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1.
Int J Mol Sci ; 22(12)2021 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-34203967

RESUMEN

A substantial proportion of subjects with autosomal recessive retinitis pigmentosa (arRP) or Usher syndrome type II (USH2) lacks a genetic diagnosis due to incomplete USH2A screening in the early days of genetic testing. These cases lack eligibility for optimal genetic counseling and future therapy. USH2A defects are the most frequent cause of USH2 and are also causative in individuals with arRP. Therefore, USH2A is an important target for genetic screening. The aim of this study was to assess unscreened or incompletely screened and unexplained USH2 and arRP cases for (likely) pathogenic USH2A variants. Molecular inversion probe (MIP)-based sequencing was performed for the USH2A exons and their flanking regions, as well as published deep-intronic variants. This was done to identify single nucleotide variants (SNVs) and copy number variants (CNVs) in 29 unscreened or partially pre-screened USH2 and 11 partially pre-screened arRP subjects. In 29 out of these 40 cases, two (likely) pathogenic variants were successfully identified. Four of the identified SNVs and one CNV were novel. One previously identified synonymous variant was demonstrated to affect pre-mRNA splicing. In conclusion, genetic diagnoses were obtained for a majority of cases, which confirms that MIP-based sequencing is an effective screening tool for USH2A. Seven unexplained cases were selected for future analysis with whole genome sequencing.


Asunto(s)
Análisis Costo-Beneficio , Exones/genética , Proteínas de la Matriz Extracelular/genética , Sondas Moleculares/metabolismo , Sitios de Empalme de ARN/genética , Retinitis Pigmentosa/genética , Análisis de Secuencia de ADN , Síndromes de Usher/genética , Secuencia de Bases , Variaciones en el Número de Copia de ADN/genética , Eliminación de Gen , Humanos , Polimorfismo de Nucleótido Simple/genética , Retinitis Pigmentosa/economía , Síndromes de Usher/economía
2.
Artículo en Inglés | MEDLINE | ID: mdl-34209328

RESUMEN

BACKGROUND: The epidemiological situation generated by COVID-19 has highlighted the importance of applying non-pharmacological measures in the management of the epidemic. Mass screening of the asymptomatic general population has been established as a priority strategy by carrying out diagnostic tests to detect possible cases, isolate contacts, cut transmission chains and thus limit the spread of the virus. OBJECTIVE: To evaluate the economic impact of mass COVID-19 screenings of an asymptomatic population during the first and second wave of the epidemic in Catalonia, Spain. METHODOLOGY: Cost-Benefit Analysis based on the estimated total costs of mass screening versus health gains and associated health costs avoided. RESULTS: Excluding the value of monetized health, the Benefit-Cost ratio was estimated at 0.45, a low value that would seem to advise against mass screening policies. However, if monetized health is included, the ratio is close to 1.20, reversing the interpretation. In other words, the monetization of health is the critical element that tips the scales in favour of the desirability of screening. Results show that the interventions with the highest return are those that maximize the percentage of positives detected. CONCLUSION: Efficient management of resources for the policy of mass screening in asymptomatic populations can generate high social returns. The positivity rate critically determines its desirability. Likewise, precocity in the detection of cases will cut more transmissions in the chain of contagion and increase the economic return of these interventions. Maximizing the value of resources depends on screening strategies being accompanied by contact-tracing and specific in their focus, targeting, for example, high-risk subpopulations with the highest rate of expected positives.


