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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5394-5397, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019200

RESUMO

The breast cancer is a prevalent problem that undermines quality of patients' lives and causes significant impacts on psychosocial wellness. Advanced sensing provides unprecedented opportunities to develop smart cancer care. The available sensing data captured from individuals enable the extraction of information pertinent to the breast cancer conditions to construct efficient and personalized intervention and treatment strategies. This research develops a novel sequential decision-making framework to determine optimal intervention and treatment planning for breast cancer patients. We design a Markov decision process (MDP) model for both objectives of intervention and treatment costs as well as quality adjusted life years (QALYs) with the data-driven and state-dependent intervention and treatment actions. The state space is defined as a vector of age, health status, prior intervention, and treatment plans. Also, the action space includes wait, prophylactic surgery, radiation therapy, chemotherapy, and their combinations. Experimental results demonstrate that prophylactic mastectomy and chemotherapy are more effective than other intervention and treatment plans in minimizing the expected cancer cost of 25 to 60 years-old patient with in-situ stage of cancer. However, wait policy leads to an optimal quality of life for a patient with the same state. The proposed MDP framework can also be generally applicable to a variety of medical domains that entail evidence-based decision making.


Assuntos
Neoplasias da Mama , Adulto , Neoplasias da Mama/terapia , Humanos , Cadeias de Markov , Mastectomia , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
3.
J Assoc Physicians India ; 68(10): 60-65, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32978928

RESUMO

Rheumatic heart disease (RHD) disables millions in Asia and Africa. Epidemiological data and clinical studies in India have reported a significant decline in its prevalence in last century. Global Burden of Disease (GBD) study estimated that RHD in India led to 395/100000 disability adjusted life years (DALYs) and 9.2/100000 deaths in 1990. This declined to 270/100000 and 7.9/100000, respectively, in 2017. School-based epidemiological studies in India have reported decline in clinically diagnosed RHD. On the other hand, GBD study has reported that in terms of absolute numbers, India contributes to one-third of global RHD burden. RHD in 1990 led to 3.44 million DALYs and 80,470 deaths which has increased to 3.73 million DALYs and 108,460 deaths in 2017. India Disease Burden Initiative has reported high RHD burden in many less developed states of the country, e.g., Bihar, Odisha, Assam, Chhattisgarh, Uttar Pradesh, etc. Echocardiographic epidemiology studies have reported high burden of subclinical RHD. Significant proportions of patients in hospital-based echocardiographic clinics have RHD and it contributes to 25-45% of cardiac surgeries in government hospitals. The continuing burden of RHD needs proper public health and clinical response.


Assuntos
Cardiopatia Reumática/epidemiologia , África , Ásia , Carga Global da Doença , Humanos , Índia/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
4.
Cuad Bioet ; 31(102): 151-165, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910669

RESUMO

The public health crisis caused by COVID-19 disease has bring again to the public arena the old debate of the role in decision-making process of politics and science. In this paper we analyze, in the context of the current pandemics, how politics has left a stellar role for science, either because science has anticipated in its proposals to politics, or because politics has opted for it as a premeditated strategy. The references to the opinion of scientists as a decision-making criterion or, furthermore, their presence as true spokesmen for authority have been so frequent. This means rediscovering science and health as instruments of power, in terms that remind us of what Foucault denounced almost fifty years ago with his Biopolitics.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Política , Ciência , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Democracia , Teoria Ética , Política de Saúde , Prioridades em Saúde , Recursos em Saúde/provisão & distribução , Humanos , Pandemias/ética , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Poder Psicológico , Saúde Pública , Anos de Vida Ajustados por Qualidade de Vida , Alocação de Recursos/ética , Papel (figurativo) , Valores Sociais , Sociedades Científicas , Espanha , Vacinas Virais
5.
BMC Public Health ; 20(1): 1461, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993585

