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1.
Eur J Cancer ; 127: 207-223, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980322

RESUMO

BACKGROUND: Organised cervical cancer (CC) screening programmes are delivered in many different ways across the European Union and its regions. Our aim was to systematically review the impact of these programs on CC mortality. METHODS: Two independent reviewers identified all eligible studies investigating the effect of organised screening on CC mortality in Europe. Six databases including Embase, Medline and Web of Science were searched (March 2018) with predefined inclusion and exclusion criteria. Only original studies with at least five years of follow-up were considered. Validated tools were used to assess the risk of bias of the included studies. RESULTS: Ten observational studies were included: seven cohort and three case-control studies. No randomised controlled trials were found, and there were no eligible studies from the eastern and southern part of Europe. Among the eligible studies, seven were conducted in the twentieth century; they scored lower on the risk of bias assessment. CC mortality reduction for women attending organised screening vs. non-attenders ranged from 41% to 92% in seven studies. Reductions were similar in Western (45-92%) and Northern (41-87%) Europe and were higher in the three more recent studies (66-92%). For invited vs. non-invited women, this reduction ranged from 17% to 79% in five studies. CONCLUSION: Although data were lacking in Southern and Eastern Europe and the effect size varied between countries and studies, this systematic review provides evidence that organised CC screening reduces CC mortality in those parts of Europe where CC screening was implemented and monitored.

2.
Cancer Manag Res ; 11: 9849-9861, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819622

RESUMO

The evidence base of policies that improve the timeliness of cancer care is under ongoing debate. Pancreatic cancer is frequently diagnosed in a stage when curative therapy is not feasible; hence, it is an important target for timelier healthcare interventions. The objectives of our research were to identify all clinical studies on pancreatic cancer care delays via a systematic literature review, to assess the study methodologies for possible biases, to conclude on the available evidence, and to formulate research recommendations on evidence gaps. Nineteen studies were identified and eight reported multivariate analyses. Although many sources of bias shifted the results towards negative or paradoxical findings, a statistically significant association of shorter delays with better clinical outcomes was demonstrated in the majority of studies reporting multivariate analyses. Noninferiority analyses were not published. Further efforts to provide timely care for pancreatic cancer patients are encouraged, and studies on the associations of delay with patient experience and healthcare resource utilization are warranted.

3.
Front Oncol ; 9: 1051, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31709174

RESUMO

Objective: While Hungary is often reported to have the highest incidence and mortality rates of lung cancer, until 2018 no nationwide epidemiology study was conducted to confirm these trends. The objective of this study was to estimate the occurrence of lung cancer in Hungary based on a retrospective review of the National Health Insurance Fund (NHIF) database. Methods: Our retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between 1 Jan 2011 and 31 Dec 2016. Age-standardized incidence and mortality rates were calculated using both the 1976 and 2013 European Standard Populations (ESP). Results: Between 2011 and 2016, 6,996 - 7,158 new lung cancer cases were recorded in the NHIF database annually, and 6,045 - 6,465 all-cause deaths occurred per year. Age-adjusted incidence rates were 115.7-101.6/100,000 person-years among men (ESP 1976: 84.7-72.6), showing a mean annual change of - 2.26% (p = 0.008). Incidence rates among women increased from 48.3 to 50.3/100,000 person-years (ESP 1976: 36.9-38.0), corresponding to a mean annual change of 1.23% (p = 0.028). Age-standardized mortality rates varied between 103.8 and 97.2/100,000 person-years (ESP 1976: 72.8-69.7) in men and between 38.3 and 42.7/100,000 person-years (ESP 1976: 27.8-29.3) in women. Conclusion: Age-standardized incidence and mortality rates of lung cancer in Hungary were found to be high compared to Western-European countries, but lower than those reported by previous publications. The incidence of lung cancer decreased in men, while there was an increase in incidence and mortality among female lung cancer patients.

