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Slesnick N, Brakenhoff B, Chavez LJ, Cuthbertson CL, Famelia R, Feng X, Ford J, Holowacz E, Jaderlund S, Kelleher K, Luthy E, Mallory AM, Pizzulo A, Slesnick TD, Yilmazer T. Suicide prevention for substance using youth experiencing homelessness: study protocol for a randomized controlled trial. Trials 2024; 25:174. [PMID: 38461275 PMCID: PMC10924986 DOI: 10.1186/s13063-024-07997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/21/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective suicide prevention intervention that can be readily adopted by communities that serve these youth. METHODS Three hundred (N = 300) YEH with recent substance use and suicidal ideation or a recent suicide attempt will be recruited from the streets as well as a drop-in center serving YEH. After the baseline assessment, all youth will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N = 150) or to SAU alone (N = 150). SAU includes outreach, advocacy, and service linkage whereas YEH who receive CTSP will also receive ten CTSP sessions and an optional nine booster sessions. Follow-up assessments will be conducted at 3, 6, 9, and 12 months post-baseline. Theoretically derived mediators (e.g., cognitive distortions) will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation, and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity, and cost associated with the delivery of our intervention approach using a mixed-methods approach. DISCUSSION This study adds to a very small number of clinical trials seeking to prevent lethal suicide among a very high-risk group by addressing suicidal ideation directly rather than underlying conditions. It is hypothesized that youth receiving CTSP + SAU will show greater reductions in suicidal ideation (primary outcome), substance use, and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. TRIAL REGISTRATION NCT05994612. Date of Registration: August 16, 2023.
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Affiliation(s)
- Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
| | - Brittany Brakenhoff
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Laura J Chavez
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Avenue, Columbus, OH, 43210, USA
| | - Caleb L Cuthbertson
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Ruri Famelia
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, 1577 Neil Ave, Columbus, OH, 43210, USA
| | - Eugene Holowacz
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Soren Jaderlund
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Kelly Kelleher
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Allen M Mallory
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Alexis Pizzulo
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Tatiana D Slesnick
- College of Food, Agriculture and Environmental Science, School of Environment and National Resources, 2021 Fyffe Rd, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
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Suzuki Y, Hoshi K, Shiroiwa T, Fukuda T. Cost-effectiveness analysis of lifestyle interventions for preventing kidney disease in patients with type 2 diabetes. Clin Exp Nephrol 2023; 27:728-736. [PMID: 37195388 DOI: 10.1007/s10157-023-02357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Lifestyle interventions in patients with type-2 diabetes contribute to reducing the incidence of chronic kidney disease. The cost-effectiveness of lifestyle interventions to prevent kidney disease in patients with type-2 diabetes remains undetermined. We aimed to develop a Markov model from a Japanese healthcare payer's perspective focusing on the development of kidney disease in patients with type-2 diabetes and examine the cost-effectiveness of lifestyle interventions. METHODS To develop the model, the parameters, including lifestyle intervention effect, were derived from results of the Look AHEAD trial and previously published literature. Incremental cost-effectiveness ratios (ICER) were calculated from the difference in cost and quality-adjusted life years (QALY) between lifestyle intervention and diabetes support education groups. We estimated lifetime costs and effectiveness assuming patient's life span to be 100 years. Costs and effectiveness were discounted by 2% annually. RESULTS ICER for lifestyle intervention compared to diabetes support education was JPY 1,510,838 (USD 13,031) per QALY. Cost-effectiveness acceptability curve showed that the probability that lifestyle intervention is cost-effective at the threshold of JPY 5,000,000 (USD 43,084) per QALY gained, compared to diabetes support education, is 93.6%. CONCLUSIONS Using a newly-developed Markov model, we illustrated that lifestyle interventions for preventing kidney disease in patients with diabetes would be more cost-effective from a Japanese healthcare payer's perspective compared to diabetes support education. The model parameters in the Markov model must be updated to adapt to the Japanese setting.
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Affiliation(s)
- Yuta Suzuki
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Keika Hoshi
- Center for Health Informatics Policy, National Institute of Public Health, Saitama, Japan
- Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
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Michaud TL, Wilson KE, Katula JA, You W, Estabrooks PA. Cost and cost-effectiveness analysis of a digital diabetes prevention program: results from the PREDICTS trial. Transl Behav Med 2023; 13:501-510. [PMID: 36809348 DOI: 10.1093/tbm/ibad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Although technology-assisted diabetes prevention programs (DPPs) have been shown to improve glycemic control and weight loss, information are limited regarding relevant costs and their cost-effectiveness. To describe a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a digital-based DPP (d-DPP) with small group education (SGE), over a 1-year study period. The costs were summarized into direct medical costs, direct nonmedical costs (i.e., times that participants spent engaging with the interventions), and indirect costs (i.e., lost work productivity costs). The CEA was measured by the incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed using nonparametric bootstrap analysis. Over 1 year, the direct medical costs, direct nonmedical costs, and indirect costs per participant were $4,556, $1,595, and $6,942 in the d-DPP group versus $4,177, $1,350, and $9,204 in the SGE group. The CEA results showed cost savings from d-DPP relative to SGE based on a societal perspective. Using a private payer perspective for d-DPP, ICERs were $4,739 and $114 to obtain an additional unit reduction in HbA1c (%) and weight (kg), and were $19,955 for an additional unit gain of quality-adjusted life years (QALYs) compared to SGE, respectively. From a societal perspective, bootstrapping results indicated that d-DPP has a 39% and a 69% probability, at a willingness-to-pay of $50,000/QALY and $100,000/QALY, respectively, of being cost-effective. The d-DPP was cost-effective and offers the prospect of high scalability and sustainability due to its program features and delivery modes, which can be easily translated to other settings.