RESUMO

BACKGROUND: The aim of this study is to quantify the burden caused by viral hepatitis in China from 1990 to 2016. METHODS: Data from the GBD 2016 study were extracted to calculate incidence, prevalence and disability-adjusted life years (DALYs). Trends in DALYs were assessed in 33 provinces/regions. RESULTS: From 1990 to 2016, the total incidence of hepatitis decreased by 88.5%. However, the prevalence of hepatitis (counts in thousands), increased by 37.6% from 153,856 (95% UI: 136,047-172,319) in 1990 to 211,721 (95% UI: 179,776-240,981) in 2016, with age-standardized prevalence rates changing slightly. The number and age-standardized rates of prevalence increased by 35.9 and 1.6% for hepatitis B, respectively, and by 81.8 and 30.4% for hepatitis C. Guangxi, Guangdong and Hainan had the highest age-standardized prevalence rates (≥16,500 per 100,000). Tibet, Qinghai and Gansu had the highest age-standardized DALYs rates (≥40 per 100,000). The largest absolute number of DALYs was observed in the 15-49 year age group in 2016. The highest rate of DALYs occurred in males aged 50-69 years and in females aged ≧70 years. CONCLUSION: The incidence and DALYs of viral hepatitis decreased dramatically from 1990 to 2016. However, the prevalence still remains at a high level, which may result in heavy burdens in the future.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Carga Global da Doença/estatística & dados numéricos , Hepatite/epidemiologia , Idoso , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Sorogrupo
6.
BMC Public Health ; 20(1): 1475, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993606

RESUMO

BACKGROUND: In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS: We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS: In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS: The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.


Assuntos
Doença Crônica/tendências , Pessoas com Deficiência/estatística & dados numéricos , Promoção da Saúde/organização & administração , Anos de Vida Ajustados por Qualidade de Vida , Cloreto de Sódio na Dieta/efeitos adversos , Adulto , Doenças Cardiovasculares/epidemiologia , Dieta/estatística & dados numéricos , Previsões , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Cloreto de Sódio na Dieta/administração & dosagem
7.
Crit Care Resusc ; 22(3): 191-199, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32900325

RESUMO

OBJECTIVE: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN: Data linkage-based cost-effectiveness analysis. SETTING: New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION: Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES: Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS: Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS: Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.


Assuntos
Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Hidrocortisona/economia , Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , Análise Custo-Benefício , Feminino , Humanos , Masculino , New South Wales , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Choque Séptico/mortalidade
8.
Value Health ; 23(9): 1171-1179, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940235

RESUMO

OBJECTIVES: To evaluate cost-effectiveness of a novel screening strategy using a microRNA (miRNA) blood test as a screen, followed by endoscopy for diagnosis confirmation in a 3-yearly population screening program for gastric cancer. METHODS: A Markov cohort model has been developed in Microsoft Excel 2016 for the population identified to be at intermediate risk (Singaporean men, aged 50-75 years with Chinese ethnicity). The interventions compared were (1) initial screening using miRNA test followed by endoscopy for test-positive individuals and a 3-yearly follow-up screening for test-negative individuals (proposed strategy), and (2) no screening with gastric cancer being diagnosed clinically (current practice). The model was evaluated for 25 years with a healthcare perspective and accounted for test characteristics, compliance, disease progression, cancer recurrence, costs, utilities, and mortality. The outcomes measured included incremental cost-effectiveness ratios, cancer stage at diagnosis, and thresholds for significant variables. RESULTS: The miRNA-based screening was found to be cost-effective with an incremental cost-effectiveness ratio of $40 971/quality-adjusted life-year. Key drivers included test costs, test accuracy, cancer incidence, and recurrence risk. Threshold analysis highlights the need for high accuracy of miRNA tests (threshold sensitivity: 68%; threshold specificity: 77%). A perfect compliance to screening would double the cancer diagnosis in early stages compared to the current practice. Probabilistic sensitivity analysis reported the miRNA-based screening to be cost-effective in >95% of iterations for a willingness to pay of $70 000/quality-adjusted life-year (approximately equivalent to 1 gross domestic product/capita) CONCLUSIONS: The miRNA-based screening intervention was found to be cost-effective and is expected to contribute immensely in early diagnosis of cancer by improving screening compliance.