4.
Orphanet J Rare Dis ; 14(1): 84, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023387

RESUMO

Methylmalonic acidemia/aciduria (MMA) is a genetically heterogeneous group of inherited metabolic disorders biochemically characterized by the accumulation of methylmalonic acid. Isolated MMA is primarily caused by the deficiency of methylmalonyl-CoA mutase (MMA mut; EC 5.4.99.2). A systematic literature review and a meta-analysis were undertaken to assess and compile published epidemiological data on MMA with a focus on the MMA mut subtype (OMIM #251000). Of the 1114 identified records, 227 papers were assessed for eligibility in full text, 48 articles reported on disease epidemiology, and 39 articles were included into the quantitative synthesis. Implementation of newborn screening in various countries has allowed for the estimation of birth prevalence of MMA and its isolated form. Meta-analysis pooled point estimates of MMA (all types) detection rates were 0.79, 1.12, 1.22 and 6.04 per 100,000 newborns in Asia-Pacific, Europe, North America and the Middle East and North Africa (MENA) regions, respectively. The detection rate of isolated MMA was < 1 per 100,000 newborns in all regions with the exception of MENA where it approached 6 per 100,000 newborns. Few studies published data on the epidemiology of MMA mut, therefore no meta-analysis could have been performed on this subtype. Most of the identified papers reported birth prevalence estimates below 1 per 100,000 newborns for MMA mut. The systematic literature review clearly demonstrates that MMA and its subtypes are ultra-rare disorders.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/enzimologia , Erros Inatos do Metabolismo dos Aminoácidos/epidemiologia , Metilmalonil-CoA Mutase/genética , Erros Inatos do Metabolismo dos Aminoácidos/genética , Feminino , Humanos , Recém-Nascido , Masculino , Erros Inatos do Metabolismo/enzimologia , Erros Inatos do Metabolismo/epidemiologia , Erros Inatos do Metabolismo/genética , Metilmalonil-CoA Mutase/deficiência , Triagem Neonatal
5.
PLoS One ; 14(4): e0207046, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30986207

RESUMO

BACKGROUND: This study aimed to investigate the distribution of European Union (EU) healthcare research grants across EU countries, and to study the effect of the potential influencing factors on grant allocation. METHODS: We analysed publicly available data on healthcare research grants from the 7th Framework Programme and the Horizon 2020 Programme allocated to beneficiaries between 2007 and 2016. Grant allocation was analysed at the beneficiary-, country-, and country group-level (EU-15 versus newer Member States, defined as EU-13). The investigated country-level explanatory variables included GDP per capita, population size, overall disease burden, and healthcare research excellence. Grant amounts per 100,000 inhabitants were used as an outcome variable in the regression analyses. RESULTS: Research funds were disproportionally allocated to EU-15 versus the EU-13, as 96.9% of total healthcare grants were assigned to EU-15 countries. At the beneficiary level, EU funding was positively influenced by participating in previous grants. The average grant amount per beneficiary was higher for EU-15 organizations. In the multiple regression analysis GDP per capita (p = 0.002) and research excellence (p<0.001) had a significant positive association with EU funding. Population size had an inverted U-shaped relationship with EU funding for healthcare research, having the largest per capita funding in second and the third quartiles (p = 0.03 and p = 0.02). CONCLUSION: The uneven allocation of healthcare research funds across EU countries was influenced by GDP per capita, medical research excellence and population size. Wealthier countries with an average population size and strong research excellence in healthcare had more EU funding for healthcare research. Higher disease burden apparently was not associated with more EU research funding. While our findings are in line with analyses on previous periods, they suggest that the EU did not implement any effective policy measures to improve the unfair allocation of research grants.


