Informal care time and costs of dementia care in Benin (West Africa).

BACKGROUND: Dementia is a growing global health challenge, with significant socioeconomic implications. This study examined the informal care duration and related costs along with the total cost of care for older individuals with dementia in Benin, West Africa, providing insights into a region with limited dementia research. METHODS: We conducted a cost-of-illness study in Benin. Both hospital and community recruitments were used to enroll adults aged ≥ 60 years and their primary caregivers. Structured questionnaire and validated tools were used to collect the demographic, clinical, healthcare resource utilization data as well as informal care duration. Replacement costs approach was performed to valuate informal care time. Official exchange rates from the World Bank were used to convert costs from local currency to purchasing power parities dollars (PPP$). RESULTS: Data from 135 individuals with varying dementia stages revealed that dementia places substantial caregiving demands, predominantly on women who provide up to eight hours of daily care. In 2021, the mean annual cost of dementia care was estimated to be PPP$2,399.66 ± 2,057.07. Informal care represented a significant portion of dementia expenses, up to 92% of the total care costs in this study. DISCUSSION: Policy interventions are urgently needed to address the dementia-care challenges in Benin, especially because economic transitions and educational advancements may reduce the availability of informal caregivers. This emphasizes the vital role of informal caregivers and underscores the need of implementing dementia policies to support families facing the evolving challenges of dementia care.

Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning: The SIMULATOR Randomized Clinical Trial.

Importance: Evidence is scarce on the effectiveness of simulation-based training in transesophageal echocardiography (TEE). Objective: To assess the effectiveness of simulation-based teaching vs traditional teaching of TEE knowledge and skills of cardiology fellows. Design, Setting, and Participants: Between November 2020 and November 2021, all consecutive cardiology fellows inexperienced in TEE from 42 French university centers were randomized (1:1; n = 324) into 2 groups with or without simulation support. Main Outcomes and Measures: The co-primary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the fellows' self-assessment of their proficiency were also assessed. Results: While the theoretical and practical test scores were similar between the 2 groups (324 participants; 62.6% male; mean age, 26.4 years) before the training (33.0 [SD, 16.3] points vs 32.5 [SD, 18.5] points; P = .80 and 44.2 [SD, 25.5] points vs 46.1 [SD, 26.1] points; P = .51, respectively), the fellows in the simulation group (n = 162; 50%) displayed higher theoretical test and practical test scores after the training than those in the traditional group (n = 162; 50%) (47.2% [SD, 15.6%] vs 38.3% [SD, 19.8%]; P < .001 and 74.5% [SD, 17.7%] vs 59.0% [SD, 25.1%]; P < .001, respectively). Subgroup analyses showed that the effectiveness of the simulation training was even greater when performed at the beginning of the fellowship (ie, 2 years or less of training) (theoretical test: an increase of 11.9 points; 95% CI, 7.2-16.7 vs an increase of 4.25 points; 95% CI, -1.05 to 9.5; P = .03; practical test: an increase of 24.9 points; 95% CI, 18.5-31.0 vs an increase of 10.1 points; 95% CI, 3.9-16.0; P < .001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group ( 8.3 [SD, 1.4] minutes vs 9.4 [SD, 1.2] minutes; P < .001, respectively). Additionally, fellows in the simulation group felt more ready and more confident about performing a TEE alone after the training (mean score, 3.0; 95% CI, 2.9-3.2 vs mean score, 1.7; 95% CI, 1.4-1.9; P < .001 and mean score, 3.3; 95% CI, 3.1-3.5 vs mean score, 2.4; 95% CI, 2.1-2.6; P < .001, respectively). Conclusions and Relevance: Simulation-based teaching of TEE showed a significant improvement in the knowledge, skills, and self-assessment of proficiency of cardiology fellows, as well as a reduction in the amount of time needed to complete the examination. These results should encourage further investigation of clinical performance and patient benefits of TEE simulation training.

Costs of Dementia in Low- And Middle-Income Countries: A Systematic Review.