Assuntos
Detecção Precoce de Câncer/economia , Endoscopia/economia , Programas de Rastreamento/economia , MicroRNAs/economia , Neoplasias Gástricas/diagnóstico , Idoso , Grupo com Ancestrais do Continente Asiático , Análise Custo-Benefício , Detecção Precoce de Câncer/métodos , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento/estatística & dados numéricos , MicroRNAs/sangue , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Sensibilidade e Especificidade , Singapura/epidemiologia , Neoplasias Gástricas/epidemiologia
9.
Value Health ; 23(9): 1180-1190, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940236

RESUMO

OBJECTIVE: Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. METHODS: A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. RESULTS: All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. CONCLUSIONS: Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.


Assuntos
Antivirais/economia , Hepatite C Crônica/tratamento farmacológico , Antivirais/uso terapêutico , Análise Custo-Benefício , Quimioterapia Combinada , Feminino , Hepatite C Crônica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Vietnã
10.
Value Health ; 23(9): 1256-1267, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940244

RESUMO

OBJECTIVES: Patient preferences are increasingly important in informing clinical and policy decisions. Health-state utility values (HSUVs) are quantitative measures of people's preferences over different health states. In schizophrenia, there is no clarity about HSUVs across the symptoms' severity spectrum. This meta-analysis aims to synthesize the literature on HSUVs in people with schizophrenia. METHODS: We searched Medline, PsycInfo, Embase, EconLit, The Cochrane Library, and specialized databases. The studies reporting HSUVs in people with schizophrenia were selected and pooled in a random-effects meta-analysis. The primary outcome was the mean HSUV obtained from participants. RESULTS: A total of 54 studies involving 87 335 participants were included. The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states. Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale. All the estimates resulted in considerable heterogeneity, partially reduced by meta-regression. CONCLUSION: Our findings suggest that the severity of psychotic symptoms has an important effect on HSUVs in schizophrenia, with values mirroring patients with disabling physical conditions such as cancer and stroke. Decision makers should be aware of these results when including people's preferences in trials, models, and policy decisions.


Assuntos
Indicadores Básicos de Saúde , Preferência do Paciente , Qualidade de Vida , Esquizofrenia , Humanos , Anos de Vida Ajustados por Qualidade de Vida
11.
BMC Public Health ; 20(1): 1374, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907562

RESUMO

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Saúde Pública , Vacinação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Economia Médica , Feminino , Hospitalização/economia , Humanos , Lactente , Vírus da Influenza B/classificação , Vírus da Influenza B/imunologia , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano , Incerteza , Vacinação/economia , Adulto Jovem
12.
Value Health ; 23(8): 1027-1033, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828214

RESUMO

OBJECTIVES: In many countries, future unrelated medical costs occurring during life-years gained are excluded from economic evaluation, and benefits of unrelated medical care are implicitly included, leading to life-extending interventions being disproportionately favored over quality of life-improving interventions. This article provides a standardized framework for the inclusion of future unrelated medical costs and demonstrates how this framework can be applied in England and Wales. METHODS: Data sources are combined to construct estimates of per-capita National Health Service spending by age, sex, and time to death, and a framework is developed for adjusting these estimates for costs of related diseases. Using survival curves from 3 empirical examples illustrates how our estimates for unrelated National Health Service spending can be used to include unrelated medical costs in cost-effectiveness analysis and the impact depending on age, life-years gained, and baseline costs of the target group. RESULTS: Our results show that including future unrelated medical costs is feasible and standardizable. Empirical examples show that this inclusion leads to an increase in the ICER of between 7% and 13%. CONCLUSIONS: This article contributes to the methodology debate over unrelated costs and how to systematically include them in economic evaluation. Results show that it is both important and possible to include future unrelated medical costs.


