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1.
BMC Public Health ; 20(1): 480, 2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-32276624

RESUMEN

BACKGROUND: Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to determine the husband's willingness-to-pay (WTP) for his HIV and syphilis screening tests and potential factors affecting STI screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand. METHODS: A pilot open-ended interview was conducted among 50 participants to estimate the mean and standard deviation of WTP prices for HIV and syphilis screening tests. A questionnaire was developed to obtain demographics, STI knowledge and screening history, as well as two contingent valuation methods (bidding and payment scale), using the mean WTP prices identified from the pilot study as a starting WTP with »SD step-up/down. The survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. Descriptive statistics and logistic regression were used for data analysis. RESULTS: During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27-36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP prices for HIV and syphilis screening tests were US$14.5 (IQR 12.4-14.5) and US$9.7 (IQR 10-12), respectively. The payment scale method suggested approximately three-quarters of the WTP prices from the bidding method. CONCLUSIONS: The husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.


Asunto(s)
Financiación Personal , Infecciones por VIH/prevención & control , Tamizaje Masivo/economía , Esposos/psicología , Sífilis/prevención & control , Adulto , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Proyectos Piloto , Embarazo , Atención Prenatal , Esposos/estadística & datos numéricos , Encuestas y Cuestionarios , Tailandia , Cobertura Universal del Seguro de Salud
3.
Braz J Med Biol Res ; 53(3): e9614, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32159613

RESUMEN

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.


Asunto(s)
Carga Global de Enfermedades , Equidad en Salud , Accesibilidad a los Servicios de Salud , Insuficiencia Renal Crónica/epidemiología , Diagnóstico Precoz , Política de Salud , Promoción de la Salud , Humanos , Tamizaje Masivo/economía , Servicios Preventivos de Salud/métodos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Factores de Riesgo
5.
N Engl J Med ; 382(12): 1166-1174, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32187475
6.
PLoS One ; 15(2): e0228660, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053648

RESUMEN

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d'information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.


Asunto(s)
Detección Precoz del Cáncer/métodos , Tamizaje Masivo/métodos , Lesiones Intraepiteliales Escamosas/diagnóstico , Lesiones Intraepiteliales Escamosas/terapia , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/economía , Neoplasia Intraepitelial Cervical/epidemiología , Neoplasia Intraepitelial Cervical/virología , Cuello del Útero/patología , Cuello del Útero/virología , Colposcopía/economía , Conización , Estudios Transversales , Detección Precoz del Cáncer/economía , Femenino , Francia/epidemiología , Costos de la Atención en Salud , Humanos , Tamizaje Masivo/economía , Persona de Mediana Edad , Infecciones por Papillomavirus/virología , Lesiones Intraepiteliales Escamosas/economía , Lesiones Intraepiteliales Escamosas/epidemiología , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/epidemiología , Frotis Vaginal/economía , Frotis Vaginal/métodos
7.
PLoS One ; 15(2): e0229081, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32069323

RESUMEN

BACKGROUND AND OBJECTIVES: Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation. METHODS: Mixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component. RESULTS: A total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index ≥25 kg/m2 (30.6%), raised blood pressure i.e. ≥ 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score ≥20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key essential medicines for PEN were available in half of the facilities surveyed. Confidence of the health care staff in managing common NCD and perceived benefits of the project were some of the strengths. CONCLUSION: High loss to follow up, poor recording of CVD risk score, lack of essential medicines and equipments were the key challenges identified that need to be addressed before further expansion of PEN project to other townships.


Asunto(s)
Implementación de Plan de Salud/organización & administración , Promoción de la Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Tamizaje Masivo/organización & administración , Enfermedades no Transmisibles/prevención & control , Adulto , Estudios Transversales , Medicamentos Esenciales/uso terapéutico , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Implementación de Plan de Salud/economía , Promoción de la Salud/economía , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Mianmar/epidemiología , Enfermedades no Transmisibles/economía , Enfermedades no Transmisibles/epidemiología , Educación del Paciente como Asunto , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Estudios Retrospectivos , Factores de Riesgo
8.
PLoS One ; 15(2): e0226258, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32074101

RESUMEN

Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980-2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.