Asunto(s)
COVID-19 , Trazado de Contacto , Análisis Costo-Beneficio , Humanos , SARS-CoV-2 , España/epidemiología
3.
Artículo en Inglés | MEDLINE | ID: covidwho-1288889

RESUMEN

BACKGROUND: The epidemiological situation generated by COVID-19 has highlighted the importance of applying non-pharmacological measures in the management of the epidemic. Mass screening of the asymptomatic general population has been established as a priority strategy by carrying out diagnostic tests to detect possible cases, isolate contacts, cut transmission chains and thus limit the spread of the virus. OBJECTIVE: To evaluate the economic impact of mass COVID-19 screenings of an asymptomatic population during the first and second wave of the epidemic in Catalonia, Spain. METHODOLOGY: Cost-Benefit Analysis based on the estimated total costs of mass screening versus health gains and associated health costs avoided. RESULTS: Excluding the value of monetized health, the Benefit-Cost ratio was estimated at 0.45, a low value that would seem to advise against mass screening policies. However, if monetized health is included, the ratio is close to 1.20, reversing the interpretation. In other words, the monetization of health is the critical element that tips the scales in favour of the desirability of screening. Results show that the interventions with the highest return are those that maximize the percentage of positives detected. CONCLUSION: Efficient management of resources for the policy of mass screening in asymptomatic populations can generate high social returns. The positivity rate critically determines its desirability. Likewise, precocity in the detection of cases will cut more transmissions in the chain of contagion and increase the economic return of these interventions. Maximizing the value of resources depends on screening strategies being accompanied by contact-tracing and specific in their focus, targeting, for example, high-risk subpopulations with the highest rate of expected positives.


Asunto(s)
COVID-19 , Trazado de Contacto , Análisis Costo-Beneficio , Humanos , SARS-CoV-2 , España/epidemiología
4.
Bone Joint J ; 103-B(7): 1277-1283, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192942

RESUMEN

AIMS: The aim of the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) was to determine the optimal treatment for adults with a bicortical undisplaced or minimally displaced fracture of the waist of the scaphoid, comparing early surgical fixation with initial cast immobilization, with immediate fixation being offered to patients with nonunion. METHODS: A cost-effectiveness analysis was conducted to assess the relative merits of these forms of treatment. The differences in costs to the healthcare system and quality-adjusted life years (QALYs) of the patients over the one-year follow-up of the trial in the two treatment arms were estimated using regression analysis. RESULTS: Our base case analysis found that patients randomized to early surgical fixation had statistically significantly higher mean costs to the NHS of £1,295 more than for the cast immobilization arm (p < 0.001), primarily due to the cost of surgery. They also had a marginally better quality of life, over the period, of 0.0158 QALYs; however, this was not statistically significant (p = 0.379). The mean combined cost per additional QALY was £81,962, well above the accepted threshold for cost-effectiveness used in the UK and internationally. The probability of early surgery being cost-effective in this setting was only 5.6%. CONCLUSION: Consistent with the clinical findings of SWIFFT, these results indicate that initial cast immobilization of minimally displaced scaphoid fractures, with immediate fixation only offered to patients with nonunion, is the optimal form of treatment, resulting in comparable outcomes with less cost to the healthcare system. Cite this article: Bone Joint J 2021;103-B(7):1277-1283.


Asunto(s)
Moldes Quirúrgicos , Análisis Costo-Beneficio , Fijación de Fractura/economía , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Años de Vida Ajustados por Calidad de Vida , Hueso Escafoides/lesiones , Adulto , Anciano , Femenino , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Reino Unido
5.
BMC Gastroenterol ; 21(1): 276, 2021 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-34229619

RESUMEN

BACKGROUND: Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. METHODS: Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. RESULTS: TCBT cost £956 more than TAU (95% CI, £601-£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, - £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, - £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, - £448 to £2580). CONCLUSIONS: TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).


Asunto(s)
Terapia Cognitivo-Conductual , Síndrome del Colon Irritable , Automanejo , Adulto , Análisis Costo-Beneficio , Inglaterra , Humanos , Internet , Síndrome del Colon Irritable/terapia , Años de Vida Ajustados por Calidad de Vida
6.
BMC Health Serv Res ; 21(1): 685, 2021 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-34247604

RESUMEN

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Entrevista Motivacional , Adolescente , Fármacos Anti-VIH/uso terapéutico , Análisis Costo-Beneficio , Estudios de Factibilidad , Infecciones por VIH/tratamiento farmacológico , Humanos , Motivación , Nigeria , Evaluación de Resultado en la Atención de Salud , Calidad de Vida
7.
Artículo en Inglés | MEDLINE | ID: mdl-34231822