Assuntos
União Europeia/economia , Organização do Financiamento/economia , Pesquisa sobre Serviços de Saúde/economia , Alocação de Recursos , Humanos
6.
Prim Care Diabetes ; 13(5): 462-467, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30928431

RESUMO

AIM: To investigate the cost-effectiveness of the endowment of the same authority and responsibility in diabetes management to licensed GPs as licensed outpatient specialists in Hungary. METHODS: The Syreon Diabetes Control Model (SDM) was used to evaluate life expectancy, quality-adjusted life expectancy (QALY) and direct medical costs over patient lifetimes. Cohort characteristics were derived from national database, clinical history data of 476,211 persons with diabetes were used, treatment effects and costs were derived from literature, national databases and expert opinions. RESULTS: The purchase of one additional quality adjusted life year with the use of licensed general practitioners was EUR 51,420 compared to making the service available only through universal GPs. The purchase of one additional quality adjusted life year through the service of licensed GPs is EUR 459,950 compared to outpatient care provision. CONCLUSIONS: The management of diabetes care with licensed GPs has the potential to improve patients health gains compared to the current patterns of care in Hungary in a cost-effective way if licensed GPs are reimbursed below the average current cost of outpatient diabetes services. Increase of the capitation for diabetic patients would be a practical way to reimburse the GP's additional service.

7.
Expert Rev Hematol ; 12(5): 295-309, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30925855

RESUMO

INTRODUCTION: Chronic graft-versus-host disease (GVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study aims to provide a systematic overview of evidence on the health-related quality of life (HRQoL) and functional capacity of HSCT patients with National Institutes of Health (NIH)-defined chronic GVHD. Areas covered: English-language articles published between 2007 and 2017 were searched using PubMed. Studies that used the 2005 or 2015 NIH consensus criteria for the diagnosis and staging of chronic GVHD and had a cohort size of at least 100 patients were included. Expert opinion: Disease severity and organ involvement were the most important predictors of HRQoL and functionality in chronic GVHD patients. Further, identified predictors of HRQoL were nutrition status and functional capacity, while functional status was also associated with disease symptoms, nutrition status, age, and survival. Data regarding the effect of symptom bother on HRQoL were limited. Our findings confirm that the management of chronic GVHD should focus on improving not only clinical outcomes but also on HRQoL and functional capacity. Therefore, to evaluate new treatment options it is recommended to include patient relevant endpoints into prospective studies. This study also highlights the importance of nonpharmacological aspects in the management of chronic GVHD.

8.
Orphanet J Rare Dis ; 14(1): 40, 2019 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760309

RESUMO

Propionic acidemia (PA, OMIM #606054) is a serious, life-threatening, inherited, metabolic disorder caused by the deficiency of the mitochondrial enzyme propionyl-coenzyme A (CoA) carboxylase (EC 6.4.1.3). The primary objective of this study was to conduct a systematic literature review and meta-analysis on the epidemiology of PA. The literature search was performed covering Medline, Embase, Cochrane Database of Systematic Reviews, CRD Database, Academic Search Complete, CINAHL and PROSPERO databases. Websites of rare disease organizations were also searched for eligible studies. Of the 2338 identified records, 188 articles were assessed for eligibility in full text, 43 articles reported on disease epidemiology, and 31 studies were included into the quantitative synthesis. Due to the rarity of PA, broadly targeted population-based prevalence studies are not available. Nonetheless, implementation of newborn screening programs has allowed the estimation of the birth prevalence data of PA across multiple geographic regions. The pooled point estimates indicated detection rates of 0.29; 0.33; 0.33 and 4.24 in the Asia-Pacific, Europe, North America and the Middle East and North Africa (MENA) regions, respectively. Our systematic literature review and meta-analysis confirm that PA is an ultra-rare disorder, with similar detection rates across all regions with the exception of the MENA region where the disease, similar to other inherited metabolic disorders, is more frequent.


Assuntos
Acidemia Propiônica/diagnóstico , Acidemia Propiônica/epidemiologia , Humanos , Recém-Nascido , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/epidemiologia , Triagem Neonatal/métodos
10.
Eur J Cancer ; 104: 127-136, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30347288