Asunto(s)
Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Detección Precoz del Cáncer , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Tamizaje Masivo/economía , Persona de Mediana Edad , Mortalidad , Prueba de Papanicolaou , Adulto Joven
9.
Medicine (Baltimore) ; 99(2): e18741, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914092

RESUMEN

Inappropriate care for patients with cognitive dysfunction in the hospital could worsen quality of care and medical service satisfaction.All elderly participants were recruited from acute wards of 5 departments in an university hospital. They were administered the Chinese version of Ascertain Dementia 8 (AD8) at admission and the Nursing Service Satisfaction Questionnaire before discharge.A total of 345 participants completed the study. There were 91 (26.4%) participants with AD8 ≥ 2, the cut-off value of high risk of dementia. The prevalence was much higher than prior community-based reports. The Nursing Service Satisfaction Score was significantly lower in AD8 ≥ 2 than in AD8 < 2 (56.99 ±â€Š0.94 vs 60.55 ±â€Š0.48, P < .01).Using AD8 in hospital-based screening might be more efficient than in the community in terms of cost-effectiveness due to higher positive rate and easier approach to diagnostic facilities. AD8 ≥ 2 is also an indicator to identify care dissatisfaction among inpatients. By identifying patients with cognitive dysfunction, such as its related communication barriers, care systems could be tailored for more friendly services.


Asunto(s)
Demencia/diagnóstico , Demencia/enfermería , Tamizaje Masivo/métodos , Satisfacción del Paciente , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Demencia/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/normas , Persona de Mediana Edad , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados
10.
PLoS One ; 15(1): e0228216, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31986183

RESUMEN

INTRODUCTION: Over the years, technological and process innovations enabled active case finding (ACF) programs to expand their capacities and scope to have evolved to close gaps in missing TB patients globally. However, with increased ACF program's operational complexity and a need for significant resource commitments, a comprehensive, transparent, and standardized approach in evaluating costs of ACF programs is needed to properly determine costs and value of ACF programs. METHODS: Based on reviews of program activity and financial reports, multiple interviews with program managers of two TB REACH funded ACF programs deployed in Cambodia and Tajikistan, we first identified common program components, which formed the basis of the cost data collection, analysis, reporting framework. Within each program component and sub-activity group, cost data were collected and organized by relevant resource types (human resource, capital, recurrent, and overhead costs). Total shared, indirect and overhead costs were apportioned into each activity category based on direct human resource contribution (e.g. a number of staff and their relative level of effort dedicated to each program component). Capital assets were assessed specific to program components and were annualized based on their expected useful life and a 3% discount rate. All costs were assessed based on the service provider perspective and expressed in 2015 USD. RESULTS: Over the two program years (April 2013 to December 2015), the Cambodia and Tajikistan ACF programs cumulated a total cost of $336,951 and $771,429 to screen 68,846 and 1,980,516 target population, bacteriologically test 4,589 and 19,764 presumptive TB, diagnose 731 and 2,246 TB patients in the respective programs. Recurrent costs were the largest cost components (54% and 34%) of the total costs for the respective programs and Xpert MTB/RIF (Xpert) testing incurred largest program component/activity cost for both programs. Cost per screening was $0.63 and $0.10 and cost per Xpert test was $25 and $18; Cost per TB case detected (Xpert) was $373 and $343 in Cambodia and Tajikistan. CONCLUSIONS: Results from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.


Asunto(s)
Análisis Costo-Beneficio/normas , Tamizaje Masivo/economía , Cambodia , Humanos , Estándares de Referencia , Tayikistán , Tuberculosis/diagnóstico
11.
PLoS One ; 15(1): e0227694, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31961894

RESUMEN

OBJECTIVES: Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. We aimed to determine whether a semi-quantitative urinary albumin-creatinine ratio test could be used as a screening tool for microalbuminuria in diabetic patients. METHODS: We assessed the diagnostic accuracy of the semi-quantitative method. The costs of false results in the semi-quantitative method were calculated based on the annual probability of disease progression analyzed through a systematic literature review and meta-analysis. The pooled long-term cost-saving effect of the semi-quantitative method compared with the quantitative test was assessed using a Markov model simulating a long-term clinical setting. Diagnostic accuracy and the cost-saving effect were also validated in an independent external cohort. RESULTS: Compared with the quantitative test, the semi-quantitative method had sensitivities of 93.5% and 81.3% and specificities of 61.4% and 63.1% in the overall sample of diabetic patients (n = 1,881) and in diabetic patients with eGFR ≥60 ml/min/1.73 m2 and a negative dipstick test (n = 1,110), respectively. After adjusting for direct and indirect medical costs, including the risk of disease progression, which was adjusted by the meta-analyzed hazard ratio for clinical outcomes, it was determined that using the semi-quantitative method could save 439.4 USD per person for 10 years. Even after adjusting the result to the external validation cohort, 339.6 USD could be saved for one diabetic patient for 10 years. CONCLUSIONS: The semi-quantitative method could be an appropriate screening tool for albuminuria in diabetic patients. Moreover, it can minimize the testing time and inconvenience and significantly reduce national health costs.