RESUMEN

Cryptococcal infection is a frequent cause of mortality in Brazilian HIV-infected patients. The present study aimed to evaluate the cost-effectiveness and budgetary impact of four cryptococcosis screening strategies in HIV-infected patients with CD4+ ≤ 200 cells/mm3, in Brazil. A Monte Carlo microsimulation was used to compare the following diagnostic tests: a systematic serum cryptococcal antigen (CRAG) screening with latex agglutination (CRAG-LA), a lateral flow immunochromatographic test (CRAG-LFA), India ink staining and no intervention. The rationale was that of the Unified Health System (SUS), and the time horizon was of one year for the intervention and of five years for the budgetary impact analysis (BIA). The effectiveness outcomes were years of life and years of life adjusted for quality (QALY). The cost-effectiveness analysis showed that the two cryptococcal antigen tests were cost-effective, presenting with superior results in comparison with India ink and no screening. CRAG-LFA, compared to CRAG-LA, has an incremental cost of US$0.25 and an incremental cost-effectiveness ratio of US$73.36 (considering the US dollar equal to 5 reais, the Brazilian current money). The probabilistic sensitivity analysis between CRAG-LFA and CRAG-LA, despite showing a high agreement between the two tests, indicated the superiority of CRAG-LFA. The BIA estimated that the incorporation of CRAG-LFA would have an additional cost of approximately U$S 10.4 million dollars in five years. These findings suggest that, for the group of studied patients, the adoption of CRAG-LFA and CRAG-LA are cost-effective, while the India ink test and no intervention are less effective strategies. The BIA showed that using the CRAG-LFA test for people living with HIV (PLHIV) with CD4+ ≤ 200 cells/mm3 could reduce costs for the Brazilian Unified Health System (SUS).


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Criptococosis , Cryptococcus , Infecciones por VIH , Meningitis Criptocócica , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Antígenos Fúngicos , Brasil , Recuento de Linfocito CD4 , Análisis Costo-Beneficio , Criptococosis/diagnóstico , Infecciones por VIH/complicaciones , Humanos
8.
Value Health ; 24(7): 917-924, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34243834

RESUMEN

OBJECTIVES: Throughout the coronavirus disease 2019 pandemic, susceptible-infectious-recovered (SIR) modeling has been the preeminent modeling method to inform policy making worldwide. Nevertheless, the usefulness of such models has been subject to controversy. An evolution in the epidemiological modeling field is urgently needed, beginning with an agreed-upon set of modeling standards for policy recommendations. The objective of this article is to propose a set of modeling standards to support policy decision making. METHODS: We identify and describe 5 broad standards: transparency, heterogeneity, calibration and validation, cost-benefit analysis, and model obsolescence and recalibration. We give methodological recommendations and provide examples in the literature that employ these standards well. We also develop and demonstrate a modeling practices checklist using existing coronavirus disease 2019 literature that can be employed by readers, authors, and reviewers to evaluate and compare policy modeling literature along our formulated standards. RESULTS: We graded 16 articles using our checklist. On average, the articles met 6.81 of our 19 categories (36.7%). No articles contained any cost-benefit analyses and few were adequately transparent. CONCLUSIONS: There is significant room for improvement in modeling pandemic policy. Issues often arise from a lack of transparency, poor modeling assumptions, lack of a system-wide perspective in modeling, and lack of flexibility in the academic system to rapidly iterate modeling as new information becomes available. In anticipation of future challenges, we encourage the modeling community at large to contribute toward the refinement and consensus of a shared set of standards for infectious disease policy modeling.


