Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
1.
Ophthalmic Epidemiol ; : 1-13, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530688

RESUMO

PURPOSE: To estimate the prevalence of diagnosis of major eye disorders and their associated payments, in total and per-person diagnosed, among Medicare fee-for-service (FFS) beneficiaries in 2018. METHODS: We analyzed 100% Medicare Part B FFS claims and Part D Events among beneficiaries continuously enrolled for 12 months in 2018 to calculate the proportion of beneficiaries with ≥1 claim indicating age-related macular degeneration (AMD), cataract, diabetic retinopathy (DR), or glaucoma, and their associated payments, including Medicare and patient out-of-pocket. Eye disease and eye care services were identified using case definitions from the Centers for Disease Control and Prevention's (CDC) Vision & Eye Health Surveillance System (VEHSS). Outcomes are reported by disease overall and by age group (0-39, 40-64, 65-84, 85+ years), sex, race/ethnicity, and U.S. state. RESULTS: Among nearly 30 million Medicare Part B FFS beneficiaries in 2018, over 41% (12.4 million) had a claim containing a diagnosis of at least one of the four eye disorders; 33.7% with cataract, 13.3% with glaucoma, 9.2% with AMD and 3.2% with DR. Payments for eye care services and drugs associated with these four conditions were $10.1billion; $3.6 billion for cataract, $3.5 billion for AMD, $2.2 billion for glaucoma and $0.8 billion for DR. The average cost per beneficiary diagnosed was $816: $1,290 for AMD, $781 for DR, $543 for glaucoma, and $360 for cataract. CONCLUSIONS: Major eye disorders are common among Medicare FFS beneficiaries and account for approximately 4.3% of Medicare Part B and 1% of Medicare Part D spending.

2.
Ophthalmology ; 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34560128

RESUMO

PURPOSE: To estimate the economic burden of vision loss (VL) in the United States and by state. DESIGN: Analysis of secondary data sources (American Community Survey [ACS], American Time Use Survey, Bureau of Labor Statistics, Medical Expenditure Panel Survey [MEPS], National and State Health Expenditure Accounts, and National Health Interview Survey [NHIS]) using attributable fraction, regression, and other methods to estimate the incremental direct and indirect 2017 costs of VL. PARTICIPANTS: People with a yes response to a question asking if they are blind or have serious difficulty seeing even when wearing glasses in the ACS, MEPS, or NHIS. MAIN OUTCOME MEASURES: We estimated the direct costs of medical, nursing home (NH), and supportive services and the indirect costs of absenteeism, lost household production, reduced labor force participation, and informal care by age group, sex, and state in aggregate and per person with VL. RESULTS: We estimated an economic burden of VL of $134.2 billion: $98.7 billion in direct costs and $35.5 billion in indirect costs. The largest burden components were NH ($41.8 billion), other medical care services ($30.9 billion), and reduced labor force participation ($16.2 billion), all of which accounted for 66% of the total. Those with VL incurred $16 838 per year in incremental burden. Informal care was the largest burden component for people 0 to 18 years of age, reduced labor force participation was the largest burden component for people 19 to 64 years of age, and NH costs were the largest burden component for people 65 years of age or older. New York, Connecticut, Massachusetts, Rhode Island, and Vermont experienced the highest costs per person with VL. Sensitivity analyses indicate total burden may range between $76 and $218 billion depending on the assumptions used in the model. CONCLUSIONS: Self-reported VL imposes a substantial economic burden on the United States. Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on the age composition of the population with VL. Information on state variation can help local decision makers target resources better to address the burden of VL.

3.
JAMA Ophthalmol ; 139(7): 717-723, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33983373

RESUMO

Importance: Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US. Objective: To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state. Data Sources: Data from the American Community Survey (2017), National Health and Nutrition Examination Survey (1999-2008), and National Survey of Children's Health (2017), as well as population-based studies (2000-2013), were included. Study Selection: All relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System were included. Data Extraction and Synthesis: The prevalence of visual acuity loss or blindness was estimated, stratified when possible by factors including US state, age group, sex, race/ethnicity, and community-dwelling or group-quarters status. Data analysis occurred from March 2018 to March 2020. Main Outcomes or Measures: The prevalence of visual acuity loss (defined as a best-corrected visual acuity greater than or equal to 0.3 logMAR) and blindness (defined as a logMAR of 1.0 or greater) in the better-seeing eye. Results: For 2017, this meta-analysis generated an estimated US prevalence of 7.08 (95% uncertainty interval, 6.32-7.89) million people living with visual acuity loss, of whom 1.08 (95% uncertainty interval, 0.82-1.30) million people were living with blindness. Of this, 1.62 (95% uncertainty interval, 1.32-1.92) million persons with visual acuity loss are younger than 40 years, and 141 000 (95% uncertainty interval, 95 000-187 000) persons with blindness are younger than 40 years. Conclusions and Relevance: This analysis of all available data with modern methods produced estimates substantially higher than those previously published.

