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1.
BMJ Open ; 11(9): e049581, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489283

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model. METHODS: Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty. RESULTS: All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively. CONCLUSIONS: All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , China , Colonoscopia , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Humanos , Cadeias de Markov , Programas de Rastreamento , Sangue Oculto , Anos de Vida Ajustados por Qualidade de Vida
2.
BMC Public Health ; 21(1): 1619, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488700

RESUMO

BACKGROUND: To evaluate global burden of refraction disorders by year, age, region, gender, socioeconomic status and other national characteristics in terms of disability adjusted life years (DALYs) and prevalence from Global Burden of Disease (GBD) study 2019 and World Bank Open Data 2019. METHODS: Global, regional, and national DALY numbers, crude DALY rates, age-standardized DALY and prevalence rates of refraction disorders were acquired from the GBD study 2019. Mobile cellular subscriptions, urban population, GDP per capita, access to electricity and total fertility rate were obtained from the World Bank to explore the factors that influenced the health burden of refraction disorders. Kruskal-Wallis test, linear regression and multiple linear regression were performed to evaluate the associations between the health burden with socioeconomic levels and other national characteristics. Wilcoxon Signed-Rank Test was used to investigate the gender disparity. RESULTS: Globally, age-standardized DALY rates of refraction disorders decreased from 88.9 (95% UI: 60.5-120.3) in 1990 to 81.5 (95% UI: 55.0-114.8) in 2019, and might fall to 73.16 (95% UI: 67.81-78.51) by 2050. Age-standardized prevalence rates would also reduce to 1830 (95% UI: 1700-1960) by 2050, from 2080 (95% UI: 1870-2310) in 1990 to 1960 (95% UI: 1750-2180) in 2019. In low SDI region, age-standardized DALY rates (equation: Y = 114.05*X + 27.88) and prevalence rates (equation: Y = 3171.1*X + 403.2) were positively correlated with SDI in linear regression respectively. East Asia had the highest blindness rate caused by refraction disorders in terms of age-standardized DALY rates (11.20, 95% UI: 7.38-16.36). Gender inequality was found among different age groups and SDI regions. CONCLUSION: Health burden of refraction disorders decreased in recent years, and may continue to alleviate in the next three decades. Older ages, females and lower socioeconomic status were associated with higher refraction disorders health burden.


Assuntos
Pessoas com Deficiência , Carga Global da Doença , Idoso , Feminino , Saúde Global , Humanos , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida
3.
Sci Rep ; 11(1): 17787, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493774

RESUMO

Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/economia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/economia , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/economia , Alanina/uso terapêutico , COVID-19/diagnóstico , COVID-19/economia , COVID-19/mortalidade , COVID-19/virologia , Tomada de Decisão Clínica/métodos , Simulação por Computador , Análise Custo-Benefício , Dexametasona/economia , Dexametasona/uso terapêutico , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Oxigênio/economia , Anos de Vida Ajustados por Qualidade de Vida , Respiração Artificial/economia , SARS-CoV-2 , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
BMC Health Serv Res ; 21(1): 916, 2021 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482831

RESUMO

BACKGROUND: Early identification of people at elevated risk of type 2 diabetes (T2D) is an important step in preventing or delaying its onset. Pharmacies can serve as a significant channel to reach these people. This study aimed to assess the potential health economic impact of screening and recruitment services in pharmacies in referring people to preventive interventions. METHODS: A decision analytic model was constructed to perform a cost-utility analysis of the expected national health economic consequences (in terms of costs and quality-adjusted life years, QALYs) of a hypothetical pharmacy-based service where people screened and recruited through pharmacies would participate in a digital lifestyle program. Cost-effectiveness was considered in terms of net monetary benefit (NMB). In addition, social return on investment (SROI) was calculated as the ratio of the intervention and recruitment costs and the net present value of expected savings. Payback time was the time taken to reach the break-even point in savings. In the base scenario, a 20-year time horizon was applied. Probabilistic and deterministic sensitivity analyses were applied to study robustness of the results. RESULTS: In the base scenario, the expected savings from the pharmacy-based screening and recruitment among the reached target cohort were 255.3 m€ (95% CI - 185.2 m€ to 717.2 m€) in pharmacy visiting population meaning 1412€ (95% CI - 1024€ to 3967€) expected savings per person. Additionally, 7032 QALYs (95% CI - 1344 to 16,143) were gained on the population level. The intervention had an NMB of 3358€ (95% CI - 1397€ to 8431€) using a cost-effectiveness threshold of 50,000 €/QALY. The initial costs were 122.2 m€ with an SROI of 2.09€ (95% CI - 1.52€ to 5.88€). The expected payback time was 10 and 8 years for women and men, respectively. Results were most sensitive for changes in effectiveness of the intervention and selected discount rate. CONCLUSIONS: T2D screening and recruitment to prevention programs conducted via pharmacies was a dominant option providing both cost savings and QALY gains. The highest savings can be potentially reached by targeting recruitment at men at elevated risk of T2D.