Asunto(s)
Enfermedades Transmisibles Emergentes/tratamiento farmacológico , Enfermedades Transmisibles Emergentes/prevención & control , Métodos Epidemiológicos , Análisis Costo-Beneficio , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Predicción/métodos , Humanos , Formulación de Políticas , Estándares de Referencia
9.
Zhonghua Yi Xue Za Zhi ; 101(26): 2029-2036, 2021 Jul 13.
Artículo en Chino | MEDLINE | ID: mdl-34275235

RESUMEN

The disease burden and economic burden of seasonal influenza is substantial in China, and the Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges to the prevention and control of influenza. As a priority group of influenza vaccination, the elderly are at higher risk of influenza-associated severe symptoms and deaths, and they are more price-sensitive vaccine users with better cost-effectiveness of vaccination program. Therefore, a reasonable financing mechanism of influenza vaccination should be designed for the elderly to increase their vaccination rate. This study proposes three financing strategies of influenza vaccination for the elderly in China, trying to explore the distribution of vaccination costs among individuals, central government and local governments under different financing strategies, including the individual-central-local mechanism (strategy 1), the central-local mechanism (strategy 2), and the local payment mechanism (strategy 3). Strategy 1 is feasible and sustainable for most regions in the short term. Strategy 2 is conducive to further increasing the vaccine coverage rate of the elderly. Strategy 3 encourages local fiscal payments to help relieve the financial pressure of the central government. The results revealed a relatively heavy financial burden of influenza vaccination for the elderly, and it is recommended to promote the development of a multiparty co-payment mechanism gradually based on local conditions.


Asunto(s)
COVID-19 , Gripe Humana , Anciano , China , Análisis Costo-Beneficio , Humanos , Gripe Humana/prevención & control , SARS-CoV-2 , Vacunación
10.
JAMA Netw Open ; 4(6): e2115850, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34081135

RESUMEN

Importance: Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. Objective: To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. Design, Setting, and Participants: This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. Main Outcomes and Measures: For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. Results: The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. Conclusions and Relevance: In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts.


Asunto(s)
COVID-19/prevención & control , Trazado de Contacto , Salud Pública , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/epidemiología , Prueba de COVID-19 , Trazado de Contacto/estadística & datos numéricos , Análisis Costo-Beneficio , Estudios Transversales , Revelación/estadística & datos numéricos , Servicios de Salud del Indígena , Humanos , Incidencia , Prevalencia , SARS-CoV-2 , Teléfono , Estados Unidos/epidemiología
11.
BMJ Open ; 11(6): e043943, 2021 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-34083328

RESUMEN

INTRODUCTION: This study will evaluate the acceptability and effectiveness of a new intervention programme called teach-test-link-trace (TTLT) model in Tigrai, Ethiopia, where peer educators counsel about HIV (teach), perform house-to-house HIV testing (test) through pinprick HIV testing (H2H) or OraQuick HIV self-testing (HIVST), link HIV-positive patients to HIV care (link) and trace lost patients house-to-house (trace). METHODS AND ANALYSIS: The four-arm cluster randomised trial will be conducted in five phases: Phase 1 will assess the acceptability of the TTLT model using a cross-sectional survey among adults aged 18 years irrespective of HIV status in 6909 households from 40 villages (kebeles). Phase 2 will assess effectiveness of the TTLT model through comparing intervention and control groups among HIV negative or unknown HIV status. The intervention groups will receive one of the three home-based interventions provided by peer educators: (1) demonstrate and distribute OraQuick HIV self-testing kits (HIVST), (2) perform pinprick HIV testing (H2H) and (3) offer a choice to either receive HIVST or H2H. The control group will receive the standard care in which nurses counsel and refer eligible household members to nearby health facilities to access existing HIV testing services. The primary outcomes of the interventions are proportion of individuals who know of their HIV status (first 90), link to HIV care and treatment (second 90) and meet virological suppression (third 90). We will perform process evaluation through qualitative interviews in phase 3, economic evaluation for cost-effectiveness analysis in phase 4 and a sustainability exit strategy using nominal group technique in phase 5. We will apply descriptive and inferential statistics for quantitative studies, and thematic framework analysis for qualitative studies. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Southern Adelaide Clinical Health Research Ethics Committee (SAC HREC), South Australia, and findings will be disseminated through publications, conference presentations, media release and policy briefs. TRIAL REGISTRATION NUMBER: ACTRN12620000570987p.


