficio , Neoplasias Esofágicas/economía , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Modelos Económicos , Paclitaxel/economía , Paclitaxel/uso terapéutico , Supervivencia sin Progresión , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Estómago/patología , Neoplasias Gástricas/economía
11.
PLoS One ; 15(5): e0232129, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32379783

RESUMEN

BACKGROUND: In China, the disease burden of cervical cancer remains substantial. Human papillomavirus (HPV) vaccines are expensive and not yet centrally funded. To inform immunization policy, understanding the economic burden of the disease is necessary. This study adopted a societal perspective and investigated costs and quality of life changes associated with cervical cancer from diagnosis to one year after final discharge in Henan province, China. METHODS: Inpatient records of cervical cancer patients admitted to the largest cancer hospital in Henan province between Jan. 2017 and Dec. 2018 were extracted. A telephone interview with four modules was conducted in Jun.-Jul. 2019 with a 40% random draw of patients to obtain direct non-medical costs and indirect costs associated with inpatients, costs associated with outpatient visits, and changes in quality of life status using the EQ-5D-5L instrument. Direct medical expenditures were converted to opportunity costs of care using cost-to-charge ratios obtained from hospital financial reports. For each clinical stage (IA-IV), total costs per case from diagnosis to one year after final discharge were extrapolated based on inpatient records, responses to the telephone interview, and recommendation on outpatient follow-ups by Chinese cervical cancer treatment guidelines. Loss in quality-adjusted life years was obtained using the 'under the curve' method and regression predictions. RESULTS: A total of 3,506 inpatient records from 1,323 patients were obtained. Among 541 randomly selected patients, 309 completed at least one module of the telephone interview. The average total costs per case associated with cervical cancer from diagnosis to one year after final discharge ranged from $8,066-$22,888 (in 2018 US Dollar) and the quality-adjusted life years loss varied from 0.05-0.26 for IA-IV patients. CONCLUSIONS: The economic burden associated with cervical cancer is substantial in Henan province. Our study provided important baseline information for cost-effectiveness analysis of HPV immunization program in China.


Asunto(s)
Vacunas contra Papillomavirus/economía , Neoplasias del Cuello Uterino/economía , Adulto , Atención Ambulatoria/economía , China/epidemiología , Costo de Enfermedad , Análisis Costo-Beneficio/métodos , Femenino , Gastos en Salud , Hospitalización/economía , Humanos , Pacientes Internos , Persona de Mediana Edad , Pacientes Ambulatorios , Calidad de Vida/psicología , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Vacunación/economía
12.
PLoS One ; 15(5): e0232753, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32407326

RESUMEN

INTRODUCTION: Allergic rhino-conjunctivitis (ARC) is an IgE-mediated disease that occurs after exposure to indoor or outdoor allergens, or to non-specific triggers. Effective treatment options for seasonal ARC are available, but the economic aspects and burden of these therapies are not of secondary importance, also considered that the prevalence of ARC has been estimated at 23% in Europe. For these reasons, we propose a novel flexible cost-effectiveness analysis (CEA) model, intended to provide healthcare professionals and policymakers with useful information aimed at cost-effective interventions for grass-pollen induced allergic rhino-conjunctivitis (ARC). METHODS: Treatments compared are: 1. no AIT, first-line symptomatic drug-therapy with no allergoid immunotherapy (AIT). 2. SCIT, subcutaneous immunotherapy. 3. SLIT, sublingual immunotherapy. The proposed model is a non-stationary Markovian model, that is flexible enough to reflect those treatment-related problems often encountered in real-life and clinical practice, but that cannot be adequately represented in randomized clinical trials (RCTs). At the same time, we described in detail all the structural elements of the model as well as its input parameters, in order to minimize any issue of transparency and facilitate the reproducibility and circulation of the results among researchers. RESULTS: Using the no AIT strategy as a comparator, and the Incremental Cost Effectiveness Ratio (ICER) as a statistic to summarize the cost-effectiveness of a health care intervention, we could conclude that: SCIT systematically outperforms SLIT, except when a full societal perspective is considered. For example, for T = 9 and a pollen season of 60 days, we have ICER = €16,729 for SCIT vs. ICER = €15,116 for SLIT (in the full societal perspective).For longer pollen seasons or longer follow-up duration the ICER decreases, because each patient experiences a greater clinical benefit over a larger time span, and Quality-adjusted Life Year (QALYs) gained per cycle increase accordingly.Assuming that no clinical benefit is achieved after premature discontinuation, and that at least three years of immunotherapy are required to improve clinical manifestations and perceiving a better quality of life, ICERs become far greater than €30,000.If the immunotherapy is effective only at the peak of the pollen season, the relative ICERs rise sharply. For example, in the scenario where no clinical benefit is present after premature discontinuation of immunotherapy, we have ICER = €74,770 for SCIT vs. ICER = €152,110 for SLIT.The distance between SCIT and SLIT strongly depends on under which model the interventions are meta-analyzed. CONCLUSIONS: Even though there is a considerable evidence that SCIT outperforms SLIT, we could not state that both SCIT and SLIT (or only one of these two) can be considered cost-effective for ARC, as a reliable threshold value for cost-effectiveness set by national regulatory agencies for pharmaceutical products is missing. Moreover, the impact of model input parameters uncertainty on the reliability of our conclusions needs to be investigated further.