Assuntos
Diabetes Mellitus Tipo 2 , Farmácias , Farmácia , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida
5.
Front Public Health ; 9: 686700, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485216

RESUMO

Mexico is one of the countries most affected by the COVID-19 disease. Although there is vast information on the disease, there still are unknown data on the societal and economic cost of the pandemic. To estimate this impact, the disability-adjusted life years (DALYs) can be a useful tool. Objective: To assess the DALYs due to COVID-19 in Mexico. Methods: We used the data released by the Mexican Ministry of Health to estimate the DALYs by the sum of the years of life lived with disability (YLDs) and the years of life lost (YLLs). Results: A total of 1,152,885 confirmed cases and 324,570 suspected cases of COVID-19 have been registered. Half of the cases were men, with a median age of 43.4 ± 16.9 years. About 8.3% died. A total of 39,202 YLDs were attributable to COVID-19. The total YLLs caused by COVID-19 were 2,126,222. A total of 2,165,424.5 DALYs for COVID-19 were estimated. The total DALYs were the highest in people between 50 and 59 years. The DALYs for each COVID-19 case were the highest in individuals between 60 and 79 years. Conclusion: The DALYs generated by the COVID-19 represent a more significant disease burden than that reported for other causes, such as the 2009 H1N1 influenza pandemic. Although it impacts all age groups in terms of disability, the most affected group are people over 50 years of age, whose risk of death is higher.


Assuntos
COVID-19 , Vírus da Influenza A Subtipo H1N1 , Adulto , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Anos de Vida Ajustados por Qualidade de Vida , SARS-CoV-2
6.
Artigo em Inglês | MEDLINE | ID: mdl-34444091

RESUMO

Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3-5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider's perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members' HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.


Assuntos
Neoplasias Colorretais , Qualidade de Vida , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Análise Custo-Benefício , Estudos Transversais , Testes Genéticos , Humanos , Anos de Vida Ajustados por Qualidade de Vida
7.
AMA J Ethics ; 23(8): E601-606, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34459726

RESUMO

Before updating any willingness-to-pay (WTP) per quality-adjusted life-year (QALY) threshold, a few points must be recognized. Ethical justification for using WTP thresholds and QALYs lies in incorporating the preferences of those whose treatment could be affected by resulting resource allocations. For WTP thresholds, such justification depends on the sufficiency of a match between a group-members of an insurance pool from which health care payments and services are drawn-and those whose health care is potentially affected. For QALYs, that justification depends on eliciting the right persons' preferences to inform quality-adjustment ratings; on balance it should be from those who have the conditions being rated. Because the value of simply being alive is not adequately accounted for, how life extension and quality improvement are combined in constructing the QALY is its most significant shortcoming as a measure. Although updating WTP thresholds might be better than not updating them, this manuscript suggests why drawing on a less fundamentally flawed concept than the conventional QALY is more important.


Assuntos
Atenção à Saúde , Financiamento Pessoal , Análise Custo-Benefício , Humanos , Anos de Vida Ajustados por Qualidade de Vida
8.
Artigo em Inglês | MEDLINE | ID: mdl-34444222

RESUMO

BACKGROUND: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. METHODS: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. RESULTS: The CUA produced an incremental cost-effectiveness ratio (ICER) of -GBP 23,278.51 (-EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. CONCLUSION: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of -GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.


Assuntos
Apendicite , Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Análise Custo-Benefício , Humanos , Estudos Prospectivos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Medicina Estatal
9.
Sports Med Arthrosc Rev ; 29(3): e24-e33, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398119

RESUMO

Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.