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Affiliation(s)
- Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn E Wilson
- Department of Kinesiology and Health, College of Education & Human Development, Georgia State University, Atlanta, GA, USA
- Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
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Railey AF, Muller C, Noonan C, Schmitter-Edgecombe M, Sinclair K, Kim C, Look M, Kaholokula JK. Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension. PHARMACOECONOMICS - OPEN 2022; 6:85-94. [PMID: 34389923 PMCID: PMC8807791 DOI: 10.1007/s41669-021-00291-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this study was to calculate the costs and assess whether a culturally grounded physical activity intervention offered through community-based organizations is cost effective in reducing blood pressure among Native Hawaiian adults with hypertension. METHODS Six community-based organizations in Hawai'i completed a randomized controlled trial between 2015 and 2019. Overall, 263 Native Hawaiian adults with uncontrolled hypertension (≥ 140 mmHg systolic, ≥ 90 mmHg diastolic) were randomized to either a 12-month intervention group of hula (traditional Hawaiian dance) lessons and self-regulation classes, or to an education-only waitlist control group. The primary outcome was change in systolic blood pressure collected at baseline and 3, 6, and 12 months for the intervention compared with the control group. Incremental cost-effectiveness ratios (ICERs) were calculated for primary and secondary outcomes. Non-parametric bootstrapping and sensitivity analyses evaluated uncertainty in parameters and outcomes. RESULTS The mean intervention cost was US$361/person, and the 6-month ICER was US$103/mmHg reduction in systolic blood pressure and US$95/mmHg in diastolic blood pressure. At 12 months, the intervention group maintained reductions in blood pressure, which exceeded reductions for usual care based on blood pressure outcomes. The change in blood pressure at 12 months resulted in ICERs of US$100/mmHg reduction in systolic blood pressure and US$93/mmHg in diastolic blood pressure. Sensitivity analyses suggested that at the estimated intervention cost, the probability that the program would lower systolic blood pressure by 5 mmHg was 67 and 2.5% at 6 and 12 months, respectively. CONCLUSION The 6-month Ola Hou program may be cost effective for low-resource community-based organizations. Maintenance of blood pressure reductions at 6 and 12 months in the intervention group contributed to potential cost effectiveness. Future studies should further evaluate the cost effectiveness of indigenous physical activity programs in similar settings and by modeling lifetime costs and quality-adjusted life-years. TRIAL REGISTRATION NUMBER NCT02620709.
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Affiliation(s)
- Ashley F Railey
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
- Department of Sociology, Indiana University, 1022 E. Third St, Bloomington, IN, 47405-7103, USA.
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Ka'imi Sinclair
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Corin Kim
- Kilohana, University of Hawai'i at Hilo, Hilo, HI, USA
| | - Mele Look
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
| | - J Keawe'aimoku Kaholokula
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Shearer J, Kalyani M, Mangelis A, de Silva D, de Silva P, Wijesuriya M, Karalliedde J. Cost-Effectiveness of Peer-Educator-Delivered Lifestyle Modification for Type 2 Diabetes Prevention in a Young Healthy Population in Sri Lanka: A Trial-Based Economic Evaluation and Economic Model. PHARMACOECONOMICS - OPEN 2021; 5:693-700. [PMID: 34254276 PMCID: PMC8611152 DOI: 10.1007/s41669-021-00284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study evaluated the cost effectiveness of an intensive lifestyle modification (LSM) intervention delivered by peer educators for the prevention of type 2 diabetes mellitus in a young at-risk population in a low healthcare resource setting. OBJECTIVE The aim of this study was to evaluate the short-term and long-term cost effectiveness of an intensive lifestyle modification intervention for type 2 diabetes prevention in a young urban at-risk population in Sri Lanka. METHODS This was an economic evaluation using cost and outcome data from a randomized controlled trial. We randomized 3539 healthy individuals aged 5-40 years with risk factors for type 2 diabetes to either 3-monthly (P-LSM n = 1727) or 12-monthly (C-LSM n = 1812) peer-educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. A cost-effectiveness analysis was conducted from a health system perspective with outcomes expressed as disability-adjusted life-years (DALYs). Intervention costs and outcomes were collected during a median clinical trial period of 3 years and extrapolated to a lifetime horizon using economic modelling. Uncertainty in the lifetime model was explored by structural and probabilistic sensitivity analyses. RESULTS The costs of the more intensive peer support programme were partially offset by reduced costs of type 2 diabetes complications recorded over the trial period and completely offset by lifetime cost savings of 6000 LKR. The more intensive P-LSM also averted more DALYs, estimated at 0.456 DALYs over the lifetime of participants. CONCLUSIONS In a young at-risk Sri Lanka population, an intensive LSM programme was cost effective, averting more DALYs at an acceptable additional cost than a much less intensive LSM programme. Early intervention in young at-risk people represents good value for money from the Sri Lankan health care payer perspective.