RESUMO

Cancer research is an essential part of national cancer control programmes, and the emerging economies of Central and Eastern Europe (CEE) and the Russian Federation and Central Asia (R-CA) (Commonwealth of Independent States) remain relatively understudied. Here, we map the cancer research activity from the 29 countries across these regions over a 10-year period (2007-2016), using a standard scientometric approach. Research activity was compared with the countries' wealth and with the disease burden from different cancers, and analyses were also performed by the research domain (e.g. fundamental cancer biology, surgery). We found that although there was a correlation between outputs and national wealth, there were many outliers; the CEE countries publishing relatively more, and the R-CA, less. Outputs reflected cancer burdens, but there was a relative paucity of research on lung, colorectal, gastric and pancreatic cancer, as well as research domains such as screening and palliative care. Clinical trials accounted for only 3% of all research outputs from all countries, and were very international, with on average 1.5 CEE countries and 8.0 others involved in each article, and they were heavily cited (on average, 84 times in 5 years). Poland was by far the most research-active country, but significant needs and opportunities have been identified to expand the cancer research activity in all CEE and R-CA countries to enhance national cancer control planning.


Assuntos
Bibliometria , Oncologia , Pesquisa/estatística & dados numéricos , Ásia/epidemiologia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Efeitos Psicossociais da Doença , Europa (Continente)/epidemiologia , Feminino , Previsões , Geografia Médica , Produto Interno Bruto , Humanos , Masculino , Oncologia/estatística & dados numéricos , Oncologia/tendências , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Neoplasias/terapia , Cuidados Paliativos , Técnicas de Planejamento , Medicina Preventiva , Federação Russa/epidemiologia
11.
Health Policy ; 122(11): 1198-1205, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30195444

RESUMO

The benefits of population-based screening for breast cancer are now accepted although, in practice, programmes often fail to achieve their full potential. In this paper, we propose a conceptual model that situates screening programmes within the broader health system to understand the factors that influence their outcomes. We view the overall screening system as having multiple sub-systems to identify the population at risk, generate knowledge of effectiveness, maximise uptake, operate the programme, and optimise follow-up and assurance of subsequent treatment. Based on this model we have developed the Barriers to Effective Screening Tool (BEST) for analysing government-led, population-based screening programmes from a health systems perspective. Conceived as a self-assessment tool, we piloted the tool with key informants in six European countries (Estonia, Finland, Hungary, Italy, The Netherlands and Slovenia) to identify barriers to the optimal operation of population-based breast cancer screening programmes. The pilot provided valuable feedback on the barriers affecting breast cancer screening programmes and stimulated a greater recognition among those operating them of the need to take a health systems perspective. In addition, the pilot led to further development of the tool and provided a foundation for further research into how to overcome the identified barriers.


Assuntos
Neoplasias da Mama/diagnóstico , Assistência à Saúde/organização & administração , Detecção Precoce de Câncer , Programas Governamentais/organização & administração , Programas de Rastreamento/métodos , Idoso , Europa (Continente) , Feminino , Política de Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População/métodos , Inquéritos e Questionários
12.
BMC Fam Pract ; 19(1): 67, 2018 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-29778099

RESUMO

BACKGROUND: Cervical cancer is a preventable disease. Unfortunately, its mortality is high in Hungary: 9.2 deaths /100000 women/year in 2015. The Hungarian organized, nationwide cervical screening program was launched in 2003, but it could improve the coverage rate of cervical cancer screening only by a few percentage points. The vast majority of women still uses opportunistic screening and the organized screening program had little impact on participation by women who never or rarely consult their gynecologists. We assessed whether involving general practitioners in the cervical cancer screening process would increase participation. METHODS: The study consisted of two parts: 1. A questionnaire-based health survey was conducted using a representative sample of women aged 25 to 65 years from 11 Hungarian counties, in which we studied where women obtained information about cervical cancer screening. 2. Additionally, a model program and its evaluation were implemented in the practices of general practitioners in one of the 11 counties (Zala county). In this program, general practitioners were informed of their patients' participation in the cervical cancer screening program, and they motivated those who refused the invitation. RESULTS: Questionnaire-based health survey: A total of 74% (95% confidence interval (CI): 70-77%) of the target population had a screening examination within the previous 3 years. The majority (58, 95% CI: 54-62%) of the target population did not ask for information about cervical cancer screening at all. Only 21% (95% CI: 17-26%) consulted their general practitioners about cancer screening. Evaluation of the model program: the general practitioners effectively motivated 24 out of 88 women (27, 95% CI: 18-38%) who initially refused to participate in the screening program. CONCLUSION: The majority of Hungarian women are not informed about cervical cancer screening beyond the invitation letter. General practitioners could play a more important role in mobilizing the population to utilize preventive services. The involvement of general practitioners in the organization of the cervical cancer screening program could increase the participation of those women who generally refuse the services.