4.
Ophthalmology ; 128(1): 15-27, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663529

RESUMO

PURPOSE: To support survey validation efforts by comparing prevalence rates of self-reported and examination evaluated presenting visual impairment (VI) and blindness measured across national surveys. DESIGN: Cross-sectional comparison. PARTICIPANTS: Participants in the 2016 American Community Survey, the 2016 Behavioral Risk Factor Surveillance System, the 2016 National Health Interview Survey, the 2005-2008 National Health and Nutrition Examination Survey (NHANES), and the 2016 National Survey of Children's Health. METHODS: We estimated VI and blindness prevalence rates and confidence intervals for each survey measure and age group using the Clopper-Pearson method. We used inverse variance weighting to estimate the central tendency across measures by age-group, fitted trend lines to age-group estimates, and used the trend-line equations to estimate the number of United States persons with VI and blindness in 2016. We compared self-report estimates with those from NHANES physical evaluations of presenting VI and blindness. MAIN OUTCOME MEASURES: Variability of prevalence estimates of VI and blindness. RESULTS: Self-report estimates of blindness varied between 0.1% and 5.6% for those younger than 65 years and from 0.6% to 16.6% for those 65 or older. Estimates of VI varied between 1.6% and 24.8% for those younger than 65 years and between 2.2% and 26.6% for those 65 years or older. For summarized survey results and NHANES physical evaluation, prevalence rates for VI increased significantly with increasing age group. Blindness prevalence increased significantly with increasing age group for summarized survey responses but not for NHANES physical examination. Based on extrapolations of NHANES physical examination data to all ages, we estimated that in 2016, 23.4 million persons in the United States (7.2%) had VI or blindness, an evaluated presenting visual acuity of 20/40 or worse in the better-seeing eye before correction. Based on weighted self-reported surveys, we estimated that 24.8 million persons (7.7%) had presenting VI or blindness. CONCLUSIONS: Prevalence rates of VI and blindness obtained from national survey measures varied widely across surveys and age groups. Additional research is needed to validate the ability of survey self-report measures of VI and blindness to replicate results obtained through examination by an eye health professional.


Assuntos
Cegueira/epidemiologia , Inquéritos Nutricionais , Baixa Visão/epidemiologia , Acuidade Visual , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prevalência , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
7.
JAMA Ophthalmol ; 135(5): 452-459, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28358948

RESUMO

Background: Medicare recently approved coverage of home telemonitoring for early detection of incident choroidal neovascularization (CNV) among patients with age-related macular degeneration (AMD), but no economic evaluation has yet assessed its cost-effectiveness and budgetary impact. Objectives: To evaluate a home-based daily visual-field monitoring system using simulation methods and to apply the findings of the Home Monitoring of the Eye study to the US population at high risk for wet-form AMD. Design, Setting, and Participants: In this economic analysis, an evaluation of the potential cost, cost-effectiveness, and government budgetary impact of adoption of a home-based daily visual-field monitoring system among eligible Medicare patients was performed. Effectiveness and visual outcomes data from the Age-Related Eye Disease Study 2 Home Monitoring of the Eye study, treatment data from the Wills Eye Hospital Treat & Extend study, and AMD progression data from the Age-Related Eye Disease Study 1 were used to simulate the long-term effects of telemonitoring patients with CNV in one eye or large drusen and/or pigment abnormalities in both eyes. Univariate and probabilistic sensitivity analysis and an alternative scenario using the Treat & Extend study control group outcomes were used to examine uncertainty in these data and assumptions. Interventions: Home telemonitoring of patients with AMD for early detection of CNV vs usual care. Main Outcomes and Measures: Incremental cost-effectiveness ratio, net present value of lifetime societal costs, and 10-year nominal government expenditures. Result: Telemonitoring of patients with existing unilateral CNV or multiple bilateral risk factors for CNV (large drusen and retinal pigment abnormalities) incurs $907 (95% CI, -$6302 to $2809) in net lifetime societal costs, costs $1312 (95% CI, $222-$2848) per patient during 10 years from the federal government's perspective, and results in an incremental cost-effectiveness ratio of $35 663 (95% CI, cost savings to $235 613) per quality-adjusted life-year gained. Conclusions and Relevance: Home telemonitoring of patients with AMD who are at risk for CNV was cost-effective compared with scheduled examinations alone. Monitoring patients with existing CNV in one eye is cost saving, but monitoring is generally not cost-effective among patients with low risk of CNV, including those with no or few risk factors. With Medicare coverage, monitoring incurs budgetary expenditures for the government but is cost-saving for patients at high risk of AMD. Monitoring could be cost saving to society if monitoring reduced the frequency of scheduled examinations or led to a reduction of one or more injections of ranibizumab.