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Affiliation(s)
- James Shearer
- King's Health Economics, Institute of Psychiatry, The David Goldberg Centre, Psychology and Neuroscience at King's College London, De Crespigny Park, Box P024, London, SE5 8AF, UK.
| | - Miral Kalyani
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anastasios Mangelis
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Dileep de Silva
- Health Human Resources, Ministry of Health, Colombo, Sri Lanka
| | | | | | - Janaka Karalliedde
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Malinowska AM. Easy Diet Screener: A quick and easy tool for determining dietary patterns associated with lipid profile and body adiposity. J Hum Nutr Diet 2021; 35:590-604. [PMID: 34841622 DOI: 10.1111/jhn.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of simple tools that could allow members of the general population to estimate their own dietary patterns and to associate them with unfavourable health outcomes. The present study aimed to develop and validate a simple self-administered tool, called the Easy Diet Screener (EDS), that would identify healthy and unhealthy dietary patterns and evaluate their association with unfavourable blood and anthropometric parameters (i.e. values outside the recommended values). METHODS In total, 259 adult people (31-50 years of age) participated in this observational study. They filled out an online version of the EDS questionnaire; those who scored highly were assigned to the healthy dietary pattern (HDP) group, whereas those with a low score were assigned to the western dietary pattern (WDP) group. The dietary records, anthropometric and biochemical parameters were evaluated in a subset of 200 participants who obtained similar score in the repeated EDS (paper version). RESULTS People assigned to HDP on the basis of EDS had significantly better diet quality than those assigned to WDP, with values of the Healthy Eating Index being 76.9 ± 9.2 and 58.7 ± 10.5, respectively. People classed as WDP had a higher risk of too high serum low-density lipoproteins [odds ratio (OR) = 2.65], triglycerides (OR = 3.67), body mass index (OR = 2.87) and percentage of fat tissue (OR = 3.98) than did people in the HDP. CONCLUSIONS EDS is an easy tool for quickly identifying healthy and western dietary patterns that are associated with lipid profile and body adiposity.
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Affiliation(s)
- Anna M Malinowska
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland
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8
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Meng F, Tan AL, Heng BH, Leow MKS, Kannapiran P. Feasibility analysis of a prevention programme for patients with early chronic disease using A mathematical model. Health Syst (Basingstoke) 2021; 11:75-83. [PMID: 35655608 PMCID: PMC9154777 DOI: 10.1080/20476965.2020.1860654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/02/2020] [Indexed: 10/22/2022] Open
Abstract
The increasing prevalence of the chronic disease is of considerable concern to health-care organisations. Prevention programmes to patients with early chronic disease have the potential to improve individual health and quality of life through disease avoidance or delay and to save the medical cost of the health care system. Due to the limited budget in healthcare this study seeks to analyse the feasibility of a programme prior to implementation. A mathematical model is developed to determine incidence reduction rate at which the underlying cost break-even can be achieved; consequently, the programme would be feasible. We show the existence and uniqueness of the underlying incidence reduction and establish the feasibility frontier concerning the trade-offs between intervention effective period and incidence reduction rate. We use a diabetes prevention programme to demonstrate the efficiency and advantage of the model. The proposed model would inform decision-makers scientific principles in determining an intervention for implementation.
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Affiliation(s)
- Fanwen Meng
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore
| | | | - Bee Hoon Heng
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Melvin Khee Shing Leow
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Cardiovascular Metabolic Disease Program,Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Palvannan Kannapiran
- Department of Health Services and Outcomes Research, National Healthcare Group, Singapore
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Baessler F, Zafar A, Ciprianidis A, Wagner FL, Klein SB, Schweizer S, Bartolovic M, Roesch-Ely D, Ditzen B, Nikendei C, Schultz JH. Analysis of risk communication teaching in psychosocial and other medical departments. MEDICAL EDUCATION ONLINE 2020; 25:1746014. [PMID: 32249706 PMCID: PMC7170276 DOI: 10.1080/10872981.2020.1746014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Aims: Teaching students about risk communication is an important aspect at medical schools given the growing importance of informed consent in healthcare. This observational study analyzes the quality of teaching content on risk communication and biostatistics at a medical school.Methods: Based on the concept of curriculum mapping, purpose-designed questionnaires were used via participant observers to record the frequency, characteristics and context of risk communication employed by lecturers during teaching sessions for one semester. The data was analyzed quantitatively and descriptively.Results: Teaching about risk communication was observed in 24.4% (n = 95 of 390) sessions. Prevalence varied significantly among different departments with dermatology having the highest rate (67.9%) but lesser in-depth teaching than medical psychology where risk communication concepts were discussed on a higher scale in 61.4% sessions. Relevant statistical values were not mentioned at all in 69% of these 95 sessions and clinical contexts were used rarely (55.8%). Supplementary teaching material was provided in 50.5% sessions while students asked questions in 18.9% sessions.Conclusions: Students are infrequently taught about communicating risks. When they are, the teaching does not include the mention of core biostatistics values nor does the teaching involve methods for demonstrating risk communication.