BACKGROUND: The proportion of people living with dementia in low- and middle-income countries (LMICs) is expected to reach 71% by 2050. Appraising the economic burden of the disease may contribute to strategic policy planning. OBJECTIVE: To review studies conducted on the costs of dementia in LMICs, describe their methodology and summarize available costs estimates. METHODS: Systematic review, including a search of health, economics, and social science bibliographic databases. No date or language restrictions were applied. All studies with a direct measure of the costs of dementia care were included. RESULTS: Of the 6,843 publications reviewed, 17 studies from 11 LMICs were included. Costs of dementia tended to increase with the severity of the disease. Medical costs were greater in the mild stage, while social and informal care costs were highest in the moderate and severe stages. Annual cost estimates per patient ranged from PPP$131.0 to PPP$31,188.8 for medical costs; from PPP$16.1 to PPP$10,581.7 for social care services and from PPP$140.0 to PPP$25,798 for informal care. Overall, dementia care can cost from PPP$479.0 to PPP$66,143.6 per year for a single patient. CONCLUSION: Few studies have been conducted on the costs of dementia in LMICs, and none so far in Africa. There seems to be a need to provide accurate data on the burden of disease in these countries to guide public health policies in the coming decades.

Impact of the abandonment of assistive technologies for mobility on the incidence of serious falls in older adults living at home: Results of the ECOCAT study.

Purpose: To examine the impact of discontinuing the use of assistive technology for mobility (ATM) devices on the 6-months incidence of falls in older adults (OA) living at home. Materials and methods: A medico-socioeconomic survey was performed to collect information on the quality of life and well-being of older adults, before and 6 months after being loaned an ATM device. Personal data (medical, social, and economic) were collected via a geriatric survey. Results: In all, 102 OA participated in the study. Over the 6-months observation period, 17 (n = 81) serious falls were recorded among participants who were using their ATM device optimally; in those who discontinued device use, 12 falls (n = 21) were recorded (57.1%; p = 0.001). Factors significantly associated with falls at home were living in an urban area (odds ratio [OR]: 11.46; 95% confidence interval [CI]: 1.48; 88.98; p = 0.020), an Instrumental Activities of Daily Living Scale score > 4 (OR: 34.04; 95% CI: 1.59; 727.86; p = 0.024), and discontinuation of ATM device use (OR: 17.41; 95% CI: 2.59; 117.02; p = 0.003). Conclusion: Discontinuation of ATM device use was associated with an increased risk for serious falls.

[Protecting population health or respecting individual freedom in epidemic context: How economists could contribute?] / Protéger l'état de santé de la population ou respecter les libertés individuelles en contexte épidémique - Quelles contributions des économistes ?

Title: Protéger l'état de santé de la population ou respecter les libertés individuelles en contexte épidémique - Quelles contributions des économistes ? Abstract: La crise sanitaire liée à la pandémie de COVID-19 a conduit la collectivité à s'interroger sur la valeur accordée à la santé, par rapport aux autres dimensions de la vie. Mais dans quelle mesure les économistes disposaient-ils d'outils pour guider les décisions publiques dans ce contexte épidémique ? Certains arbitrages préexistaient à la crise : entre la protection de la santé de la population à court, ou moyen ou long terme, entre la protection de la santé de certaines populations au détriment d'autres, entre la protection de la santé de la population et la satisfaction de besoins extra-sanitaires (loisirs, éducation, etc.). Les outils que les économistes mobilisent pour évaluer les interventions innovantes et coûteuses (médicaments, programmes de dépistage, etc.) peuvent être utilisés pour éclairer le débat démocratique. La crise a toutefois soulevé des arbitrages plus inédits lorsqu'il s'est agi de choisir entre, d'une part, la protection de l'état de santé de la population, et, de l'autre, la protection des libertés individuelles. Est-il possible et légitime de mobiliser les méthodes issues de l'économie du bien-être pour trancher ce dilemme ?

Instruments for investigation of epilepsy in low- and middle-income countries: A systematic review.

OBJECTIVE: Systematic reviews were conducted on the existence of screening tools for epilepsy, quality of life or comorbidities tools, but not specifically in low- and middle-income countries. This study aimed to identify the different tools developed and validated in low- and middle-income countries for the investigation of epilepsy. This to facilitate research in these regions and to identify needs in areas where few instruments are available. METHODS: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, MedLine, Google Scholar, Web of Science, SciELO, Neurology Asia, African Journal of Neurological Sciences and Institute of Epidemiology and Tropical Neurology bibliographic databases were investigated. Articles were included according to the following criteria: (1) to be validation studies on tool for investigating epilepsy, (2) to be conducted in a low- or middle-income country, (3) to be published between 1980 and 2021, and (4) to be written in English, French, Spanish or Portuguese. The characteristics of the tools and validation methods were collected. The frequency of use of the tools was estimated. RESULTS: Ninety-three articles were retained, corresponding to 91 tools from 44 countries. The main tools targeted quality of life (n = 30), comorbidities (n = 19) and screening (n = 13). Instruments were mainly developed and validated in Asia (n = 43), then in Central and South America (n = 24). The IENT (Institute of Epidemiology and Tropical Neurology) questionnaire was developed in several tropical countries (Africa, South East Asia and Latin America). The development and validation methods were heterogeneous from one tool to another and some tools (e.g., QOLIE-31, NDDI-E, PATE, etc.) were culturally adapted. CONCLUSION: This review identifies geographic specificity regarding the creation, validation and use of tools for investigating epilepsy available in low- and middle-income countries. It will help investigators in the choice of tools in their future epidemiological studies on epilepsy in this context.