Assuntos
Análise Custo-Benefício/métodos , Gastos em Saúde/estatística & dados numéricos , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores Etários , Inglaterra , Humanos , Expectativa de Vida , Modelos Econométricos , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Medicina Estatal/economia , País de Gales
13.
Value Health ; 23(8): 1096-1108, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828223

RESUMO

OBJECTIVES: Several evidence-based interventions exist for people who misuse opioids, but there is limited guidance on optimal intervention selection. Economic evaluations using simulation modeling can guide the allocation of resources and help tackle the opioid crisis. This study reviews methods employed by economic evaluations using computer simulations to investigate the health and economic effects of interventions meant to address opioid misuse. METHODS: We conducted a systematic mapping review of studies that used simulation modeling to support the economic evaluation of interventions targeting prevention, treatment, or management of opioid misuse or its direct consequences (ie, overdose). We searched 6 databases and extracted information on study population, interventions, costs, outcomes, and economic analysis and modeling approaches. RESULTS: Eighteen studies met the inclusion criteria. All of the studies considered only one segment of the continuum of care. Of the studies, 13 evaluated medications for opioid use disorder, and 5 evaluated naloxone distribution programs to reduce overdose deaths. Most studies estimated incremental cost per quality-adjusted life-years and used health system and/or societal perspectives. Models were decision trees (n = 4), Markov (n = 10) or semi-Markov models (n = 3), and microsimulations (n = 1). All of the studies assessed parameter uncertainty though deterministic and/or probabilistic sensitivity analysis, 4 conducted formal calibration, only 2 assessed structural uncertainty, and only 1 conducted expected value of information analyses. Only 10 studies conducted validation. CONCLUSIONS: Future economic evaluations should consider synergies between interventions and examine combinations of interventions to inform optimal policy response. They should also more consistently conduct model validation and assess the value of further research.


Assuntos
Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Análise Custo-Benefício , Redução do Dano , Humanos , Cadeias de Markov , Modelos Econométricos , Naloxona/economia , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/economia , Antagonistas de Entorpecentes/provisão & distribução , Uso Indevido de Medicamentos sob Prescrição/economia , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida
14.
Value Health ; 23(8): 985-993, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828226

RESUMO

OBJECTIVE: France has included health economic assessment (HEA) as an official criterion for innovative drug pricing since 2013. Until now, no cost-effectiveness threshold (CET) has been officially proposed to qualify incremental cost-effectiveness ratios (ICERs). Although the French health authorities have publicly expressed the need for such reference values, previous initiatives to determine these have failed. The study aims to propose a locally adapted method for estimating a preference-based value for a quality-adjusted life-year (QALY) based on a rational approach to public policy choices in France. METHODS: We used the official French value of statistical life (VSL) of €3 million (USD 3.25 million), proposed in 2013 by the French General Commission on Strategy and Prediction. We first estimated the value of life-year (VoLY) by age category according to life expectancy and official discounts recommended for HEA in France. We then estimated a value of statistical QALY (VSQ) by weighting VoLYs with demographic data and French EQ-5D-3L tariffs. RESULTS: The estimated average VoLYs and VSQs were €120 185 (USD 130 000) and €147 093 (USD 159 022), respectively, assuming a discount rate of 2.5% and €166 205 (USD 179 681) and €201 398 (USD 217 728), respectively, assuming a discount rate of 4.5%. CONCLUSION: Assuming that, as in other public domains, equity in access to healthcare across all disease areas and between all users is desirable, we propose an estimate of VSQ that is consistent with this goal. Our estimates of €147 093 (USD 179,681) to €201 398 (USD 217 728) should be perceived as breakeven costs for a QALY rather than a market access threshold. Such VSQs could be used as reference values for ICERs in HEA in France.