Assuntos
Detecção Precoce de Câncer/métodos , Clínicos Gerais , Neoplasias do Colo do Útero , Adulto , Feminino , Clínicos Gerais/organização & administração , Clínicos Gerais/normas , Inquéritos Epidemiológicos , Humanos , Hungria/epidemiologia , Programas de Rastreamento/organização & administração , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
13.
Orphanet J Rare Dis ; 13(1): 53, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29631636

RESUMO

BACKGROUND: Sanfilippo syndrome (mucopolysaccharidosis [MPS] III subtypes A, B, C, and D) is a rare autosomal recessive inherited metabolic disorder that causes progressive neurocognitive degeneration. This systematic literature review was undertaken to compile and assess published epidemiological data, including various frequency measures and geographical variation on Sanfilippo syndrome. METHODS: The following databases were systematically searched for terms related to Sanfilippo syndrome epidemiology: Medline, Embase, Cochrane Database of Systematic Reviews, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, and the Centre for Reviews and Dissemination. Qualitative synthesis of research findings was performed. RESULTS: Of 2794 publications found in the initial search, 116 were deemed eligible after title and abstract screening. Following full-text review, 46 papers were included in the qualitative synthesis. Results of this systematic literature review indicate that lifetime risk at birth ranges from 0.17-2.35 per 100,000 live births for all 4 subtypes of MPS III together, and from 0.00-1.62 per 100,000 live births for the most frequent subtype, MPS IIIA. CONCLUSION: All 4 subtypes of MPS III are exceptionally rare, but they each have devastating effects on children. Higher-quality epidemiological data are needed to appropriately target resources for disease research and management.


Assuntos
Mucopolissacaridose III/epidemiologia , Doenças Raras/epidemiologia , Saúde Global , Humanos
14.
BMC Health Serv Res ; 18(1): 115, 2018 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-29444679

RESUMO

BACKGROUND: The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS: An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS: Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS: The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.


Assuntos
Atitude Frente a Saúde , Promoção da Saúde/organização & administração , Prevenção do Hábito de Fumar/organização & administração , Análise Custo-Benefício , Estudos Transversais , Europa (Continente) , Feminino , Promoção da Saúde/economia , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Modelos Econômicos , Prevenção do Hábito de Fumar/economia , Inquéritos e Questionários , Reino Unido
16.
Addiction ; 113 Suppl 1: 76-86, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29368363

RESUMO

AIMS: To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. METHODS: The EQUIPTMOD, a Markov-based economic model, was used to assess the cost-effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group-based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life-time costs and quality-adjusted life years (QALYs) were calculated from a health-care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost-effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. RESULTS: Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health-care cost-savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost-savings increased to €14.1598 per smoker. Doubling the reach of existing group-based behavioural support therapies and proactive telephone support resulted in health-care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. CONCLUSIONS: According to the EQUIPTMOD modelling tool, it would be cost-effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group-based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Modelos Econômicos , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/economia , Fumar/terapia , Adulto , Análise Custo-Benefício/economia , Análise Custo-Benefício/métodos , Humanos , Hungria , Estudos Prospectivos , Abandono do Hábito de Fumar/métodos
17.
J Eval Clin Pract ; 23(6): 1375-1380, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28895276