Asunto(s)
Albuminuria/diagnóstico , Diabetes Mellitus/orina , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/orina , Tamizaje Masivo/métodos , Urinálisis/métodos , Albuminuria/orina , Estudios de Cohortes , Ahorro de Costo/estadística & datos numéricos , Humanos , Tamizaje Masivo/economía , Reproducibilidad de los Resultados , República de Corea , Urinálisis/economía , Urinálisis/estadística & datos numéricos
12.
BMC Infect Dis ; 20(1): 38, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937247

RESUMEN

BACKGROUND: Group B Streptococcal (GBS) infections in the United States are a leading cause of meningitis and sepsis in newborns. The CDC therefore recommends GBS screening for all pregnant women at 35-37 weeks of gestation and administration of intrapartum prophylaxis (in those that tested positive) as an effective means of controlling disease transmission. Several FDA approved molecular diagnostic tests are available for rapid and accurate detection of GBS in antepartum women. METHOD: In this study, we report a clinical comparison of the Xpert GBS LB assay and a novel FDA-cleared test, Revogene GBS LB assay. A total of 250 vaginal-rectal swabs from women undergoing prenatal screening were submitted to the University of Wisconsin's clinical microbiology laboratory for GBS testing. RESULTS: We found 96.8% of samples were concordant between the two tests, while 3.2% were discordant with a positive percent agreement of 98.0% and a negative percent agreement of 96.5% between the Revogene GBS LB assay and the GeneXpert GBS LB assay. CONCLUSION: Overall, we report that both assays perform well for the detection of GBS colonization in pregnant women.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Tamizaje Masivo/métodos , Técnicas de Diagnóstico Molecular/métodos , Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal/métodos , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , ADN Viral/análisis , Femenino , Técnicas Genéticas , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo/economía , Técnicas de Diagnóstico Molecular/economía , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Mujeres Embarazadas , Infecciones Estreptocócicas/virología , Factores de Tiempo , Vagina/virología
14.
Surgery ; 167(1): 155-159, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31604587

RESUMEN

BACKGROUND: Our study seeks to find a cost-saving screening strategy in a primary care population for diagnosing primary hyperparathyroidism based on peak serum total calcium level, age, and patient sex. METHODS: Laboratory data resulting from primary care office visits at our institution between January 2016 through December 2017 to evaluate patients who had at least 1 episode of hypercalcemia (≥10.5 mg/dL). For each serum calcium threshold, we calculated the percentage of patients who were found to have an increased parathyroid hormone level (≥65 pg/mL). We determined whether net cost savings could be achieved by screening hypercalcemic patients given their probability of primary hyperparathyroidism and expected cost savings from fracture risk reduction, given their sex and age. RESULTS: From 155,350 unique patients in the study period, a total of 2,271 had a minimum of 1 hypercalcemic lab value. After exclusion criteria, there were 1,326 patients of whom 27.5% had a parathyroid hormone level checked. Cost savings was established at a screening threshold of 10.5 for all patients until age 66 years for men and 69 years for women. For men aged 67-68 y and women aged 70-71 years, the optimal screening threshold was 10.8 mg/dl. CONCLUSION: Cost savings can be achieved by screening hypercalcemic patients with a life expectancy exceeding 16 years, with varying thresholds based on age and sex.