Asunto(s)
Infecciones por VIH , Adulto , Análisis Costo-Beneficio , Estudios Transversales , Etiopía , Infecciones por VIH/diagnóstico , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Australia del Sur
12.
BMC Public Health ; 21(1): 1065, 2021 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-34088286

RESUMEN

BACKGROUND: Population-based screening was essential for glaucoma management. Although various studies have investigated the cost-effectiveness of glaucoma screening, policymakers facing with uncontrollably growing total health expenses were deeply concerned about the potential financial consequences of glaucoma screening. This present study was aimed to explore the impact of glaucoma screening with artificial intelligence (AI) automated diagnosis from a budgetary standpoint in Changjiang county, China. METHODS: A Markov model based on health care system's perspective was adapted from previously published studies to predict disease progression and healthcare costs. A cohort of 19,395 individuals aged 65 and above were simulated over a 15-year timeframe. Fur illustrative purpose, we only considered primary angle-closure glaucoma (PACG) in this study. Prevalence, disease progression risks between stages, compliance rates were obtained from publish studies. We did a meta-analysis to estimate diagnostic performance of AI automated diagnosis system from fundus image. Screening costs were provided by the Changjiang screening programme, whereas treatment costs were derived from electronic medical records from two county hospitals. Main outcomes included the number of PACG patients and health care costs. Cost-offset analysis was employed to compare projected health outcomes and medical care costs under the screening with what they would have been without screening. One-way sensitivity analysis was conducted to quantify uncertainties around model results. RESULTS: Among people aged 65 and above in Changjiang county, it was predicted that there were 1940 PACG patients under the AI-assisted screening scenario, compared with 2104 patients without screening in 15 years' time. Specifically, the screening would reduce patients with primary angle closure suspect by 7.7%, primary angle closure by 8.8%, PACG by 16.7%, and visual blindness by 33.3%. Due to early diagnosis and treatment under the screening, healthcare costs surged dramatically to $107,761.4 dollar in the first year and then were constantly declining over time, while without screening costs grew from $14,759.8 in the second year until peaking at $17,900.9 in the 9th year. However, cost-offset analysis revealed that additional healthcare costs resulted from the screening could not be offset by decreased disease progression. The 5-, 10-, and 15-year accumulated incremental costs of screening versus no screening were estimated to be $396,362.8, $424,907.9, and $434,903.2, respectively. As a result, the incremental cost per PACG of any stages prevented was $1464.3. CONCLUSIONS: This study represented the first attempt to address decision-maker's budgetary concerns when adopting glaucoma screening by developing a Markov prediction model to project health outcomes and costs. Population screening combined with AI automated diagnosis for PACG in China were able to reduce disease progression risks. However, the excess costs of screening could never be offset by reduction in disease progression. Further studies examining the cost-effectiveness or cost-utility of AI-assisted glaucoma screening were needed.


Asunto(s)
Glaucoma de Ángulo Cerrado , Glaucoma , Anciano , Inteligencia Artificial , China/epidemiología , Análisis Costo-Beneficio , Glaucoma/diagnóstico , Costos de la Atención en Salud , Humanos
13.
Trials ; 22(1): 383, 2021 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-34099033

RESUMEN

BACKGROUND: Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. METHODS: Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. DISCUSSION: This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000477224 . Registered on 3 April 2018.


Asunto(s)
Trastorno de Personalidad Limítrofe , Servicios Comunitarios de Salud Mental , Australia , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/terapia , Análisis Costo-Beneficio , Humanos , Encuestas y Cuestionarios , Resultado del Tratamiento
14.
Health Technol Assess ; 25(39): 1-74, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34142943

RESUMEN

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. OBJECTIVE: The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. PERSPECTIVE/SETTING: The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. METHODS: A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. RESULTS: Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. LIMITATIONS: There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. CONCLUSIONS: SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. FUTURE WORK: More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. FUNDING: This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.