Assuntos
Lesões do Menisco Tibial/epidemiologia , Grupo com Ancestrais do Continente Africano , Fatores Etários , Lesões do Ligamento Cruzado Anterior/complicações , Traumatismos em Atletas/etiologia , Índice de Massa Corporal , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Traumatismos Ocupacionais/etiologia , Osteoartrite do Joelho/complicações , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Ruptura/epidemiologia , Ruptura/etiologia , Fatores Sexuais , Fumar/efeitos adversos , Fraturas da Tíbia/complicações , Lesões do Menisco Tibial/economia , Lesões do Menisco Tibial/etiologia , Lesões do Menisco Tibial/terapia
10.
BMJ Open ; 11(8): e049619, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408053

RESUMO

OBJECTIVES: From the beginning of the COVID-19 pandemic, clinical practice and research globally have centred on the prevention of transmission and treatment of the disease. The pandemic has had a huge impact on the economy and stressed healthcare systems worldwide. The present study estimates disability-adjusted life years (DALYs), years of potential productive life lost (YPPLL) and cost of productivity lost (CPL) due to premature mortality and absenteeism secondary to COVID-19 in the state of Kerala, India. SETTING: Details on sociodemographics, incidence, death, quarantine, recovery time, etc were derived from public sources and the Collective for Open Data Distribution-Keralam. The working proportion for 5-year age-gender cohorts and the corresponding life expectancy were obtained from the 2011 Census of India. PRIMARY AND SECONDARY OUTCOME MEASURES: The impact of the disease was computed through model-based analysis on various age-gender cohorts. Sensitivity analysis was conducted by adjusting six variables across 21 scenarios. We present two estimates, one until 15 November 2020 and later updated to 10 June 2021. RESULTS: Severity of infection and mortality were higher among the older cohorts, with men being more susceptible than women in most subgroups. DALYs for males and females were 15 954.5 and 8638.4 until 15 November 2020, and 83 853.0 and 56 628.3 until 10 June 2021. The corresponding YPPLL were 1323.57 and 612.31 until 15 November 2020, and 6993.04 and 3811.57 until 10 June 2021, and the CPL (premature mortality) were 263 780 579.94 and 41 836 001.82 until 15 November 2020, and 1 419 557 903.76 and 278 275 495.29 until 10 June 2021. CONCLUSIONS: Most of the COVID-19 burden was contributed by years of life lost. Losses due to YPPLL were reduced as the impact of COVID-19 infection was lesser among the productive cohorts. The CPL values for individuals aged 40-49 years old were the highest. These estimates provide the data necessary for policymakers to work on reducing the economic burden of COVID-19 in Kerala.


Assuntos
COVID-19 , Pandemias , Adulto , Efeitos Psicossociais da Doença , Feminino , Humanos , Índia/epidemiologia , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , SARS-CoV-2
11.
BMC Psychiatry ; 21(1): 402, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389017

RESUMO

BACKGROUND: Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. METHODS: An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. RESULTS: There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. CONCLUSIONS: The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. TRIAL REGISTRATION: The trial was registered in the Netherlands Trial Register ( NTR3715 ).


Assuntos
Doença das Coronárias , Transtorno Depressivo Maior , Diabetes Mellitus Tipo 2 , Doença das Coronárias/complicações , Doença das Coronárias/prevenção & controle , Análise Custo-Benefício , Depressão/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Humanos , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida
13.
Lancet HIV ; 8(9): e581-e590, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34370977