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Affiliation(s)
- Franziska Baessler
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
- CONTACT Franziska Baessler Department for General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, Heidelberg University Hospital,Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Ali Zafar
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Ciprianidis
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabienne Louise Wagner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Bettina Klein
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
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10
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Greiner GG, Emmert-Fees KMF, Becker J, Rathmann W, Thorand B, Peters A, Quante AS, Schwettmann L, Laxy M. Toward targeted prevention: risk factors for prediabetes defined by impaired fasting glucose, impaired glucose tolerance and increased HbA1c in the population-based KORA study from Germany. Acta Diabetol 2020; 57:1481-1491. [PMID: 32748175 PMCID: PMC7591423 DOI: 10.1007/s00592-020-01573-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Abstract
AIMS To identify socioeconomic, behavioral and clinical factors that are associated with prediabetes according to different prediabetes definition criteria. METHODS Analyses use pooled data of the population-based Cooperative Health Research in the Region of Augsburg (KORA) studies (n = 5312 observations aged ≥ 38 years without diabetes). Prediabetes was defined through either impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or elevated HbA1c according to thresholds of the American Diabetes Association. Explanatory variables were regressed on prediabetes using generalized estimating equations. RESULTS Mean age was 58.4 years; 50% had prediabetes (33% had IFG, 16% IGT, and 26% elevated HbA1c, 10% fulfilled all three criteria). Age, obesity, hypertension, low education, unemployment, statutory health insurance, urban residence and physical inactivity were associated with prediabetes. Male sex was a stronger risk factor for IFG (OR = 2.5; 95%-CI: 2.2-2.9) than for IGT or elevated HbA1c, and being unemployed was a stronger risk factor for IGT (OR = 3.2 95%-CI: 2.6-4.0) than for IFG or elevated HbA1c. CONCLUSIONS The overlap of people with IFG, IGT and elevated HbA1c is small, and some factors are associated with only one criterion. Knowledge on sociodemographic and socioeconomic risk factors can be used to effectively target interventions to people at high risk for type 2 diabetes.
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Affiliation(s)
- Gregory G Greiner
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
- Medical Faculty, Centre for Health and Society, Institute for Health Services Research and Health Economics, Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Jana Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Wolfgang Rathmann
- Institute for Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
| | - Barbara Thorand
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Annette Peters
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Anne S Quante
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle (Saale), Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
- Global Diabetes Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Atlanta, GA, 30322, USA
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Alshammari SA, AlDhayan AZ, Saad Al-essa OM, Alosaimi MM, Al-badr BM, Ali AB, Ajlan QA. Challenges to lifestyle modification of chronic disease patients attending primary health care centers in Riyadh. J Family Med Prim Care 2020; 9:6186-6193. [PMID: 33681062 PMCID: PMC7928105 DOI: 10.4103/jfmpc.jfmpc_1037_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/05/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The rate of chronic diseases is increasing due to the global pandemic of inactivity and an unhealthy diet. OBJECTIVE We aimed to determine the dietary habits, physical activities of the participants, and challenges facing them to adapt to a healthy lifestyle. METHODOLOGY The researchers conducted a cross-sectional study on chronic disease patients attending primary health care centers in Riyadh from January to March 2018. The estimated sample size was 250 patients. The participants completed a self-administered questionnaire. RESULT The mean age of the 250 participants was 35.3 years old. The Overweight and obese participants accounted for 67.2% of the sample (mean BMI = 28.0). Two-thirds of the participants depend mainly on rice or pasta for their diet, and 48.4-52.0% eat fruits and vegetables less than three times a week. About 50% of the participants perceived a lack of information, skills, motivation, and family or friends support as a barrier to a healthy diet. Also, (56.4%) of males and (67.8%) of females are physically inactive. Accessibility, cost, and the hot climate were physical activity obstacles in more than 60% of the respondents. Optimal BMI showed a significant association with increased physical activity P = 0.04. CONCLUSION Physical inactivity and consuming a non-balanced diet are common. So awareness campaigns of the benefit of a healthy lifestyle besides increasing physical exercise facilities, installing environmental changes, and subsidizing sports gyms would encourage people to be more physically active.
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Affiliation(s)
- Sulaiman A. Alshammari
- The Health Promotion and Health Education Research Chair, Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Z. AlDhayan
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Omar M. Saad Al-essa
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majed M. Alosaimi
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Badr M. Al-badr
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Anas B. Ali
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Qusay A. Ajlan
- Department of Family and Community Medicine, Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Facilitators and Inhibitors of Lifestyle Modification and Maintenance of KOREAN Postmenopausal Women: Revealing Conversations from FOCUS Group Interview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218178. [PMID: 33167466 PMCID: PMC7663947 DOI: 10.3390/ijerph17218178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022]
Abstract
Modifiable lifestyle behaviors, such as lack of physical activity, smoking, and unhealthy diet, are associated with the risk of cardiovascular diseases in postmenopausal women, in addition to other risk factors, such as aging and physiological changes. Therefore, it is necessary to emphasize the importance of encouraging healthy lifestyles and health-promoting behaviors among postmenopausal women, to achieve a better health status. However, it is difficult to modify lifestyle and maintain that change. This study was aimed at identifying the factors that affect the maintenance of healthy lifestyle habits in postmenopausal women, using various theoretical models. This qualitative study included focus-group interviews with 21 Korean postmenopausal women aged 54 to 69 years. A theory-guided thematic analysis was performed based on the Health Belief Model, Self-Determination Theory, Social Cognitive Theory, and Theory of Planned Behavior. As a result, facilitators and inhibitors to healthy lifestyle modification and maintenance are identified. Various sources of motivation and reinforcement are important for menopausal women to maintain a healthy lifestyle. Autonomy support and self-regulation strategies play an important role in integrating health-promoting behaviors into a daily routine. In addition to personal effort, a social support system is also important to help individuals maintain a healthy lifestyle
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13
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Kaasalainen K, Kalmari J, Ruohonen T. Developing and testing a discrete event simulation model to evaluate budget impacts of diabetes prevention programs. J Biomed Inform 2020; 111:103577. [PMID: 32992022 DOI: 10.1016/j.jbi.2020.103577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
Type 2 diabetes (T2D) is one of the most rapidly increasing non-communicable diseases worldwide. Lifestyle interventions are effective in preventing T2D but also resource intensive. This study evaluated with discrete event simulation (DES) the relative budget impacts of three hypothetical diabetes prevention programs (DPP), including group-based contact intervention, digital program with human coaching and fully automated program. The data for simulation were derived from research literature and national health and population statistics. The model was constructed using the iGrafx Process for Six Sigma software and simulations were carried out for 10 years. All simulated interventions produced cost savings compared to the situation without any intervention. However, this was a modeling study and future studies are needed to verify the results in real-life. Decision makers could benefit the predictive models regarding the long-term effects of diabetes prevention interventions, but more data is needed in particular on the usage, acceptability, effectiveness and costs of digital intervention tools.