Asunto(s)
Ahorro de Costo , Fracturas Óseas/prevención & control , Hipercalcemia/diagnóstico , Hiperparatiroidismo Primario/diagnóstico , Tamizaje Masivo/economía , Anciano , Enfermedades Asintomáticas/economía , Calcio/sangre , Estudios de Cohortes , Análisis Costo-Beneficio , Diagnóstico Tardío , Femenino , Fracturas Óseas/etiología , Humanos , Hipercalcemia/economía , Hipercalcemia/etiología , Hipercalcemia/terapia , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/economía , Hiperparatiroidismo Primario/terapia , Esperanza de Vida , Masculino , Tamizaje Masivo/métodos , Modelos Económicos , Hormona Paratiroidea/sangre
15.
Int J Gynaecol Obstet ; 148(3): 386-391, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31849036

RESUMEN

OBJECTIVE: To characterize the efficiency of screening through high-volume community health campaigns (CHCs) by comparing the costs and population reach and identify factors associated with gains in efficiency. Access to effective cervical cancer screening remains limited in low-resource settings, especially in rural areas. Periodic CHCs are a novel method of offering screening for HPV at lower costs and higher population coverage than health facilities. METHODS: A micro-costing study was conducted within a cervical cancer screening trial to measure efficiency (cost per woman screened) and population uptake of HPV-based screening offered through CHCs in Migori County, Kenya between January and September 2016. Regression analysis assessed relationships between population size and efficiency. Structured observations and qualitative interviews identified implementation factors that affected efficiency in individual campaigns. RESULTS: Communities screening through CHCs had costs per woman screened ranging from US $22.06 to $30.21. Efficiency was directly correlated to overall numbers of women screened, but not to proportion of population screened. Modifiable factors that acted as context-specific facilitators and barriers with a potential impact on efficiency were identified. CONCLUSION: There was substantial variation in efficiency among CHCs. Cultural factors, health beliefs, and poor coordination among implementation partners as potential key barriers to screening uptake were identified.


Asunto(s)
Detección Precoz del Cáncer/economía , Tamizaje Masivo/economía , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Análisis Costo-Beneficio , Femenino , Promoción de la Salud , Humanos , Kenia , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Infecciones por Papillomavirus/complicaciones , Investigación Cualitativa , Población Rural/estadística & datos numéricos , Neoplasias del Cuello Uterino/virología
16.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791253

RESUMEN

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Asunto(s)
Erradicación de la Enfermedad , Hepatitis C/prevención & control , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Adulto , Antivirales/economía , Antivirales/uso terapéutico , Estudios de Cohortes , Análisis Costo-Beneficio , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Erradicación de la Enfermedad/economía , Erradicación de la Enfermedad/métodos , Erradicación de la Enfermedad/estadística & datos numéricos , Consumidores de Drogas/estadística & datos numéricos , Femenino , Alemania/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Costos de la Atención en Salud , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C/diagnóstico , Hepatitis C/economía , Hepatitis C/epidemiología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Vigilancia de la Población/métodos , Años de Vida Ajustados por Calidad de Vida , Minorías Sexuales y de Género/estadística & datos numéricos
17.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 840-847, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31874474

RESUMEN

Objective: To evaluate the feasible cervical cancer screening strategies in rural China. Methods: The study was based on the health industry scientific research project of National Health Commission in 2015, cervical cancer screening technology and demonstration research suitable for rural areas in China, we collected health economics and epidemiological parameters and established the unscreening model and screening model with Treeage Pro 2011 software. Combining with the data acquired from site investigation, including population screening, treatment-related clinical materials and cost data, we simulated the occurrence and the development of cervical cancer of rural women in China under different screening and intervention programs and predicted the screening effects [cumulative incidence, cumulative risk of disease, life years and quality adjusted life years (QALY) , gains] and costs after 20 years, and using health economic evaluation analysis (cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis). Screening programs included five screening strategies [visual inspection with acetic acid/lugol's iodine (VIA/VILI), careHPV, ThinPrep cytology test (TCT), careHPV+TCT, careHPV+VIA/VILI] and three screening intervals (1-year, 3-year, 5-year), a total of fifteen screening programs. Results: Compared with no screening, fifteen screening programs reduced the cumulative incidence by 22.65%-51.76%. Compared with TCT or VIA/VILI, for the same screening interval, the reduced cumulative incidence, the amounts of life-year saved and QALY and benefits gained of careHPV were the highest. The cost-effectiveness ratios of these screening programs ranged (0.44-3.24)×10(4) Yuan per life-year saved, cost-utility ratios ranged (0.15- 1.01)×10(4) Yuan per QALY, benefit-cost ratios ranged 7.73-59.10. The results of incremental costeffectiveness ratios showed that VIA/VILI every five years, VIA/VILI every three years, careHPV every five years, careHPV every three years and careHPV every year were dominant programs. Conclusions: VIA/VILI screening is cost-effective, careHPV is slightly more expensive but more effective. In rural China, careHPV screening every five years could be recommended. This study provides a basis for the determination of cervical cancer screening methods feasible for rural areas in China.