RESUMO

BACKGROUND: In the USA, Black and Hispanic or Latinx individuals continue to be disproportionately affected by HIV. Applying a distributional cost-effectiveness framework, we estimated the cost-effectiveness and epidemiological impact of two combination implementation approaches to identify the approach that best meets the dual objectives of improving population health and reducing racial or ethnic health disparities. METHODS: We adapted a dynamic, compartmental HIV transmission model to characterise HIV micro-epidemics in six US cities: Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle. We considered combinations of 16 evidence-based interventions to diagnose, treat, and prevent HIV transmission according to previously documented levels of scale-up. We then identified optimal combination strategies for each city, with the distribution of each intervention implemented according to existing service levels (proportional services approach) and the racial or ethnic distribution of new diagnoses (between Black, Hispanic or Latinx, and White or other ethnicity individuals; equity approach). We estimated total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios of strategies implemented from 2020 to 2030 (health-care perspective; 20-year time horizon; 3% annual discount rate). We estimated three measures of health inequality (between-group variance, index of disparity, Theil index), incidence rate ratios, and rate differences for the selected strategies under each approach. FINDINGS: In all cities, optimal combination strategies under the equity approach generated more QALYs than those with proportional services, ranging from a 3·1% increase (95% credible interval [CrI] 1·4-5·3) in New York to more than double (101·9% [75·4-134·6]) in Atlanta. Compared with proportional services, the equity approach delivered lower costs over 20 years in all cities except Los Angeles; cost reductions ranged from $22·9 million (95% CrI 5·3-55·7 million) in Seattle to $579·8 million (255·4-940·5 million) in Atlanta. The equity approach also reduced incidence disparities and health inequality measures in all cities except Los Angeles. INTERPRETATION: Equity-focused HIV combination implementation strategies that reduce disparities for Black and Hispanic or Latinx individuals can significantly improve population health, reduce costs, and drive progress towards Ending the HIV Epidemic goals in the USA. FUNDING: National Institute on Drug Abuse.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Equidade em Saúde/economia , Adolescente , Adulto , Cidades/epidemiologia , Análise Custo-Benefício , Grupos Étnicos , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Disparidades nos Níveis de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos/epidemiologia , Adulto Jovem
14.
Spine (Phila Pa 1976) ; 46(17): 1165-1171, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34334684

RESUMO

STUDY DESIGN: General population utility valuation study. OBJECTIVE: The aim of this study was to develop a technique for calculating utilities from the Spine Oncology Study Group Outcomes Questionnaire v2.0 (SOSGOQ2.0). SUMMARY OF BACKGROUND DATA: The ability to calculate quality-adjusted life-years (QALYs) for metastatic spine disease would enhance treatment decision-making and facilitate economic analysis. QALYs are calculated using utilities. METHODS: Using a hybrid concept-retention and factorial analysis shortening approach, we first shortened the SOSGOQ2.0 to eight items (SOSGOQ-8D). This was done to lessen the cognitive burden of the utility valuation exercise. A general population sample of 2730 adults was then asked to evaluate 12 choice sets based on SOSGOQ-8D health states in a Discrete Choice Experiment. A utility scoring rubric was then developed using a mixed multinomial-logit regression model. RESULTS: We were able to reduce the SOSGOQ2.0 to an SOSGOQ-8D with a mean error of 0.003 and mean absolute error of 3.078 compared to the full questionnaire. The regression model demonstrated good predictive performance and was used to develop a utility scoring rubric. Regression results revealed that participants did not regard all SOSGOQ-8D items as equally important. CONCLUSION: We provide a simple technique for converting the SOSGOQ2.0 to utilities. The ability to evaluate QALYs in metastatic spine disease will facilitate economic analysis and patient counseling. We also quantify the importance of individual SOSGOQ-8D items. Clinicians should heed these findings and offer treatments that maximize function in the most important items.Level of Evidence: 3.


Assuntos
Qualidade de Vida , Coluna Vertebral , Adulto , Técnicas de Apoio para a Decisão , Nível de Saúde , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários
15.
Lung Cancer ; 159: 153-161, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34352591

RESUMO

OBJECTIVES: Robust economic evaluations are needed to identify efficient strategies for lung cancer prevention that combine brief and intensive smoking cessation intervention programmes with screening using low-dose computed tomography (LDCT) at different ages, frequencies, and coverages. We aimed to assess the cost-effectiveness of smoking cessation approaches combined with lung cancer screening in the European context at a population level from a societal perspective. MATERIALS AND METHODS: A microsimulation model that describes the natural history of lung cancer and incorporates several prevention strategies was developed. Discounted lifetime QALYs and costs at a rate of 3% were used to calculate incremental cost-effectiveness ratios, defined as additional costs in 2017 Euros per QALY gained. RESULTS: Smoking cessation interventions reduce the incidence of lung cancer by 8%-46% and are consistently more effective and cost-effective when starting at younger ages. Screening reduces lung cancer mortality by 1%-24% and is generally less effective and more costly than smoking cessation interventions. The most cost-effective strategy would be to implement intensive smoking cessation interventions at ages 35, 40 and 45, combined with screening every three years between the ages of 55 and 65. CONCLUSIONS: Combining smoking cessation interventions with LDCT screening is a very attractive prevention strategy that substantially diminishes the burden of lung cancer. These combined prevention strategies, especially when providing several intensive interventions for smoking cessation at early ages, are more cost-effective than both approaches separately and allow for a more intensified LDCT without losing efficiency.