Asunto(s)
Prueba de COVID-19 , Análisis Costo-Beneficio , Modelos Teóricos , Pruebas en el Punto de Atención , Instituciones Residenciales , Anciano , COVID-19 , Prueba de COVID-19/normas , Humanos , Evaluación de la Tecnología Biomédica
15.
Medicine (Baltimore) ; 100(25): e26198, 2021 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-34160384

RESUMEN

BACKGROUND: In silico medicine allows for pre-clinical and clinical simulated assessment of medical technologies and the building of patient-specific models to support medical decisions and forecast personal health status. While there is increasing trust in the potential central role of in silico medicine, there is a need to recognize its degree of reliability and evaluate its economic impact. An in silico platform has been developed within a Horizon 2020-funded project (In-Silc) for simulations functional to designing, developing, and assessing drug-eluting bioresorbable vascular scaffolds.The main purpose of this study was to compare the costs of 2 alternative strategies: the adoption of In-Silc platform versus the performance of only physical bench tests. METHODS: A case study was provided by a medical device company. The values of the model parameters were principally set by the project partners, with use of interviews and semi-structured questionnaires, and, when not available, through literature searches or derived by statistical techniques. An economic model was built to represent the 2 scenarios. RESULTS: The InSilc strategy is superior to the adoption of physical bench tests only. Ceteris paribus, the costs are 424,355€ for the former versus 857,811€ for the latter. CONCLUSIONS: In silico medicine tools can decrease the cost of the research and development of medical devices such as bioresorbable vascular scaffolds. Further studies are needed to explore the impact of such solutions on the innovation capacity of companies and the consequent potential advantages for target patients and the healthcare system.


Asunto(s)
Implantes Absorbibles , Simulación por Computador/economía , Stents Liberadores de Fármacos , Diseño de Equipo/métodos , Ensayo de Materiales/métodos , Diseño Asistido por Computadora , Análisis Costo-Beneficio , Diseño de Equipo/economía , Humanos , Ensayo de Materiales/economía , Reproducibilidad de los Resultados
16.
Pan Afr Med J ; 38: 296, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34178215

RESUMEN

The purpose of this study is to assess the role of transesophageal echocardiography at the Dax Hospital Center based on indications, patients´ profile, results, cost-effectiveness and consistency with prescribers´ expectations. We conducted a retrospective, cross-sectional, descriptive and analytical study at the Cardiovascular Laboratory of the Dax Hospital Center from January 2016 to December 2018. The study included 434 exams out of 460 requested. The variables of interest were: demographic profile of the study population, indications, results, cost-effectiveness and consistency with prescribers´ expectations. The average age of patients undergoing the 434 exams included was 64.37 years, male patients accounted for 64.29%, with a sex ratio of 1.8. Stroke assessment (63.59%), the search for infective endocarditis (16.12%) and the assessment of the treatment of intracavitary thrombi (11.75%) were the main indications. Prescribers were mainly neurologists (60.83%). The examination was normal in 58.99% of cases. The pathological results (40,78%) were dominated by thrombi in the auricle (27.65%), altered auricle emptying (9.45%), the presence of foramen oval permeable (5.07%), interatrial septal aneurysm (2.53%) and infective endocarditis (2.76%). The exam was cost-effective in 40.78% of cases and the results were consistent with prescribers´ expectations in 39.86% of cases. Our study transesophageal echocardiography showed that the indications were dominated by stroke assessment. TEE is a cost-effective diagnostic test with a low rate of complications, and whose results are in line with practitioners' expectations.


Asunto(s)
Ecocardiografía Transesofágica/estadística & datos numéricos , Endocarditis/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Estudios Transversales , Ecocardiografía Transesofágica/economía , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
17.
Trials ; 22(1): 401, 2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34134744

RESUMEN

BACKGROUND: Up to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking. METHODS: This is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months' follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund. DISCUSSION: The findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices. TRIAL REGISTRATION: ClinicalTrials.gov NCT04037501 . Registered on 30 July 2019.