Assuntos
Análise Custo-Benefício/métodos , Análise Custo-Benefício/normas , Anos de Vida Ajustados por Qualidade de Vida , França , Humanos , Modelos Econométricos , Preferência do Paciente , Valores de Referência
15.
PLoS One ; 15(8): e0237967, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857819

RESUMO

BACKGROUND: Globally, tobacco consumption continues to cause a huge burden of preventable diseases. Chile has been leading the tobacco burden ranking in the Latin American region for the last ten years; it has currently a 33. 3% prevalence of current smokers. METHODS: A microsimulation economic model was developed within the framework of a multi-country project in order to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct costs of care. We also modelled the impact of increasing cigarettes' taxes on this burden. RESULTS: In Chile, 16,472 deaths were attributable to smoking in 2017, which represent around 16% of all deaths. This burden corresponds to 416,445 DALYs per year. The country's health system spends 1.15 trillion pesos annually (in Dec 2017 CLP, approx. U$D 1.8 billion) in health care treatment of illnesses caused by smoking. If the price of tobacco cigarettes was to be raised by 50%, around 13,665 deaths and 360,476 DALYs from smoking-attributable diseases would be averted in 10 years, with subsequent savings on health care costs, and increased tax revenue collection. In Chile, the tobacco tax collection does not fully cover the direct healthcare costs attributed to smoking. CONCLUSION: Despite a reduction observed on smoking prevalence between 2010 (40.6%) and 2017 (33.3%), this study shows that the burden of disease, and the economic toll due to smoking, remain high. As we demonstrate, a rise in the price of cigarettes could lead to a significant reduction of this burden, averting deaths and disability, and reducing healthcare spending.


Assuntos
Fumar/economia , Produtos do Tabaco/economia , Adulto , Idoso , Chile/epidemiologia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Política de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Infarto do Miocárdio/economia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Anos de Vida Ajustados por Qualidade de Vida , Fumar/epidemiologia
16.
Rinsho Ketsueki ; 61(7): 725-733, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32759557

RESUMO

Recently, there has been an increasing drive to consider the cost effectiveness of healthcare. Since clinical trials usually examine disease-free survival without considering overall survival, it is difficult to determine which treatment is cost effective. At present, the overall survival time is estimated using a Markov model, and the quality-adjusted life year (QALY) is calculated by taking into account the quality and quantity of life lived. In Japan, the cost required to obtain 1 QALY is expected to be around 5 million yen, and drug prices are being influenced by policy. Indubitably, this type of health economics also has limitations and is not equal for everyone. Thus, collaboration is necessary to discuss better and more efficient medical care. It is hoped that this review of two diseases of hematopoietic malignancy will enhance our understanding of health economics.


Assuntos
Neoplasias Hematológicas , Análise Custo-Benefício , Intervalo Livre de Doença , Humanos , Japão , Anos de Vida Ajustados por Qualidade de Vida
17.
PLoS Negl Trop Dis ; 14(8): e0008521, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32750059

RESUMO

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.


Assuntos
Programas Governamentais , Hanseníase/tratamento farmacológico , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição/economia , Quimioprevenção/economia , Análise Custo-Benefício , Humanos , Índia , Hansenostáticos/economia , Hansenostáticos/uso terapêutico , Hanseníase/diagnóstico , Hanseníase/economia , Profilaxia Pós-Exposição/métodos , Anos de Vida Ajustados por Qualidade de Vida , Rifampina/economia , Rifampina/uso terapêutico
18.
Bone Joint J ; 102-B(8): 1072-1081, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731829

RESUMO

AIMS: To compare the cost-utility of standard dressing with incisional negative-pressure wound therapy (iNPWT) in adults with closed surgical wounds associated with major trauma to the lower limbs. METHODS: A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective based on data collected from the Wound Healing in Surgery for Trauma (WHiST) multicentre randomized clinical trial. Health resource utilization was collected over a six-month post-randomization period using trial case report forms and participant-completed questionnaires. Cost-utility was reported in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was conducted to test the robustness of cost-effectiveness estimates while uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. RESULTS: The incremental cost of standard dressing versus iNPWT over six months was £2,037 (95% confidence interval (CI) £349 to £3,724). There was an insignificant increment in QALYs gained in the iNPWT group (0.005, 95% CI -0.018 to 0.028). The probability of iNPWT being cost-effective at £20,000 per QALY was 1.9%. The results remained robust in the sensitivity analysis. CONCLUSION: The within-trial economic evaluation suggests that iNPWT is unlikely to be a cost-effective alternative to standard dressing in adults with closed surgical wounds to their lower limbs. Cite this article: Bone Joint J 2020;102-B(8):1072-1081.