Assuntos
Neoplasias Pulmonares , Abandono do Hábito de Fumar , Adulto , Idoso , Análise Custo-Benefício , Detecção Precoce de Câncer , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/prevenção & controle , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida
16.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(8): 958-964, 2021 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-34445833

RESUMO

Objective: To examine the trend of stroke disease burden and its main risk-attributable factors in China and regions with different Socio-Demographic Index (SDI) from 1990 to 2017. Methods: With 2017 Global Burden of Disease (GBD) data, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted of life years (DALYs) were applied to describe the disease burden and major risk factors of stroke in China and different SDI regions from 1990 to 2017, and to analyze the changing trend of the disease burden and major risk factors of stroke. Results: From 1990 to 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China showed an increasing trend and the rate of change was 126.5%, 14.6%, and 24.4%, respectively. In 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China were 502.6 per 100 000, 2 633.1 per 100 000 and 3 135.7 per 100 000, respectively. Among them, the YLD crude rate, YLL crude rate, and DALY crude rate of stroke were the highest in the ≥70 age group, which were 2 617.2 per 100 000, 16 789.4 per 100 000 and 19 406.6 per 100 000, respectively. The YLD crude rate in male was 475.5 per 100 000, which was slightly lower than that of female (530.9 per 100 000), while the DALY crude rate and YLL crude rate for stroke were 3 657.1 per 100 000 and 3 181.7 per 100 000, respectively, which were significantly higher than that of female (2 591.8 per 100 000 and 2 060.9 per 100 000). Compared with regions with different SDI, the age standardized YLD rate, the age standardized YLL rate, the age standardized DALY rate in China were all at a high level. Among them, the age-standardized YLD rate increased from 286.2 per 100 000 to 374.5 per 100 000, with a rate of change of 30.9%; the age-standardized YLL rate decreased from 3 215.6 per 100 000 to 1 967.8 per 100 000, with a rate of change of -38.8%; the age-standardized DALY rate increased from 3 501.8 per 100 000 to 2 342.3 per 100 000, with a rate of change of -33.1%. The top five risk factors for stroke in China were hypertension, excessive sodium intake, insufficient fruit intake, insufficient cereal intake, and smoking in 1990 and 2017. High Body-Mass Index and Alcohol Use's rankings rose from the 9th and 10th in 1990 to the 6th and 7th in 2017, respectively. Conclusion: The burden of stroke disease in China is at a high level, and hypertension is the primary risk factor.


Assuntos
Pessoas com Deficiência , Acidente Vascular Cerebral , China/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Carga Global da Doença , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/epidemiologia
17.
BMC Gastroenterol ; 21(1): 276, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229619

RESUMO

BACKGROUND: Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. METHODS: Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. RESULTS: TCBT cost £956 more than TAU (95% CI, £601-£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, - £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, - £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, - £448 to £2580). CONCLUSIONS: TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).


Assuntos
Terapia Cognitivo-Comportamental , Síndrome do Intestino Irritável , Autogestão , Adulto , Análise Custo-Benefício , Inglaterra , Humanos , Internet , Síndrome do Intestino Irritável/terapia , Anos de Vida Ajustados por Qualidade de Vida
18.
BMJ Open ; 11(7): e046742, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210726