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: To compare the effect of osteoporotic fractures and complications of diabetes mellitus on quality of life (QoL). METHOD: A cross-sectional study was performed in 840 patients with osteoporosis and in 943 patients with diabetes in Hungary to estimate the effect of osteoporotic fractures and microvascular and macrovascular complications of diabetes on QoL using the EQ-5D questionnaire. Ordinary least-squares regression was performed for the analysis to control for age and gender. RESULTS: The effects of certain of osteoporotic fractures and diabetes complications were similar in size measured by the EQ-5D. Patients with hip fractures and compressions of the vertebrae suffered more than 0.2 drop in their QoL, which is comparable in size to the most severe complications of diabetes, such as vision loss and amputations. CONCLUSIONS: The use of mortality and premature mortality as the traditional measures of disease burden in public health policy making means that diseases which strongly affect QoL but less survival might not get the necessary priority. This is especially the case in low-income and middle-income countries where studies on QoL are scarce. Our comparative analysis, which showed that osteoporotic fractures reduce QoL as much as major complications of diabetes, highlights the need for comprehensive disease burden assessment, including losses in functionality and QoL, to support decision making.


Assuntos
Complicações do Diabetes/psicologia , Fraturas por Osteoporose/psicologia , Qualidade de Vida , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida
18.
J Mark Access Health Policy ; 5(1): 1345580, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28740623

RESUMO

Background & Objectives: Biological disease-modifying antirheumatic drugs (bDMARDs) for the treatment of rheumatoid arthritis (RA) are not always accessible to all patients in accordance with international guidelines, partly owing to their high direct costs against a background of restricted healthcare budgets. This study compares the size of RA patient populations with access to reimbursed bDMARDs across 37 European countries, Russia, and Turkey, according to their treatment eligibility defined by European League Against Rheumatism (EULAR) recommendations and national reimbursement criteria. Methods: The size of the RA patient population eligible for bDMARD treatment was estimated in a population model using published RA epidemiological data and clinical criteria defined by 2013 EULAR recommendations along with national reimbursement criteria defined in a survey of the 39 countries in November 2015. Results: According to EULAR recommendations, 32% of the total RA population in the European region is eligible for bDMARD treatment. However, only an average 59% of this EULAR-eligible population remains eligible after applying national reimbursement criteria (from 86% in 'high access' to 13% in 'low-access' countries). Conclusion: Access to reimbursed bDMARDs remains unequal in the European region. As biosimilars of bDMARDs are introduced, changes in reimbursement criteria may increase access to bDMARDs and reduce this inequality.

19.
Orv Hetil ; 158(25): 963-975, 2017 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-28627945

RESUMO

INTRODUCTION: Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing low-dose computed tomography screening is a relevant health policy matter. AIM: The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. METHOD: A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. RESULTS: In accordance with these findings, we recommend to perform the full health-economic evaluation of low-dose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon. CONCLUSIONS: The proposed cost-effectiveness model will be suitable to provide data for further analyses that support decision-making on introducing low-dose computed tomography lung cancer screening as public health program. Orv Hetil. 2017; 158(25): 963-975.


Assuntos
Detecção Precoce de Câncer/economia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/economia , Programas de Rastreamento/economia , Tomografia Computadorizada Espiral/economia , Análise Custo-Benefício , Feminino , Humanos , Hungria , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/prevenção & controle , Masculino , Seleção de Pacientes
20.
J Comp Eff Res ; 6(8): 639-648, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28511548

RESUMO

AIM: Our study aimed at estimating differences in quality-adjusted life year (QALY) gain for patients with predominant negative symptoms of schizophrenia treated with cariprazine compared with risperidone. MATERIALS & METHODS: A Markov model was built, based on the Mohr-Lenert approach and data derived from clinical trials, to estimate potential QALY gains of patients. RESULTS: Patients had higher probability of reaching better health states treated with cariprazine compared with risperidone. In the model, this resulted in an estimated QALY gain of 0.029 per patient, after 1 year of treatment. CONCLUSION: Cariprazine, which showed clinically meaningful improvement in the symptoms, and personal and social performance, can also provide significant QALY gain in the treatment of patients with predominant negative symptoms of schizophrenia compared with risperidone.


Assuntos
Antipsicóticos/uso terapêutico , Piperazinas/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
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