Assuntos
Bandagens/economia , Análise Custo-Benefício , Traumatismos da Perna/cirurgia , Tratamento de Ferimentos com Pressão Negativa/economia , Ferida Cirúrgica/terapia , Cicatrização/fisiologia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/métodos , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido
19.
Sci Total Environ ; 737: 140296, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783866

RESUMO

Disinfection byproducts (DBPs) in drinking water is an issue in many countries. Many DBPs are possible or probable human carcinogens while few DBPs pose cyto- and genotoxic effects to the mammalian cells. The populations are likely to consume DBPs with drinking water throughout their lifetimes. A number of DBPs are regulated in many countries to protect humans. In this study, human exposure, risk and disability-adjusted life years (DALY) were predicted from DBPs in multiple water supply systems, including groundwater (GW), desalinated water (DW) and blend water (BW). The averages of lifetime excess cancer risks from GW, DW and BW were 4.15 × 10-6, 1.75 × 10-5 and 2.59 × 10-5 respectively. The populations in age groups of 0 - <2, 2-16 and >16 years contributed 25.4-25.7%, 28.6-29.6% and 45.0-45.7% to the total risks respectively. The DALY from GW, DW and BW were estimated to be 5.8, 27.0 and 39.9 years, respectively while the corresponding financial burdens were US$ 0.63, 2.93 and 4.34 million respectively. The findings are likely to assist in selecting the supply water sources to better control human exposure and risk from DBPs.


Assuntos
Desinfetantes/análise , Água Potável/análise , Poluentes Químicos da Água/análise , Purificação da Água , Animais , Desinfecção , Halogenação , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Arábia Saudita , Abastecimento de Água
20.
J Headache Pain ; 21(1): 99, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787820

RESUMO

BACKGROUND: Migraine is a common and incapacitating condition, with severe impact on the quality of life (QoL) of the afflicted and their families, and negative economic consequences through decreased workforce participation, reduced functional ability and elevated healthcare costs. This study aimed to describe the economic consequences of migraine in Sweden using cost of illness survey data and, based on this data, assess the cost-effectiveness of onabotulinumtoxinA (Botox) for the treatment of chronic migraine in Sweden and Norway. METHODS: A survey study was conducted in Swedish migraine patients, with questions on patient characteristics, headache frequency and severity, effect on daily activities and work, QoL, health resource utilization, and medication use. Resulting costs were estimated as annual averages over subgroups of average monthly headache days. Some results were used to inform a Markov cost-effectiveness chronic migraine model. The model was adapted to Sweden and Norway using local data. The analysis perspective was semi-societal. Results' robustness was tested using one-way, structural, and probabilistic sensitivity analyses. RESULTS: Results from the cost of illness analysis (n = 454) indicated a clear correlation between decreased QoL and increased costs with increasing monthly headache days. Total annual costs ranged from EUR 6221 in patients with 0-4 headache days per month, to EUR 57,832 in patients with 25-31. Indirect costs made up the majority of costs, ranging from 82% of total costs in the 0-4 headache days group, to 91% in 25-31 headache days. The cost-effectiveness analyses indicated that in Sweden, Botox was associated with 0.223 additional QALYs at an additional cost of EUR 4126 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 18,506. In Norway, Botox was associated with 0.216 additional QALYs at an additional cost of EUR 4301 compared to placebo, resulting in an ICER of EUR 19,954. CONCLUSIONS: In people with migraine, an increase in monthly headache days is clearly related to lower QoL and higher costs, indicating considerable potential costs-savings in reducing the number of headache days. The main cost driver for migraine is indirect costs. Botox reduces headache days and is a cost-effective treatment for chronic migraine in Sweden and Norway.


Assuntos
Toxinas Botulínicas Tipo A/economia , Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/economia , Adulto , Análise Custo-Benefício , Feminino , Cefaleia/tratamento farmacológico , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Suécia , Resultado do Tratamento
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