Assuntos
Neovascularização de Coroide/diagnóstico , Monitorização Fisiológica/economia , Telemedicina/economia , Acuidade Visual , Degeneração Macular Exsudativa/diagnóstico , Idoso , Neovascularização de Coroide/fisiopatologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Reprodutibilidade dos Testes , Telemedicina/instrumentação , Estados Unidos , Campos Visuais , Degeneração Macular Exsudativa/fisiopatologia
8.
JAMA Ophthalmol ; 134(10): 1111-1118, 2016 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27490785

RESUMO

Importance: Understanding the importance of eye health to the US population across ethnic and racial groups helps guide strategies to preserve vision in Americans and inform policy makers regarding priority of eye research to Americans. Objective: To understand the importance and awareness of eye health in the US population across ethnic and racial groups. Design, Setting, and Participants: Online nationwide poll created by experienced policy makers in August 2014 designed to understand the importance of eye health in the US population, although the poll was not subjected previously to formal construct-validity testing. The population survey comprised 2044 US adults including non-Hispanic white individuals and minority groups with minority oversampling to provide predicted margins of error no greater than 5%. Main Outcomes and Measures: Respondent attitudes on the importance of eye health, concerns about losing vision, support for eye health research, and awareness of eye diseases and risk factors. Results: Of the 2044 survey respondents, the weighten mean age was 46.2 years, 48% were male, and 11% were uninsured. Sixty three percent reported wearing glasses. Most individuals surveyed (87.5%; 95% CI, 84.5%-90%) believed that good vision is vital to overall health while 47.4% (95% CI, 43.7%-51.1%) rated losing vision as the worst possible health outcome. Respondents ranked losing vision as equal to or worse than losing hearing, memory, speech, or a limb. When asked about various possible consequences of vision loss, quality of life ranked as the top concern followed by loss of independence. Nearly two-thirds of respondents were aware of cataracts (65.8%) or glaucoma (63.4%); only half were aware of macular degeneration; 37.3% were aware of diabetic retinopathy; and 25% were not aware of any eye conditions. Approximately 75.8% and 58.3%, respectively, identified sunlight and family heritage as risk factors for losing vision; only half were aware of smoking risks on vision loss. Conclusions and Relevance: In this well-characterized survey across all US ethnic and racial groups, vision health was a priority with high support for ongoing research for vision and eye health. Many Americans were unaware of important eye diseases and their behavioral or familial risk factors. The consistency of these findings among the varying ethnic/racial groups underscores the importance of educating the public on eye health and mobilizing public support for vision research.


Assuntos
Atitude , Grupos Étnicos , Oftalmopatias/psicologia , Disparidades nos Níveis de Saúde , Opinião Pública , Qualidade de Vida , Inquéritos e Questionários , Adulto , Oftalmopatias/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Morbidade/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
Hepatology ; 63(4): 1135-44, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26707033