Asunto(s)
Alergoides/inmunología , Inmunoterapia/economía , Cadenas de Markov , Modelos Económicos , Poaceae/inmunología , Polen/inmunología , Adulto , Anciano , Análisis Costo-Beneficio , Humanos , Persona de Mediana Edad , Probabilidad , Años de Vida Ajustados por Calidad de Vida
13.
Med Care ; 58(6): 557-565, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32412942

RESUMEN

OBJECTIVE: The objective of this study was to develop the classification system for version of the SF-6D (SF-6Dv2) from the SF-36v2. SF-6Dv2 is an improved version of SF-6D, one of the most widely used generic measures of health for the calculation of quality-adjusted life years. STUDY DESIGN AND SETTING: A 3-step process was undertaken to generate a new classification system: (1) factor analysis to establish dimensionality; (2) Rasch analysis to understand item performance; and (3) tests of differential item function. To evaluate robustness, Rasch analyses were performed in multiple subsets of 2 large cross-sectional datasets from recently discharged hospital patients and online patient samples. RESULTS: On the basis of factor analysis, other psychometric evidence, cross-cultural considerations, and amenability to valuation, the 6-dimension classification used in SF-6D was maintained. SF-6Dv2 resulted in the following modifications to SF-6D: a simpler classification of physical function with clearer separation between levels; a more detailed 5-level description of role limitations; using negative wording to describe vitality; and using pain severity rather than pain interference. CONCLUSIONS: The SF-6Dv2 classification system describes more distinct levels of health than SF-6D, changes the descriptions used for a number of dimensions and provides clearer wording for health state valuation. The second stage of the study has developed a utility value set using discrete choice methods so that the measure can be used in health technology assessment. Further work should investigate the psychometric characteristics of the new instrument.


Asunto(s)
Análisis Costo-Beneficio/métodos , Estado de Salud , Salud Mental , Rendimiento Físico Funcional , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Análisis Costo-Beneficio/normas , Estudios Transversales , Competencia Cultural , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Psicometría , Años de Vida Ajustados por Calidad de Vida , Reproducibilidad de los Resultados , Participación Social , Factores Socioeconómicos , Adulto Joven
14.
Asia Pac J Public Health ; 32(2-3): 111-117, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32410508

RESUMEN

There is an increase in the number of patients with osteoporotic fractures due to the aging population in Korea. This study investigated the burden of osteoporotic fractures including hip, spine, and wrist fractures in the Korean population by estimating disability-adjusted life years (DALYs). The DALY for a given condition in a population captures years of life lost due to premature death and years of life lived with a disability and its severity and duration. To calculate DALYs from all relevant data collected for the 3 conditions, we used a DALY calculation template provided by the World Health Organization in 2014. DALYs per 100 000 for vertebral fractures (3168) were higher than those of hip fractures (2496) in women. Wrist fractures (1038) had the least burden, and the difference between men and women was the lowest. The aging population is expected to increase the burden of osteoporosis.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Fracturas Osteoporóticas/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , República de Corea/epidemiología
16.
Rev Bras Epidemiol ; 23: e200031, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32401916