RESUMO

OBJECTIVES: This study analyses the cost-effectiveness of annual low-dose CT (LDCT) screening of high-risk cancer populations in Chinese urban areas. DESIGN: We used a Markov model to evaluate LDCT screening from a sociological perspective. SETTING: The data from two large lung cancer screening programmes in China were used. PARTICIPANTS: The sample consisted of 100 000 smokers who underwent annual LDCT screening until age 76. INTERVENTION: The study comprises five screening strategies, with the initial screening ages in both the screening strategies and their corresponding non-screening strategies being 40, 45, 50, 55 and 60 years, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES: The incremental cost-effectiveness ratio (ICER) between screening and non-screening strategies at the same initial age was evaluated. RESULTS: In the baseline scenario, compared with those who were not screened, the specific mortality from lung cancer decreased by 18.52%-23.13% among those who underwent screening. The ICER of LDCT screening ranges from US$13 056.82 to US$15 736.06 per quality-adjusted life year, which is greater than one but less than three times the gross domestic product per capita in China. An initial screening age of 55 years is the most cost-effective strategy. CONCLUSIONS: Baseline analysis shows that annual LDCT screening of heavy smokers in Chinese urban areas is likely to be cost-effective. The sensitivity analysis reveals that sensitivity, specificity and the overdiagnosis rate influence the cost-effectiveness of LDCT screening. All scenarios tested demonstrate cost-effectiveness, except for the combination of worst values of sensitivity, specificity and overdiagnosis. Therefore, the cost-effectiveness of a screening strategy depends on the performance of LDCT screenings.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Adulto , Idoso , China/epidemiologia , Análise Custo-Benefício , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Tomografia Computadorizada por Raios X
19.
Adv Ther ; 38(8): 4354-4365, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34241780

RESUMO

INTRODUCTION: Cemiplimab may significantly increase overall survival in the first-line treatment of advanced non-small cell lung cancer (NSCLC) with a PD-L1 level of at least 50%. Therefore, there is a need to consider the cost-effectiveness of using this therapy for this indication. METHODS: This Markov model was built to estimate the cost and effectiveness of cemiplimab vs. chemotherapy in the first-line treatment of advanced NSCLC based on the data from the EMPOWER-Lung 1 trial. Life-years (LYs), quality-adjusted LYs (QALYs) and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed. RESULTS: Treatment of advanced NSCLC with cemiplimab added 0.546 QALYs (1.492 LYs) and resulted in an incremental cost of $22,069.804 compared with chemotherapy, which was associated with an incremental cost-effectiveness ratio of $40,390.412 per QALY gained. The results of one-way sensitivity analysis found that the cost of cemiplimab was the most sensitive factor in our study. The probabilistic sensitivity analysis showed that the probability of cemiplimab being cost-effective was 100%. The subgroup analysis demonstrated that high PD-L1 expression (≥ 90%, > 60 to < 90% and ≥ 50 to ≤ 60%) also kept the incremental cost-effectiveness stable at $63,415.2450 per QALY, $61,896.446 per QALY and $-71,921.259 per QALY. CONCLUSION: From the perspective of US payers, cemiplimab is cost-effective in the first-line treatment of advanced NSCLC at the willingness-to-pay threshold of $150,000 per QALY.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica , Antígeno B7-H1 , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Análise Custo-Benefício , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida
20.
BMC Geriatr ; 21(1): 440, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34311698

RESUMO

BACKGROUND: Clinical studies indicate that strength-balance training for active fall prevention can prevent fractures in older people. The present modelling study evaluates the cost-effectiveness of fall prevention exercise (FPE) provided to independently living older people compared to no intervention in Germany. METHOD: We designed a Markov model to evaluate the cost-effectiveness of a group-based FPE-program provided to independently living people ≥75 years from the perspective of the German statutory health insurance (SHI). Input data was obtained from public databases, clinical trials and official statistics. The incremental cost-effectiveness ratio (ICER) was presented as costs per avoided hip fracture. Additionally, we performed deterministic and probabilistic sensitivity analyses and, estimated monetary consequences for the SHI in a budget impact analysis (BIA). RESULTS: For women, the costs per hip fracture avoided amounted to €52,864 (men: €169,805). Results of deterministic and probabilistic sensitivity analyses confirmed the robustness of the results. According to the BIA, for the reimbursement of FPE additional costs of €3.0 million (women) and €7.8 million (men) are expected for the SHI. CONCLUSIONS: Group-based FPE appears to be no cost-effective option to prevent fall-related hip fractures in independently living elderly. To allow a more comprehensive statement on the cost effectiveness of FPE fracture types other than hip should be increasingly evaluated in clinical trials.


Assuntos
Fraturas do Quadril , Vida Independente , Idoso , Análise Custo-Benefício , Exercício Físico , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida
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