RESUMO

UNLABELLED: The aim of this work was to estimate and describe the Medicare beneficiaries diagnosed with hepatitis C virus (HCV) in 2009, incremental annual costs by disease stage, incremental total Medicare HCV payments in 2009 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data covering the years 2002 to 2009. We weighted the 2009 SEER-Medicare data to create estimates of the number of patients with an HCV diagnosis, used an inverse probability-weighted two-part, probit, and generalized linear model to estimate incremental per patient per month costs, and used simulation to estimate annual 2009 Medicare burden, presented in 2014 dollars. We summarized patient characteristics, diagnoses, and costs from SEER-Medicare files into a person-year panel data set. We estimated there were 407,786 patients with diagnosed HCV in 2009, of whom 61.4% had one or more comorbidities defined by the study. In 2009, 68% of patients were diagnosed with chronic HCV only, 9% with cirrhosis, 12% with decompensated cirrhosis (DCC), 2% with liver cancer, 2% with a history of transplant, and 8% who died. Annual costs for patients with chronic infection only and DCC were higher than the values used in many previous cost-effectiveness studies, and treatment of DCC accounted for 63.9% of total Medicare's HCV expenditures. Medicare paid $2.7 billion (credible interval: $0.7-$4.6 billion) in incremental costs for HCV in 2009. CONCLUSIONS: The costs of HCV to Medicare in 2009 were substantial and expected to increase over the next decade. Annual costs for patients with chronic infection only and DCC were higher than values used in many cost-effectiveness analyses.


Assuntos
Custos de Cuidados de Saúde , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Cirrose Hepática/economia , Medicare/economia , Idoso , Antivirais/economia , Antivirais/uso terapêutico , Estudos de Coortes , Progressão da Doença , Feminino , Hepatite C Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/terapia , Cirrose Hepática/virologia , Modelos Logísticos , Masculino , Estudos Retrospectivos , Medição de Risco , Programa de SEER , Índice de Gravidade de Doença , Estados Unidos
10.
Clin Infect Dis ; 61(2): 157-68, 2015 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-25778747

RESUMO

BACKGROUND: New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown. METHODS: We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. RESULTS: Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR. CONCLUSIONS: New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing.


Assuntos
Antivirais/economia , Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus , Hepatite C Crônica/mortalidade , Humanos , Interferon-alfa/uso terapêutico , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Ribavirina/uso terapêutico , Simeprevir/uso terapêutico , Sofosbuvir , Estados Unidos , Uridina Monofosfato/uso terapêutico , Adulto Jovem
11.
Ophthalmology ; 120(9): 1728-35, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23631946

RESUMO

OBJECTIVE: To estimate the economic burden of vision loss and eye disorders in the United States population younger than 40 years in 2012. DESIGN: Econometric and statistical analysis of survey, commercial claims, and census data. PARTICIPANTS: The United States population younger than 40 years in 2012. METHODS: We categorized costs based on consensus guidelines. We estimated medical costs attributable to diagnosed eye-related disorders, undiagnosed vision loss, and medical vision aids using Medical Expenditure Panel Survey and MarketScan data. The prevalence of vision impairment and blindness were estimated using National Health and Nutrition Examination Survey data. We estimated costs from lost productivity using Survey of Income and Program Participation. We estimated costs of informal care, low vision aids, special education, school screening, government spending, and transfer payments based on published estimates and federal budgets. We estimated quality-adjusted life years (QALYs) lost based on published utility values. MAIN OUTCOME MEASURES: Costs and QALYs lost in 2012. RESULTS: The economic burden of vision loss and eye disorders among the United States population younger than 40 years was $27.5 billion in 2012 (95% confidence interval, $21.5-$37.2 billion), including $5.9 billion for children and $21.6 billion for adults 18 to 39 years of age. Direct costs were $14.5 billion, including $7.3 billion in medical costs for diagnosed disorders, $4.9 billion in refraction correction, $0.5 billion in medical costs for undiagnosed vision loss, and $1.8 billion in other direct costs. Indirect costs were $13 billion, primarily because of $12.2 billion in productivity losses. In addition, vision loss cost society 215 000 QALYs. CONCLUSIONS: We found a substantial burden resulting from vision loss and eye disorders in the United States population younger than 40 years, a population excluded from previous studies. Monetizing quality-of-life losses at $50 000 per QALY would add $10.8 billion in additional costs, indicating a total economic burden of $38.2 billion. Relative to previously reported estimates for the population 40 years of age and older, more than one third of the total cost of vision loss and eye disorders may be incurred by persons younger than 40 years. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.