RESUMEN

INTRODUCTION: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. METHODS: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. RESULTS: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. CONCLUSION: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Distribución por Sexo , Factores de Tiempo , Adulto Joven
17.
Qual Life Res ; 29(7): 1947-1959, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32335816

RESUMEN

PURPOSE: In cost-utility analysis, outcomes are usually measured in terms of quality-adjusted life years, where length of life is adjusted by levels of health-related quality of life (HRQoL) using a single value, known as a health state utility value (HSUV). This study explores the HSUVs of parents of children with a serious illness admitted within three hospital departments (cardiology, oncology and paediatric intensive care) across four time points, compares HSUVs with Australian population norms and examines predictors of parental HSUVs. METHODS: Data were obtained from the Take a Breath study, where parental HSUVs were measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D). Descriptive statistics and t-tests compared the AQoL-8D scores with population norms, while repeated measures ANOVA was used to compare parental HSUVs of children treated across illness groups over time. Regression analysis was performed to determine predictors of parental HSUVs. RESULTS: Parental HSUVs were not significantly different from the general Australian population norms (p = 0.939), as measured by the AQoL-8D. However, statistically significant differences were observed in the psychosocial super-dimension (p < 0.01) and in all eight AQoL-8D dimensions, except for senses and self-worth. No significant differences were observed across illness groups. Parental HSUVs were associated with psychosocial risk factors of trait anxiety (p < 0.001), depression (p < 0.001) and family beliefs (p = 0.024). CONCLUSION: Having a child with a severe illness has an impact on the psychosocial aspects of parental HRQoL regardless of the type of illness. Psychosocial health factors of trait anxiety, depression and family beliefs were important predictors of parental HSUV.


Asunto(s)
Estado de Salud , Padres/psicología , Psicometría/métodos , Calidad de Vida/psicología , Años de Vida Ajustados por Calidad de Vida , Adulto , Australia , Niño , Preescolar , Análisis Costo-Beneficio , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Análisis de Regresión , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
18.
Lancet Gastroenterol Hepatol ; 5(6): 582-597, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32246941

RESUMEN

BACKGROUND: Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). METHODS: We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease). FINDINGS: There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5·9 (5·7-6·1) per 100 000 population and age-standardised mortality was 5·5 (5·3-5·6) per 100 000. Oesophageal cancer caused 9·78 million (9·53-10·03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22·0% (18·6-25·2), mortality decreased by 29·0% (25·8-32·0), and DALYs decreased by 33·4% (30·4-36·1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52·3% (45·9-58·9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40·0% (34·1-46·3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27·4% (22·1-33·1), from 7·68 million (7·42-7·97) to 9·78 million (9·53-10·03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4·46 million [4·25-4·69]) in 2017. The highest national-level age-standardised incidence rates in 2017 were observed in Malawi (23·0 [19·4-26·5] per 100 000 population) and Mongolia (18·5 [16·4-20·8] per 100 000). In 2017, age-standardised incidence was 2·7 times higher, mortality 2·9 times higher, and DALYs 3·0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39·0% [35·5-42·2]), alcohol consumption (33·8% [27·3-39·9]), high BMI (19·5% [6·3-36·0]), a diet low in fruits (19·1% [4·2-34·6]), and use of chewing tobacco (7·5% [5·2-9·6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution. INTERPRETATION: Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear. FUNDING: Bill & Melinda Gates Foundation.


Asunto(s)
Adenocarcinoma/epidemiología , Carcinoma de Células Escamosas/epidemiología , Neoplasias Esofágicas/epidemiología , Carga Global de Enfermedades , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Contaminación del Aire Interior/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Dieta , Femenino , Reflujo Gastroesofágico/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Sobrepeso/epidemiología , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Uso de Tabaco/epidemiología , Adulto Joven
19.
Am J Med Sci ; 359(5): 257-265, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32265010