Palliative care in day-hospital for advanced cancer patients: a study protocol for a multicentre randomized controlled trial.

BACKGROUND: Team-based and timely integrated palliative care is a gold standard of care in oncology, but issues concerning its optimal organization remain. Palliative Care in Day-Hospital (PCDH) could be one of the most efficient service model of palliative care to deliver interdisciplinary and multidimensional care addressing the complex supportive care needs of patients with advanced cancer. We hypothesize that, compared to conventional outpatient palliative care, PCDH allows the clinical benefits of palliative care to be enhanced. METHODS/DESIGN: This study is a multicentre parallel group trial with stratified randomization. Patient management in PCDH will be compared to conventional outpatient palliative care. The inclusion criteria are advanced cancer patients referred to a palliative care team with an estimated life expectancy of more than 2 months and less than 1 year. The primary endpoint is health-related quality of life with deterioration-free survival based on the EORTC QLQ-C30 questionnaire. The secondary objectives are the following: increase in patient satisfaction with care using the EORTC PATSAT-C33 and OUT-PATSAT7 questionnaires, better understanding of the prognosis using the PTPQ questionnaire and advance care planning; decrease in the need for supportive care among relatives using the SCNS-P&C-F questionnaire, and reduction in end-of-life care aggressiveness. Patients will complete one to five questionnaires on a tablet before each monthly visit over 6 months and will be followed for 1 year. A qualitative study will take place, aiming to understand the specificity of palliative care management in PCDH. Cost-effectiveness, cost-utility and, an additional economic evaluation based on capability approach will be conducted from a societal point of view. DISCUSSION: The first strength of this study is that it combines the main relevant outcomes assessing integrated palliative care; patient quality of life and satisfaction; discussion of the prognosis and advance care planning, family well-being and end-of-life care aggressiveness. The second strength of the study is that it is a mixed-method study associating a qualitative analysis of the specificity of PCDH organization, with a medical-economic study to analyse the cost of care. TRIAL REGISTRATION: Name of the registry: IDRCB 2019-A03116-51 Trial registration number: NCT04604873 Date of registration: October 27, 2020 URL of trial registry record.

Absenteeism and indirect costs during the year following the diagnosis of an operable breast cancer: A prospective multicentric cohort study.

BACKGROUND: Diseases consequence on individual work as much as consequences of being absent from work are matters of interest for decision makers. METHODS: We analyzed lengths of absenteeism and related indirect costs for patients with a paid activity in the year following the diagnosis of early stage breast cancer, in the prospective OPTISOINS01 cohort. Both human capital and friction costs approach were considered for the valuation of lost working days (LWD). For the analysis, the friction period was estimated from recent French data. The statistical analysis included simple and multiple linear regression to search for the determinants of absenteeism and indirect costs. RESULTS: 93 % of the patients had at least one period of sick leave, with on average 2 period and 186 days of sick leave. 24 % of the patients had a part-time resumption after their sick leave periods, during 114 days on average (i.e. 41 LWD). Estimated indirect costs were 22,722.00 € and 7,724.00 € per patient, respectively for the human capital and the friction cost approach. In the multiple linear regression model, factors associated with absenteeism were: the invasive nature of the tumor (p = .043), a mastectomy (p = .038), a surgery revision (p = .002), a chemotherapy (p = .027), being a manager (p = .025) or a craftsman (p = .005). CONCLUSION: Breast cancer lead to important lengths of absenteeism in the year following the diagnosis, but almost all patients were able to return to work. Using the friction cost or the human capital approach in the analysis led to an important gap in the results, highlighting the importance of considering both for such studies.

Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia.