Assuntos
Cegueira/economia , Efeitos Psicossociais da Doença , Oftalmopatias/economia , Custos de Cuidados de Saúde , Baixa Visão/economia , Adolescente , Adulto , Cegueira/epidemiologia , Cuidadores/economia , Criança , Pré-Escolar , Interpretação Estatística de Dados , Educação Especial/economia , Oftalmopatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Modelos Econométricos , Prevalência , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Auxiliares Sensoriais/economia , Estados Unidos/epidemiologia , Baixa Visão/epidemiologia , Adulto Jovem
12.
Diabetes Care ; 36(1): 63-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22933435

RESUMO

OBJECTIVE To examine the cost-effectiveness of a hepatitis B vaccination program for unvaccinated adults with diagnosed diabetes in the U.S. RESEARCH DESIGN AND METHODS We used a cost-effectiveness simulation model to estimate the cost-effectiveness of vaccinating adults 20-59 years of age with diagnosed diabetes not previously vaccinated for or infected by hepatitis B virus (HBV). The model estimated acute and chronic HBV infections, complications, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and vaccine prices. RESULTS With a 10% uptake rate, the intervention will vaccinate 528,047 people and prevent 4,271 acute and 256 chronic hepatitis B infections. Net health care costs will increase by $91.4 million, and 1,218 QALYs will be gained, producing a cost-effectiveness ratio of $75,094 per QALY gained. Results are most sensitive to age, the discount rate, the hepatitis B incidence ratio for people with diabetes, and hepatitis B infection rates. Cost-effectiveness ratios rise with age at vaccination; an alternative intervention that vaccinates adults with diabetes 60 years of age or older had a cost-effectiveness ratio of $2.7 million per QALY. CONCLUSIONS Hepatitis B vaccination for adults with diabetes 20-59 years of age is modestly cost-effective. Vaccinating older adults with diabetes is not cost-effective. The study did not consider hepatitis outbreak investigation costs, and limited information exists on hepatitis progression among older adults with diabetes. Partly based on these results, the Advisory Committee on Immunization Practices recently recommended hepatitis B vaccination for people 20-59 years of age with diagnosed diabetes.


Assuntos
Análise Custo-Benefício/métodos , Diabetes Mellitus/imunologia , Hepatite B/prevenção & controle , Vacinação/economia , Adulto , Feminino , Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
13.
J Am Soc Nephrol ; 23(12): 2035-41, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23204444

RESUMO

Compared with other racial groups, African Americans have a similar prevalence of CKD but are much more likely to progress to ESRD, suggesting that the cost-effectiveness of screening strategies requires dedicated study in this population. Here, we calibrated the CKD Health Policy Model so that it accurately forecasts the higher rates for ESRD observed for African Americans. We then used the calibrated model to estimate the cost-effectiveness of screening for microalbuminuria followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers. Incorporating racial differences in risk factors did not fully explain the much higher lifetime incidence of ESRD among African Americans. Thus, to calibrate the model, we applied a 20% increase in the rate of GFR decline at stage 3 and a 60% increase in the rate of GFR decline at stage 4, which resulted in a model that closely reflects lifetime ESRD incidence among African Americans. Compared with usual care, screening African Americans for microalbuminuria at 10-, 5-, 2-, and 1-year intervals had incremental cost-effectiveness ratios of $9000, $11,000, $19,000, and $35,000 per quality-adjusted life year, respectively. Incremental cost-effectiveness ratios for the same screening intervals were higher for non-African Americans: $17,000, $23,000, $44,000, and $81,000 per quality-adjusted life year, respectively. In summary, these models suggest that screening African Americans for microalbuminuria at either 5- or 10-year intervals is highly cost-effective.


Assuntos
Afro-Americanos/estatística & dados numéricos , Albuminúria/diagnóstico , Falência Renal Crônica/etnologia , Programas de Rastreamento , Albuminúria/economia , Albuminúria/etnologia , Análise Custo-Benefício , Progressão da Doença , Humanos , Falência Renal Crônica/economia , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Modelos Teóricos
14.
Swiss Med Wkly ; 142: w13508, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22307760