Asunto(s)
Cuidadores , Demencia , Anciano , Análisis Costo-Beneficio , Demencia/diagnóstico , Demencia/terapia , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Apoyo Social , Encuestas y Cuestionarios
18.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(5): 529-535, 2021 May 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-34148890

RESUMEN

OBJECTIVES: To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients. METHODS: A total of 59 358 hospitalized patients, who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale, served as a control, including 26 862 males and 32 496 females. While the 66 203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale, including 29 881 males and 36 322 females. The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups, and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing. The cost-effectiveness was analyzed. In addition, the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients. RESULTS: The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100 000 and 3.82/100 000,respectively, there was no significant difference between the 2 groups (U=0.807, P>0.05); the injury rates of falls of Grade 2 and above in the observation group and the control group were 27.30% and 20.00%, respectively, with no significant difference (χ2=0.345, P>0.05); but the labor cost was increased by 130 641.82 Chinses Yuan, and the incremental cost-effectiveness ratio was 43 547.27. However, the incidence of fall was significant higher in the falling high-risk patients by the assessment of the Morse Fall Scale than that in the non-high-risk patients (U=2.941, P<0.05). CONCLUSIONS: The evaluation of the Morse Fall Scale has a certain effect, but it is limited in the prevention of falls in adult hospitalized patients, and the cost-effectiveness analysis is not good. It is recommended to implement the intervention measures for high-risk patients after the assessment, which may improve the management level and efficiency of fall prevention.


Asunto(s)
Pacientes Internos , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Incidencia , Masculino , Medición de Riesgo
19.
Langmuir ; 37(24): 7492-7502, 2021 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-34101479

RESUMEN

One of the main protective measures against COVID-19's spread is the use of face masks. It is therefore of the utmost importance for face masks to be high functioning in terms of their filtration ability and comfort. Notwithstanding the prevalence of the commercial polypropylene face masks, its effectiveness is under contention, leaving vast room for improvement. During the pandemic, the use of at least one mask per day for each individual results in a massive number of masks that need to be safely disposed of. Fabricating biodegradable filters of high efficiency not only can protect individuals and save the environment but also can be sewed on reusable/washable cloth masks to reduce expenses. Wearing surgical masks for long periods of time, especially in hot regions, causes discomfort by irritating sensitive facial skin and warmed inhaled air. Herein, we demonstrate the fabrication of novel electrospun composites layers as face mask filters for protection against pathogens and tiny particulates. The combinatorial filter layers are made by integrating TiO2 nanotubes as fillers into chitosan/poly(vinyl alcohol) polymeric electrospun nanofibers as the outer layer. The other two filler-free layers, chitosan/poly(vinyl alcohol) and silk/poly(vinyl alcohol) as the middle and inner composite layers, respectively, were used for controlled protection, contamination prevention, and comfort for prolonged usage. The ASTM standards evaluation tests were adopted to evaluate the efficacy of the assembled filter, revealing high filtration efficiency compared to that of commercial surgical masks. The TiO2/Cs/PVA outer layer significantly reduced Staphylococcus aureus bacteria by 44.8% compared to the control, revealing the dual effect of TiO2 and chitosan toward the infectious bacterial colonies. Additionally, molecular dynamics calculations were used to assess the mechanical properties of the filter layers.


Asunto(s)
COVID-19 , Nanofibras , Análisis Costo-Beneficio , Filtración , Humanos , Máscaras , SARS-CoV-2
20.
Methodist Debakey Cardiovasc J ; 17(1): e1-e9, 2021 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-34104328

RESUMEN

Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients' health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Evaluación de Procesos y Resultados en Atención de Salud/normas , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/economía , Análisis Costo-Beneficio , Estado Funcional , Costos de la Atención en Salud , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/economía , Atención Dirigida al Paciente/economía , Psicometría , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Calidad de Vida , Resultado del Tratamiento
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