BACKGROUND: Epilepsy affects more than 50 million people worldwide, 80% of whom live in low- and middle-income countries (LMICs). In Southeast Asia, the prevalence is moderate (6‰), and the main public health challenge is reducing the treatment gap, which reaches more than 90% in rural areas. METHODS: This 12-month comparative study (intervention vs. control areas) assessed the community effectiveness of two different strategies for the identification and home follow-up of people with epilepsy by Domestic Health Visitors for epilepsy (DHVes). In Lao PDR, DHVes were health center staff covering several villages via monthly visits; in Cambodia, DHVes were health volunteers living in the villages. FINDINGS: At baseline, the treatment gap was >95% in Lao PDR and 100% in Cambodia. After 12 months, the treatment gap in Lao PDR decreased by 5·5% (range: 4·0-12·2) in the intervention area and 0·5% (range: 0·4-0·8) in the control area (p<0·0001). In Cambodia, the treatment gap decreased by 34·9% (range: 29·0-44·1) in the intervention area and 8·1% (range: 6·7-10·2) in the control area (p<0·0001). Among the PWEs followed at home by the DHVes, the proportion adhering to drug treatment was 85·2% in Lao PDR and 78·1% in Cambodia. The cost associated with strategy implemented in Cambodia, compared with the control area, was lower than the cost associated with strategy implemented in Lao PDR." INTERPRETATION: The treatment gap was significantly reduced with both intervention strategies, but the effect was larger in Cambodia. The results of this cost analysis pave the way for scaling-up in rural areas of Lao PDR and Cambodia, and experimental adaptation in other LMICs. FUNDING: The study was funded by the Global Health Department of Sanofi and Grand Challenges Canada (grant number 0325-04).

Fairness in cost-benefit analysis: A methodology for health technology assessment.

We evaluate the introduction of various forms of antihypertensive treatments in France with a distribution-sensitive cost-benefit analysis. Compared to traditional cost-benefit analysis, we implement distributional weighting based on equivalent incomes, a new concept of individual well-being that does respect individual preferences but is not subjectively welfarist. Individual preferences are estimated on the basis of a contingent valuation question, introduced into a representative survey of the French population. Compared to traditional cost-effectiveness analysis in health technology assessment, we show that it is feasible to go beyond a narrow evaluation of health outcomes while still fully exploiting the sophistication of medical information. Sensitivity analysis illustrates the relevancy of this richer welfare framework, the importance of the distinction between an ex ante and an ex post approach, and the need to consider distributional effects in a broader institutional setting.

[Haute Autorite de sante opinion on cost-effectiveness of health products : results and perspectives]. / Avis d’efficience relatifs aux produits de santé à la Haute Autorité de santé?: bilan et perspectives.

Since 3rd October 2013 in France, drug companies applying for reimbursement of an innovative and expensive drug or medical device are required to provide the French National Authority for Health (HAS) with a cost-effectiveness assessment of their product. After a methodological audit of the economic evaluation submitted by the drug company, the Health Economics and Public Health Committee (CEESP) issues an opinion on the expected or observed cost-effectiveness. This opinion is sent to the Pricing Committee (CEPS) which determines the price of the product. After summarizing the French reimburse'!lent and pricing system, the objective of this article is to review the first 22 months of activity, in which HAS issued 30 cost-effectiveness opinions. The process, based on exchanges between drug companies and HAS, allowed the pricing committee to document the economic criterion in the majority of applications, while characterizing the degree of uncertainty of the results. For ten applications, major methodological concerns led the CEESP to reject the drug company's assessment.

Dealing with moral dilemma raised by adaptive preferences in health technology assessment: the example of growth hormones and bilateral cochlear implants.

The aim of this article is to assess dilemma raised by adaptive preferences in the economic evaluation of growth hormone (GH) treatment for non-GH-deficient short children, and of bilateral cochlear implants for deaf children. Early implementation of both technologies and their irreversible consequences increase the potential conflicts faced by the assessors of health-related quality of life (HRQoL) states (on behalf of patients) who could be interviewed (parents, individuals with an experience of the same disability, or representative samples of the general public). Indeed, assessors' preferences may be influenced by their own situation and they are likely to vary according to age and the experience of disability. Three options are put forward which aim to resolve these moral dilemma and help economists make methodological choices that cannot be avoided in order to carry out this assessment. They are grounded on three specific egalitarian theories of social justice. The main contribution of this article is to show that a dialogue between ethics and economics, prior to an assessment, makes it possible to redefine the choice of effectiveness criteria (subjective well-being, capabilities or social outcomes), the choice of perspective (patients or the able-bodied), as well as the scope of assessment (medical and non-medical care).