RESUMEN

BACKGROUND: Acute myocardial infarction (AMI) carries a substantial mortality and morbidity burden. The purpose of this study is to provide annual mean cost per patient and national level estimates of direct and indirect costs (lost productivity from morbidity and premature mortality) associated with AMI. METHODS: Nationally representative data spanning 12 years (2003-2014) with a sample of 324,869 patients with AMI from the Medical Expenditure Panel Survey (MEPS) were analyzed. A novel 2-part model was used to examine the excess direct cost associated with AMI, controlling for covariates. To estimate lost productivity from morbidity, an adjusted Generalized Linear Model was used for the differential in wage earnings between participants with and without AMI. Lost productivity from premature mortality was estimated based on published data. RESULTS: The total annual cost of AMI in 2016 dollars was estimated to be $84.9 billion, including $29.8 billion in excess direct medical expenditures, $14.6 billion in lost productivity from morbidity and $40.5 billion in lost productivity from premature mortality between 2003 and 2014. In the adjusted regression, the overall excess direct medical expenditure of AMI was $7,076 (95% confidence interval [CI] $6,028-$8,125) higher than those without AMI. After adjustment, annual wages for patients with AMI were $10,166 (95% CI -$12,985 to -$7,347) lower and annual missed work days were 5.9 days (95% CI 3.57-8.27) higher than those without AMI. CONCLUSIONS: The study finds that the economic burden of AMI is substantial, for which effective prevention could result in significant health and productivity cost savings.


Asunto(s)
Costo de Enfermedad , Infarto del Miocardio/economía , Infarto del Miocardio/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , Preescolar , Bases de Datos Factuales , Eficiencia , Femenino , Costos de la Atención en Salud , Gastos en Salud/estadística & datos numéricos , Humanos , Lactante , Pacientes Internos , Seguro de Salud , Modelos Lineales , Masculino , Persona de Mediana Edad , Morbilidad , Infarto del Miocardio/mortalidad , Años de Vida Ajustados por Calidad de Vida , Estados Unidos , Adulto Joven
20.
Ann Rheum Dis ; 79(5): 556-565, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32241795

RESUMEN

OBJECTIVES: To evaluate the cost-effectiveness of treat-to-target strategies among recently diagnosed patients with rheumatoid arthritis (RA) using methotrexate (MTX) and a step-down glucocorticoid (GC) scheme (COBRA Slim) compared with (1) this combination with either sulphasalazine (COBRA Classic) or leflunomide (COBRA Avant-Garde) in high-risk patients and (2) MTX without GCs (Tight-Step-Up, TSU) in low-risk patients. METHODS: The incremental cost-utility was calculated from a healthcare perspective in the intention-to-treat population (n=379) of the 2-year open-label pragmatic randomised controlled Care in early RA trial. Healthcare costs were collected prospectively through electronic trial records. Quality-adjusted life years (QALYs) were estimated using mapping algorithms for EuroQoL-5 Dimension. Multiple imputation was used to handle missing data and bootstrapping to calculate CIs. Robustness was tested with biological disease-modifying antirheumatic drugs at biosimilar prices. RESULTS: In the high-risk group, Classic (∆k€1.464, 95% CI -0.198 to 3.127) and Avant-Garde (∆k€0.636, 95% CI -0.987 to 2.258) were more expensive compared with Slim and QALYs were slightly worse for Classic (∆-0.002, 95% CI -0.086 to 0.082) and Avant-Garde (∆-0.009, 95% CI -0.102 to 0.084). This resulted in the domination of Classic and Avant-Garde by Slim. In the low-risk group, Slim was cheaper (∆k€-0.617, 95% CI -2.799 to 1.566) and QALYs were higher (∆0.141, 95% CI 0.008 to 0.274) compared with TSU, indicating Slim dominated. Results were robust against the price of biosimilars. CONCLUSIONS: The combination of MTX with a GC bridging scheme is less expensive with comparable health utility than more intensive step-down combination strategies or a conventional step-up approach 2 years after initial treatment. TRIAL REGISTRATION NUMBER: NCT01172639.


Asunto(s)
Antirreumáticos/administración & dosificación , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/economía , Leflunamida/administración & dosificación , Dimensión del Dolor , Sulfasalazina/administración & dosificación , Anciano , Artritis Reumatoide/diagnóstico , Análisis Costo-Beneficio , Quimioterapia Combinada , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Rango del Movimiento Articular/fisiología , Inducción de Remisión , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento
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