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Affiliation(s)
- Karoliina Kaasalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Keskussairaalantie 4, P. O. Box 35 (L), FI-40014 Jyväskylä, Finland.
| | - Janne Kalmari
- Faculty of Information Technology, University of Jyväskylä, Mattilanniemi 2, P.O. Box 35, FI-40014 Jyväskylä, Finland.
| | - Toni Ruohonen
- Faculty of Information Technology, University of Jyväskylä, Mattilanniemi 2, P.O. Box 35, FI-40014 Jyväskylä, Finland.
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14
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Lundin ES, Carlsson P, Wodlin NB, Nilsson L, Kjölhede P. Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer. Int J Gynecol Cancer 2020; 30:1719-1725. [DOI: 10.1136/ijgc-2020-001611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022] Open
Abstract
ObjectivesTo compare total costs for hospital stay and post-operative recovery between robotic and abdominal hysterectomy in the treatment of early-stage endometrial cancer provided in an enhanced recovery after surgery (ERAS) setting. Costs were evaluated in relation to health impact, taking a societal perspective.MethodsCost analysis was based on data from an open randomized controlled trial in an ERAS setting at a Swedish tertiary referral university hospital: 50 women with low-risk endometrial cancer scheduled for surgery between February 2012 and May 2016 were included; 25 women were allocated to robotic and 25 to abdominal hysterectomy. We compared the total time in the operating theater, procedure costs, post-operative care, length of hospital stay, readmissions, informal care, and sick leave as well as the health-related quality of life until 6 weeks after surgery. The comparison was made by using the EuroQoL group form with five dimensions and three levels (EQ-5D). The primary outcome measure was total cost; secondary outcomes were quality-adjusted life-years (QALYs) and cost per QALY. The costs were calculated in Swedish Krona (SEK).ResultsAge (median (IQR) 68 (63–72) vs 67 (59–75) years), duration of hospital stay (ie, time to discharge criteria were met) (median (IQR) 36 (36–36) vs 36 (36–54) hours), and sick leave (median (IQR) 25 (17–30) vs 31 (36–54) days) did not differ between the robotic and abdominal group. Time of surgery was significantly longer in the robotic group than in the abdominal group (median (IQR) 70 (60–90) vs 56 (49–84) min; p<0.05). The robotic group recovered significantly faster as measured by the EQ-5D health index and gained 0.018 QALYs until 6 weeks after surgery. Total costs were 20% higher for the robotic procedure (SEK71 634 vs SEK59 319). The total cost per QALY gained for women in the robotic group was slightly under SEK700 000.ConclusionsRobotic hysterectomy used in an ERAS setting in the treatment of early endometrial cancer improved health within 6 weeks after the operation at a high cost for the health gained compared with abdominal hysterectomy. The productivity loss and informal care were lower for robotic hysterectomy, while healthcare had a higher procedure cost that could not be offset by the higher cost due to complications in the abdominal group.
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15
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Economic benefit of dietetic-nutritional treatment in the multidisciplinary primary care team. NUTR HOSP 2020; 37:863-874. [PMID: 32686448 DOI: 10.20960/nh.03025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Chronic diseases and aging are placing an ever increasing burden on healthcare services worldwide. Nutritional counselling is a priority for primary care because it has shown substantial cost savings. This review aims to evaluate the evidence of the cost-effectiveness of nutritional care in primary care provided by health professionals. A literature search was conducted using PubMed/MEDLINE between January 2000 and February 2019. The review included thirty-six randomized controlled trials (RCTs) and systematic reviews conducted in healthy people and people with obesity, type-2 diabetes mellitus, cardiovascular risk or malnutrition. All the RCTs and reviews showed that nutritional intervention led by dietitians-nutritionists in people with obesity or cardiovascular risk factors was cost-effective. Dietary interventions led by nurses were cost-effective in people who needed to lose weight but not in people at high cardiovascular risk. Some dietary changes led by a primary care team in people with diabetes were cost-effective. Incorporating dietitians-nutritionists into primary care settings, or increasing their presence, would give people access to the healthcare professionals who are best qualified to carry out nutritional treatment, and may be the most cost-effective intervention in terms of health expenditure. Notwithstanding the limitations described, this review suggests that incorporating dietitians-nutritionists into primary health care as part of the multidisciplinary team could be regarded as an investment in health. Even so, more research is required to confirm the conclusions.
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16
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Zhou X, Siegel KR, Ng BP, Jawanda S, Proia KK, Zhang X, Albright AL, Zhang P. Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review. Diabetes Care 2020; 43:1593-1616. [PMID: 33534726 DOI: 10.2337/dci20-0018] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. RESEARCH DESIGN AND METHODS Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars. RESULTS Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results. CONCLUSIONS Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings.