RESUMO

PRINCIPLES: Current evidence indicates that chronic kidney disease (CKD) can be detected by simple laboratory tests. This study aimed to evaluate the cost-effectiveness of microalbuminuria screening and subsequent treatment in different populations. METHODS: Cost-effectiveness of microalbuminuria screening in a cohort of simulated subjects aged ≥50 years was assessed using a validated microsimulation model. Microalbuminuria screening was simulated for 1-, 2-, 5- or 10-year intervals and for 3 groups: diabetes (DM), hypertension but no diabetes (HTN), and no diabetes or hypertension. Positive microalbuminuria screening was followed by treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). The model outcomes evaluate costs from a health care system perspective. RESULTS: Screening of risk groups is cost-effective at a 2-year interval for the DM group with an incremental cost-effectiveness ratio (ICER) of 54,000 CHF/ Quality-Adjusted-Life-Years (QALY) and at a 5-year interval for the HTN group with an ICER of 33,000 CHF/QALY. Screening of the remaining population is cost-effective at a 10-year interval with an ICER of 34,000 CHF/QALY. The ICER improves with longer screening intervals for all groups. A probabilistic sensitivity analysis (PSA) confirmed 2-year, 5-year and 10-year intervals as the most cost-effective for the DM group, the HTN group and the remaining population respectively. CONCLUSIONS: Microalbuminuria screening can be considered cost-effective starting at the age of 50 years at bi-annual intervals for subjects with diabetes, at 5-year intervals for subjects with hypertension and at 10-year intervals for the remaining population. Our results indicate that early detection and treatment of CKD might lead to optimised patient care, and offer guidance for future implementation of CKD screening programmes.


Assuntos
Albuminúria/diagnóstico , Albuminúria/economia , Programas de Rastreamento/economia , Modelos Econômicos , Adulto , Idoso , Albuminúria/epidemiologia , Análise Custo-Benefício , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Suíça/epidemiologia
15.
Arch Ophthalmol ; 130(5): 607-14, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22232367

RESUMO

OBJECTIVE: To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. DESIGN: Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. RESULTS: Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years(QALYs) by 0.008 (95% credible interval [CrI], 0.005-0.011) and increased costs by $94 (95% CrI, −$35 to$222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and$12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. CONCLUSIONS: The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, anew policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective.


Assuntos
Diabetes Mellitus/economia , Medicare/economia , Midriáticos/administração & dosagem , Pupila/efeitos dos fármacos , Seleção Visual/economia , Acuidade Visual/fisiologia , Idoso , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Modelos Econômicos , Método de Monte Carlo , Oftalmologia/economia , Exame Físico/economia , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos
16.
Hepatology ; 55(4): 988-97, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22121109

RESUMO

UNLABELLED: We estimated the global burden of hepatitis E virus (HEV) genotypes 1 and 2 in 2005. HEV is an emergent waterborne infection that causes source-originated epidemics of acute disease with a case fatality rate thought to vary by age and pregnancy status. To create our estimates, we modeled the annual disease burden of HEV genotypes 1 and 2 for 9 of 21 regions defined for the Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2010 Study), which represent 71% of the world's population. We estimated the seroprevalence of anti-HEV antibody and annual incidence of infection for each region using data from 37 published national studies and the DISMOD 3, a generic disease model designed for the GBD Study. We converted incident infections into three mutually exclusive results of infection: (1) asymptomatic episodes, (2) symptomatic disease, and (3) death from HEV. We also estimated incremental cases of stillbirths among infected pregnant women. For 2005, we estimated 20.1 (95% credible interval [Cr.I.]: 2.8-37.0) million incident HEV infections across the nine GBD Regions, resulting in 3.4 (95% Cr.I.: 0.5-6.5) million symptomatic cases, 70,000 (95% Cr.I.: 12,400-132,732) deaths, and 3,000 (95% Cr.I.: 1,892-4,424) stillbirths. We estimated a probability of symptomatic illness given infection of 0.198 (95% Cr.I.: 0.167-0.229) and a probability of death given symptomatic illness of 0.019 (95% Cr.I.: 0.017-0.021) for nonpregnant cases and 0.198 (95% Cr.I.: 0.169-0.227) for pregnant cases. CONCLUSION: The model was most sensitive to estimates of age-specific incidence of HEV disease.


Assuntos
Genótipo , Saúde Global , Vírus da Hepatite E/genética , Hepatite E/epidemiologia , Adolescente , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Ásia/epidemiologia , Criança , Pré-Escolar , Feminino , Hepatite E/sangue , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Soroepidemiológicos , Adulto Jovem
17.
J Pediatr Ophthalmol Strabismus ; 49(3): 146-55; quiz 145, 156, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21877675

RESUMO

PURPOSE: To estimate the incremental cost-effective-ness of amblyopia screening at preschool and kindergarten, the costs and benefits of three amblyopia screening scenarios were compared to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. METHODS: A probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from two state programs was programmed. The probability was calculated that no screening and each of the three interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. RESULTS: Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective at a WTP between $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective at a WTP between $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. CONCLUSION: All three screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies.