Asunto(s)
Detección Precoz del Cáncer/economía , Tamizaje Masivo/economía , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , China , Análisis Costo-Beneficio , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Cadenas de Markov , Tamizaje Masivo/métodos , Salud Rural , Neoplasias del Cuello Uterino/economía
18.
BMC Public Health ; 19(1): 1746, 2019 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-31881876

RESUMEN

BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. METHODS: The screenings tools evaluated were chosen from Children's Healthcare Canada's National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. RESULTS: Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390. CONCLUSION: Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.


Asunto(s)
Trastornos del Espectro Alcohólico Fetal/diagnóstico , Tamizaje Masivo/economía , Canadá , Niño , Análisis Costo-Beneficio , Humanos , Modelos Económicos
19.
Afr J AIDS Res ; 18(4): 341-349, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31779565

RESUMEN

Objective: Explore facility-level average costs per client of HIV testing and counselling (HTC) and voluntary medical male circumcision (VMMC) services in 13 countries.Methods: Through a literature search we identified studies that reported facility-level costs of HTC or VMMC programmes. We requested the primary data from authors and standardised the disparate data sources to make them comparable. We then conducted descriptive statistics and a meta-analysis to assess the cost variation among facilities. All costs were converted to 2017 US dollars ($).Results: We gathered data from 14 studies across 13 countries and 772 facilities (552 HTC, 220 VMMC). The weighted average unit cost per client served was $15 (95% CI 12, 18) for HTC and $59 (95% CI 45, 74) for VMMC. On average, 38% of the mean unit cost for HTC corresponded to recurrent costs, 56% to personnel costs, and 6% to capital costs. For VMMC, 41% of the average unit cost corresponded to recurrent costs, 55% to personnel costs, and 4% to capital costs. We observed unit cost variation within and between countries, and lower costs in higher scale categories in all interventions.


Asunto(s)
Circuncisión Masculina/economía , Consejo/economía , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Tamizaje Masivo/economía , Costos y Análisis de Costo , Infecciones por VIH/economía , Instituciones de Salud , Humanos , Masculino
20.
Afr J AIDS Res ; 18(4): 350-359, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31779567

RESUMEN

Background: HIV programmes are achieving significant scale, even as external financing plateaus. Maximising achievement from identification to viral suppression is key to epidemic control and reaching global 95-95-95 goals. Cost and technical efficiency analyses can help programs understand why losses occur along the cascade, which tactics prevent losses, and additional investments required for cost-efficient solutions.Methodology: The PEPFAR- and USAID-funded Health Policy Plus (HP+) project identified cascade failure points and interventions needed in six countries (Ghana, Indonesia, Kyrgyz Republic, Kenya, Tajikistan, Tanzania). Methods included secondary data analysis and expert interviews. HP+ estimated unit costs and effectiveness of tactics to model future costs and cascade outcomes across scenarios. Conclusions across countries are synthesised for overall best practices.Results: In Ghana, Indonesia, Tajikistan, and the Kyrgyz Republic, HIV identification strategies need to evolve to counter diminishing testing yields. Higher-yield testing modes may have higher costs per person tested, yet lower costs per person identified compared to previous strategies. In Kenya, investments in linkage and retention require additional funding, and will reduce the need for expensive loss-to-follow-up activities. In Tanzania, differentiated antiretroviral therapy can improve patient management while reducing facility-level costs.Conclusion: Results from diverse settings suggest that cost-efficiency analyses aimed at smart cascades will help countries identify and resolve reasons for poor outcomes. The analyses are predicated on contextual exploration of how interventions are linked, and should inform prioritisation and investment strategies. While improving the cascade often has incremental costs, it may be cost-efficient versus the long-term cost of poor outcomes.


Asunto(s)
Costos y Análisis de Costo , Infecciones por VIH/economía , Infecciones por VIH/prevención & control , Antivirales/uso terapéutico , Análisis Costo-Beneficio , Prestación de Atención de Salud/economía , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Política de Salud , Humanos , Tamizaje Masivo/economía
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