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Affiliation(s)
- Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL
| | - Shawn Jawanda
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Krista K Proia
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xuanping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Islek D, Weber MB, Ranjit Mohan A, Mohan V, Staimez LR, Harish R, Narayan KMV, Laxy M, Ali MK. Cost-effectiveness of a Stepwise Approach vs Standard Care for Diabetes Prevention in India. JAMA Netw Open 2020; 3:e207539. [PMID: 32725244 DOI: 10.1001/jamanetworkopen.2020.7539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A stepwise approach that includes screening and lifestyle modification followed by the addition of metformin for individuals with high risk of diabetes is recommended to delay progression to diabetes; however, there is scant evidence regarding whether this approach is cost-effective. OBJECTIVE To estimate the cost-effectiveness of a stepwise approach in the Diabetes Community Lifestyle Improvement Program. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation study included 578 adults with impaired glucose tolerance, impaired fasting glucose, or both. Participants were enrolled in the Diabetes Community Lifestyle Improvement Program, a randomized clinical trial with 3-year follow-up conducted at a diabetes care and research center in Chennai, India. INTERVENTIONS The intervention group underwent a 6-month lifestyle modification curriculum plus stepwise addition of metformin; the control group received standard lifestyle advice. MAIN OUTCOMES AND MEASURES Cost, health benefits, and incremental cost-effectiveness ratios (ICERs) were estimated from multipayer (including direct medical costs) and societal (including direct medical and nonmedical costs) perspectives. Costs and ICERs were reported in 2019 Indian rupees (INR) and purchasing power parity-adjusted international dollars (INT $). RESULTS The mean (SD) age of the 578 participants was 44.4 (9.3) years, and 364 (63.2%) were men. Mean (SD) body mass index was 27.9 (3.7), and the mean (SD) glycated hemoglobin level was 6.0% (0.5). Implementing lifestyle modification and metformin was associated with INR 10 549 (95% CI, INR 10 134-10 964) (INT $803 [95% CI, INT $771-834]) higher direct costs; INR 5194 (95% CI, INR 3187-INR 7201) (INT $395; 95% CI, INT $65-147) higher direct nonmedical costs, an absolute diabetes risk reduction of 10.2% (95% CI, 1.9% to 18.5%), and an incremental gain of 0.099 (95% CI, 0.018 to 0.179) quality-adjusted life-years per participant. From a multipayer perspective (including screening costs), mean ICERs were INR 1912 (INT $145) per 1 percentage point diabetes risk reduction, INR 191 090 (INT $14 539) per diabetes case prevented and/or delayed, and INR 196 960 (INT $14 986) per quality-adjusted life-year gained. In the scenario of a 50% increase or decrease in screening and intervention costs, the mean ICERs varied from INR 855 (INT $65) to INR 2968 (INT $226) per 1 percentage point diabetes risk reduction, from INR 85 495 (INT $6505) to INR 296 681 (INT $22 574) per diabetes case prevented, and from INR 88 121 (INT $6705) to INR 305 798 (INT $23 267) per quality-adjusted life-year gained. CONCLUSIONS AND RELEVANCE The findings of this study suggest that a stepwise approach for diabetes prevention is likely to be cost-effective, even if screening costs for identifying high-risk individuals are added.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Beth Weber
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Lisa R Staimez
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Ranjani Harish
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Michael Laxy
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
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Economic evaluations of public health interventions for physical activity and healthy diet: A systematic review. Prev Med 2020; 136:106100. [PMID: 32353572 DOI: 10.1016/j.ypmed.2020.106100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022]
Abstract
Physical inactivity and unhealthy dietary habits are associated with an increased disease and economic burden. The aim of this systematic review was to identify economic evaluations of public health interventions targeting physical activity and healthy diet, and assess the quality and transferability of the findings to the Swedish context. A search of published economic evaluations was conducted through electronic databases including PubMed, Web of Science, PsycINFO, National Health Service Economic Evaluation Databases (NHS EED) and the Health Technology Assessment Database (HTA). An additional search was done using references of relevant systematic reviews and websites of relevant organizations were checked to find grey literature. Quality and transferability of the economic evaluations were appraised using a quality assessment tool developed by the Swedish Agency for Health Technology Assessment. Thirty-two economic evaluations, rated as moderate or high quality, of 178 interventions were included; thirteen studies targeting physical activity, thirteen targeting healthy diet and six targeting both. The interventions varied in terms of their content, setting, mode of delivery and target populations. A majority of the economic evaluations reported that the interventions were likely to be cost-effective; however, considerable variations in the methodological and reporting qualities were observed. Only half of the economic evaluations were rated to have a high probability of transferring to the Swedish context. Public health interventions targeting physical activity and dietary habits have a high potential to be cost-effective. However, decision makers should consider the variation in quality and transferability of the available evidence.
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Bevan G, De Poli C, Keng MJ, Raine R. How valid are projections of the future prevalence of diabetes? Rapid reviews of prevalence-based and Markov chain models and comparisons of different models' projections for England. BMJ Open 2020; 10:e033483. [PMID: 32132137 PMCID: PMC7059487 DOI: 10.1136/bmjopen-2019-033483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine validity of prevalence-based models giving projections of prevalence of diabetes in adults, in England and the UK, and of Markov chain models giving estimates of economic impacts of interventions to prevent type 2 diabetes (T2D). METHODS Rapid reviews of both types of models. Estimation of the future prevalence of T2D in England by Markov chain models; and from the trend in the prevalence of diabetes, as reported in the Quality and Outcomes Framework (QOF), estimated by ordinary least squares regression analysis. SETTING Adult population in England and UK. MAIN OUTCOME MEASURE Prevalence of T2D in England and UK in 2025. RESULTS The prevalence-based models reviewed use sample estimates of past prevalence rates by age and sex and projected population changes. Three most recent models, including that of Public Health England (PHE), neither take account of increases in obesity, nor report Confidence Intervals (CIs). The Markov chain models reviewed use transition probabilities between states of risk and death, estimated from various sources. None of their accounts give the full matrix of transition probabilities, and only a minority report tests of validation. Their primary focus is on estimating the ratio of costs to benefits of preventive interventions in those with hyperglycaemia, only one reported estimates of those developing T2D in the absence of a preventive intervention in the general population.Projections of the prevalence of T2D in England in 2025 were (in millions) by PHE, 3.95; from the QOF trend, 4.91 and by two Markov chain models, based on our review, 5.64 and 9.07. CONCLUSIONS To inform national policies on preventing T2D, governments need validated models, designed to use available data, which estimate the scale of incidence of T2D and survival in the general population, with and without preventive interventions.
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Affiliation(s)
- Gwyn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Chiara De Poli
- Department of Management, London School of Economics and Political Science, London, UK
| | - Mi Jun Keng
- Department of Management, London School of Economics and Political Science, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 585] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4490] [Impact Index Per Article: 1122.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Wang H, Wang M, Wang J, Liu H, Lu R, Duan T, Gong X, Feng S, Cui Z, Liu Y, Li C, Ma J. Cost-effectiveness analysis of comprehensive intervention programs to control blood glucose in overweight and obese type 2 diabetes mellitus patients based on a real-world setting: Markov modeling. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:676. [PMID: 31930077 DOI: 10.21037/atm.2019.10.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Blood glucose control management in overweight and obese diabetic patients poses heavy public health and economic burdens on the health system. This study aimed to evaluate the short-term cost-effectiveness of a comprehensive intervention program for blood glucose management in different groups using a Markov model. Methods Based on real-world data, a Markov model was developed to calculate the cost per quality-adjusted life-year (QALY) gained. The division of Markov states was in accordance with clinical practice. A three-month cycle length and a 5-year time horizon were applied. A 3% discounting rate was applied for both the costs and utilities. Results The incremental cost-effectiveness ratios (ICER) was more favorable for the male group than the female group, with an associated ICER of 104 K RMB per QALY gained. Compared with the younger group, the incremental gain of the middle-aged group was -0.062 QALY, and the incremental cost was -3,198.64 RMB; meanwhile, the incremental gain of the elderly group was -0.176 QALY, and the incremental cost was 4,485.746 RMB. The sensitivity analysis showed that the ICER is sensitive to the costs of this program and less sensitive to the discounting rate and the time horizon. Conclusions The comprehensive intervention program for blood glucose management of overweight and obese patients with diabetes is cost-effective for the middle-aged male group and elderly female group, respectively. Moreover, the male group was more favorable than the female group if three times the gross domestic product (GDP) per capita was adopted as the maximum willingness to pay (WTP) for a QALY in China.
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Affiliation(s)
- Hui Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Mengyang Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Jiao Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Hongwei Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Rui Lu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Tongqing Duan
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Xiaowen Gong
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Siyuan Feng
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhuang Cui
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yuanyuan Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Changping Li
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
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Recreational Centres' Facilities and Activities to Support Healthy Ageing in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183343. [PMID: 31510094 PMCID: PMC6766068 DOI: 10.3390/ijerph16183343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
Objective: This study examined the physical and social environment (facilities and activities) of Singapore’s Recreational Centres (RCs) and female patrons’ (>50 years) perception of the RC facilities and activities. Materials and Methods: A total of 100 RCs were audited, and 22 face-to-face interviews were undertaken. Results: Physical activity classes were the main activity offered (mean = eight classes per month), with walking (29.8%) and aerobics sessions (17.5%) being the most frequent. Nutrition classes and social activities were offered less often (mean = one class per month). The activities were well received by patrons, offering opportunities to interact while participating in physical activity and nutrition classes. However, the need for staff training, consideration of patron’s abilities and the desire to engage in alternative activities were expressed. Conclusion: Overall, RCs’ facilities and activities were well liked by the patrons but opportunities for improvements were identified. Regular reviews of facilities and activities through consultation with the RC patrons and managers are needed to ensure that the facilities and activities remain relevant and practical to the patrons. This will help to support active lifestyles and healthy eating practices among older adults residing within the community.
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Leal J, Morrow LM, Khurshid W, Pagano E, Feenstra T. Decision models of prediabetes populations: A systematic review. Diabetes Obes Metab 2019; 21:1558-1569. [PMID: 30828927 PMCID: PMC6619188 DOI: 10.1111/dom.13684] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/07/2019] [Accepted: 02/28/2019] [Indexed: 01/16/2023]
Abstract
AIMS With evidence supporting the use of preventive interventions for prediabetes populations and the use of novel biomarkers to stratify the risk of progression, there is a need to evaluate their cost-effectiveness across jurisdictions. Our aim is to summarize and assess the quality and validity of decision models and model-based economic evaluations of populations with prediabetes, to evaluate their potential use for the assessment of novel prevention strategies and to discuss the knowledge gaps, challenges and opportunities. MATERIALS AND METHODS We searched Medline, Embase, EconLit and NHS EED between 2000 and 2018 for studies reporting computer simulation models of the natural history of individuals with prediabetes and/or we used decision models to evaluate the impact of treatment strategies on these populations. Data were extracted following PRISMA guidelines and assessed using modelling checklists. Two reviewers independently assessed 50% of the titles and abstracts to determine whether a full text review was needed. Of these, 10% was assessed by each reviewer to cross-reference the decision to proceed to full review. Using a standardized form and double extraction, each of four reviewers extracted 50% of the identified studies. RESULTS A total of 29 published decision models that simulate prediabetes populations were identified. Studies showed large variations in the definition of prediabetes and model structure. The inclusion of complications in prediabetes (n = 8) and type 2 diabetes (n = 17) health states also varied. A minority of studies simulated annual changes in risk factors (glycaemia, HbA1c, blood pressure, BMI, lipids) as individuals progressed in the models (n = 7) and accounted for heterogeneity among individuals with prediabetes (n = 7). CONCLUSIONS Current prediabetes decision models have considerable limitations in terms of their quality and validity and do not allow evaluation of stratified strategies using novel biomarkers, highlighting a clear need for more comprehensive prediabetes decision models.
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Affiliation(s)
- Jose Leal
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Liam Mc Morrow
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Waqar Khurshid
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Eva Pagano
- Unit of Clinical Epidemiology and CPO PiemonteCittà della Salute e della Scienza HospitalTurinItaly
| | - Talitha Feenstra
- Groningen UniversityUMCG, Department of EpidemiologyGroningenThe Netherlands
- RIVMBilthovenThe Netherlands
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Does Diabetes Influence Oral Health in Children? ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Diabetes has a high prevalence in both pediatric as well as adult populations in present times. Dental caries represents also a very serious problem form the health point of view in all population. Our study wishes to emphasize the relation between diabetes and oral health status in pediatric patients, also inquiring upon their awareness of the link between the two.
Material and method: 15 diabetic patients were compared with 15 non-diabetic matching patients.
Results: The study concluded in showing the importance of a correct oral hygiene in all patients with emphasize in cases of diabetic patients.
Conclusions: Awareness of the link between diabetes and oral health status should be promoted not only by dentists but also by their general medicine practitioner as well as diabetes specialists and nutrition specialist.
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Cost–utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain. Clin Transl Oncol 2019; 21:1076-1084. [DOI: 10.1007/s12094-018-02026-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023]
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Shrestha SS, Honeycutt AA, Yang W, Zhang P, Khavjou OA, Poehler DC, Neuwahl SJ, Hoerger TJ. Economic Costs Attributable to Diabetes in Each U.S. State. Diabetes Care 2018; 41:2526-2534. [PMID: 30305349 PMCID: PMC8851543 DOI: 10.2337/dc18-1179] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate direct medical and indirect costs attributable to diabetes in each U.S. state in total and per person with diabetes. RESEARCH DESIGN AND METHODS We used an attributable fraction approach to estimate direct medical costs using data from the 2013 State Health Expenditure Accounts, 2013 Behavioral Risk Factor Surveillance System, and the Centers for Medicare & Medicaid Services' 2013-2014 Minimum Data Set. We used a human capital approach to estimate indirect costs measured by lost productivity from morbidity (absenteeism, presenteeism, lost household productivity, and inability to work) and premature mortality, using the 2008-2013 National Health Interview Survey, 2013 daily housework value data, 2013 mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research, and mean wages from the 2014 Bureau of Labor Statistics. Costs were adjusted to 2017 U.S. dollars. RESULTS The estimated median state economic cost was $5.9 billion, ranging from $694 million to $55.5 billion, in total and $18,248, ranging from $15,418 to $30,915, per person with diabetes. The corresponding estimates for direct medical costs were $2.8 billion (range $0.3-22.9) and $8,544 (range $6,591-12,953) and for indirect costs were $3.0 billion (range $0.4-32.6) and $9,672 (range $7,133-17,962). In general, the estimated state median indirect costs resulting from morbidity were larger than costs from mortality both in total and per person with diabetes. CONCLUSIONS Economic costs attributable to diabetes were large and varied widely across states. Our comprehensive state-specific estimates provide essential information needed by state policymakers to monitor the economic burden of the disease and to better plan and evaluate interventions for preventing type 2 diabetes and managing diabetes in their states.
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Affiliation(s)
| | | | | | - Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
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Harreiter J, Kautzky-Willer A. Sex and Gender Differences in Prevention of Type 2 Diabetes. Front Endocrinol (Lausanne) 2018; 9:220. [PMID: 29780358 PMCID: PMC5945816 DOI: 10.3389/fendo.2018.00220] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
Lifestyle intervention programs are effective in the prevention of type 2 diabetes mellitus (T2DM) in high risk populations. However, most studies only give limited information about the influence of sex and/or gender effectiveness of these interventions. So far, similar outcome was reported for diabetes progression and weight loss. Nevertheless, long-term data on cardiovascular outcome are sparse but favoring women regarding all-cause and cardiovascular mortality. In both men and women, sex hormone imbalances and reproductive disorders are associated with a higher risk of T2DM development. Diabetes prevention approaches are reported for polycystic ovary syndrome, gestational diabetes mellitus, and erectile dysfunction and are presented in this review. In the surgical treatment options for morbid obese patients, sex and gender differences are present. Choices and preferences of adherence to lifestyle and pharmacological interventions, expectations, treatment effects, and complications are influenced by sex or gender. In general, bariatric surgery is performed more often in women seeking medical/surgical help to lose weight. Men are older and have higher comorbidities and mortality rates and worse follow-up outcome after bariatric surgery. A more gender-sensitive clinical approach, as well as consideration of ethnicity may improve quality of life and increase health and life expectancy in men and women with a high risk for subsequent progression to T2DM.
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