Assuntos
Ambliopia/diagnóstico , Ambliopia/economia , Modelos Econômicos , Seleção Visual/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise Custo-Benefício , Financiamento Pessoal , Custos de Cuidados de Saúde , Humanos , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
18.
Ann Intern Med ; 156(4): 263-70, 2012 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-22056542

RESUMO

BACKGROUND: In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection. OBJECTIVE: To estimate the cost-effectiveness of birth-cohort screening. DESIGN: Cost-effectiveness simulation. DATA SOURCES: National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources. TARGET POPULATION: Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually. TIME HORIZON: Lifetime. PERSPECTIVE: Societal, health care. INTERVENTION: One-time antibody test of 1945-1965 birth cohort. OUTCOME MEASURES: Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER). RESULTS OF BASE-CASE ANALYSIS: Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved. RESULTS OF SENSITIVITY ANALYSIS: The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states. LIMITATION: Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce. CONCLUSION: Birth-cohort screening for HCV in primary care settings was cost-effective. PRIMARY FUNDING SOURCE: Division of Viral Hepatitis, Centers for Disease Control and Prevention.


Assuntos
Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/diagnóstico , Programas de Rastreamento/economia , Atenção Primária à Saúde/economia , Idoso , Antivirais/uso terapêutico , Estudos de Coortes , Simulação por Computador , Contraindicações , Análise Custo-Benefício , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/mortalidade , Humanos , Interferon-alfa/uso terapêutico , Cadeias de Markov , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Ribavirina/uso terapêutico , Sensibilidade e Especificidade , Estados Unidos/epidemiologia
19.
Prev Chronic Dis ; 8(6): A136, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22005629

RESUMO

INTRODUCTION: By improving lipid standardization, the Centers for Disease Control and Prevention's (CDC's) Lipid Standardization Program and Cholesterol Reference Method Laboratory Network have contributed to the marked reduction in heart disease deaths since 1980. The objective of this study was to estimate the benefits (ie, the value of reductions in heart disease deaths) and costs attributable to these lipid standardization programs. METHODS: We developed a logic model that shows how the inputs and activities of the lipid standardization programs produce short- and medium-term outcomes that in turn lead to improvements in rates of cardiovascular disease and death. To calculate improvements in long-term outcomes, we applied previous estimates of the change in heart disease deaths between 1980 and 2000 that was attributable to statin treatment and to the reduction in total cholesterol during the period. Experts estimated the share of cholesterol reduction that could be attributed to lipid standardization. We applied alternative assumptions about the value of a life-year saved to estimate the value of life-years saved attributable to the programs. RESULTS: Assuming that 5% of the cholesterol-related benefits were attributable to the programs and a $113,000 value per life-year, the annual benefit attributable to the programs was $7.6 billion. With more conservative assumptions (0.5% of cholesterol-related benefits attributable to the programs and a $50,000 value per life-year), the benefit attributable to the programs was $338 million. In 2007, the CDC lipid standardization programs cost $1.7 million. CONCLUSION: Our estimates suggest that the benefits of CDC's lipid standardization programs greatly exceed their costs.


Assuntos
Doenças Cardiovasculares/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Lipídeos/normas , Avaliação de Programas e Projetos de Saúde , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Causas de Morte/tendências , Análise Custo-Benefício , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipídeos/sangue , Modelos Logísticos , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Padrões de Referência , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
Health Serv Res ; 46(5): 1534-61, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21492158

RESUMO

OBJECTIVE: To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30-84 with diabetes but no or minimal diabetic retinopathy. DATA SOURCES: United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule. STUDY DESIGN: Cost-effectiveness Monte Carlo simulation. DATA COLLECTION/EXTRACTION METHODS: Literature review, analysis of existing surveys. PRINCIPAL FINDINGS: Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels. CONCLUSIONS: Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation.


Assuntos
Análise Custo-Benefício , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/economia , Telemedicina/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/epidemiologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Inquéritos Nutricionais , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...