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Artigo em Inglês | MEDLINE | ID: mdl-30262740


There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over $180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.

Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Análise Custo-Benefício , Disparidades nos Níveis de Saúde , Vacina contra Herpes Zoster/economia , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Vacinação/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Equidade em Saúde , Herpes Zoster/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Vacinação/estatística & dados numéricos
J Comp Eff Res ; 7(6): 603-614, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29478331


The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.

Serviços de Saúde Comunitária/organização & administração , Assistência à Saúde/organização & administração , Planejamento em Saúde/organização & administração , Serviços de Saúde Comunitária/normas , Humanos , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/normas , Melhoria de Qualidade , Estados Unidos
BMC Public Health ; 15: 1201, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26627449


BACKGROUND: This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. METHODS: Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. RESULTS: For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). CONCLUSIONS: Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

Redução de Custos , Análise Custo-Benefício , Tuberculose Latente , Programas de Rastreamento/economia , Refugiados , Árvores de Decisões , Emigração e Imigração , Feminino , Humanos , Internacionalidade , Tuberculose Latente/diagnóstico , Tuberculose Latente/economia , Tuberculose Latente/epidemiologia , Tuberculose Latente/terapia , Masculino , Programas de Rastreamento/métodos , Prevalência , Tuberculose , Estados Unidos
PLoS One ; 10(4): e0124116, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25924009


INTRODUCTION: The Centers for Disease Control and Prevention is considering implementation of overseas medical screening of student-visa applicants to reduce the numbers of active tuberculosis cases entering the United States. OBJECTIVE: To evaluate the costs, cases averted, and cost-effectiveness of screening for, and treating, tuberculosis in United States-bound students from countries with varying tuberculosis prevalence. METHODS: Costs and benefits were evaluated from two perspectives, combined and United States only. The combined perspective totaled overseas and United States costs and benefits from a societal perspective. The United States only perspective was a domestic measure of costs and benefits. A decision tree was developed to determine the cost-effectiveness of tuberculosis screening and treatment from the combined perspective. RESULTS: From the United States only perspective, overseas screening programs of Chinese and Indian students would prevent the importation of 157 tuberculosis cases annually, and result in $2.7 million in savings. From the combined perspective, screening programs for Chinese students would cost more than $2.8 million annually and screening programs for Indian students nearly $440,000 annually. From the combined perspective, the incremental cost for each tuberculosis case averted by screening Chinese and Indian students was $22,187 and $15,063, respectively. Implementing screening programs for German students would prevent no cases in most years, and would result in increased costs both overseas and in the United States. The domestic costs would occur because public health departments would need to follow up on students identified overseas as having an elevated risk of tuberculosis. CONCLUSIONS: Tuberculosis screening and treatment programs for students seeking long term visas to attend United States schools would reduce the number of tuberculosis cases imported. Implementing screening in high-incidence countries could save the United States millions of dollars annually; however there would be increased costs incurred overseas for students and their families.

Análise Custo-Benefício/economia , Estudantes , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Emigrantes e Imigrantes , Humanos , Internacionalidade , Refugiados , Tuberculose/economia , Estados Unidos
Vaccine ; 33(11): 1393-9, 2015 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-25595868


BACKGROUND: Refugees are at an increased risk of chronic Hepatitis B virus (HBV) infection because many of their countries of origin, as well as host countries, have intermediate-to-high prevalence rates. Refugees arriving to the US are also at risk of serious sequelae from chronic HBV infection because they are not routinely screened for the virus overseas or in domestic post-arrival exams, and may live in the US for years without awareness of their infection status. METHODS: A cohort of 26,548 refugees who arrived in Minnesota and Georgia during 2005-2010 was evaluated to determine the prevalence of chronic HBV infection. This prevalence information was then used in a cost-benefit analysis comparing two variations of a proposed overseas program to prevent or ameliorate the effects of HBV infection, titled 'Screen, then vaccinate or initiate management' (SVIM) and 'Vaccinate only' (VO). The analyses were performed in 2013. All values were converted to US 2012 dollars. RESULTS: The estimated six year period-prevalence of chronic HBV infection was 6.8% in the overall refugee population arriving to Minnesota and Georgia and 7.1% in those ≥6 years of age. The SVIM program variation was more cost beneficial than VO. While the up-front costs of SVIM were higher than VO ($154,084 vs. $73,758; n=58,538 refugees), the SVIM proposal displayed a positive net benefit, ranging from $24 million to $130 million after only 5 years since program initiation, depending on domestic post-arrival screening rates in the VO proposal. CONCLUSIONS: Chronic HBV infection remains an important health problem in refugees resettling to the United States. An overseas screening policy for chronic HBV infection is more cost-beneficial than a 'Vaccination only' policy. The major benefit drivers for the screening policy are earlier medical management of chronic HBV infection and averted lost societal contributions from premature death.

Vacinas contra Hepatite B , Hepatite B Crônica/epidemiologia , Programas de Imunização/economia , Programas de Rastreamento/economia , Refugiados , Adolescente , Adulto , Criança , Estudos de Coortes , Análise Custo-Benefício , Georgia/epidemiologia , Humanos , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Minnesota/epidemiologia , Prevalência , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem