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Maeda T. Taking action for controlling high blood pressure: challenges in the real world. Hypertens Res 2024; 47:1894-1896. [PMID: 38769139 DOI: 10.1038/s41440-024-01711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Toshiki Maeda
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan Fukuoka, 814-0180, Japan.
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2
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Harris R. The costs of oral disease prevention versus treatment. Br Dent J 2024; 236:966. [PMID: 38942861 DOI: 10.1038/s41415-024-7556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Rebecca Harris
- Professor of Dental Public Health, University of Liverpool, UK.
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Kassab J, Hadi El Hajjar A, Wardrop RM, Brateanu A. Accuracy of Online Artificial Intelligence Models in Primary Care Settings. Am J Prev Med 2024; 66:1054-1059. [PMID: 38354991 DOI: 10.1016/j.amepre.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION The importance of preventive medicine and primary care in the sphere of public health is expanding, yet a gap exists in the utilization of recommended medical services. As patients increasingly turn to online resources for supplementary advice, the role of artificial intelligence (AI) in providing accurate and reliable information has emerged. The present study aimed to assess ChatGPT-4's and Google Bard's capacity to deliver accurate recommendations in preventive medicine and primary care. METHODS Fifty-six questions were formulated and presented to ChatGPT-4 in June 2023 and Google Bard in October 2023, and the responses were independently reviewed by two physicians, with each answer being classified as "accurate," "inaccurate," or "accurate with missing information." Disagreements were resolved by a third physician. RESULTS Initial inter-reviewer agreement on grading was substantial (Cohen's Kappa was 0.76, 95%CI [0.61-0.90] for ChatGPT-4 and 0.89, 95%CI [0.79-0.99] for Bard). After reaching a consensus, 28.6% of ChatGPT-4-generated answers were deemed accurate, 28.6% inaccurate, and 42.8% accurate with missing information. In comparison, 53.6% of Bard-generated answers were deemed accurate, 17.8% inaccurate, and 28.6% accurate with missing information. Responses to CDC and immunization-related questions showed notable inaccuracies (80%) in both models. CONCLUSIONS ChatGPT-4 and Bard demonstrated potential in offering accurate information in preventive care. It also brought to light the critical need for regular updates, particularly in the rapidly evolving areas of medicine. A significant proportion of the AI models' responses were deemed "accurate with missing information," emphasizing the importance of viewing AI tools as complementary resources when seeking medical information.
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Affiliation(s)
- Joseph Kassab
- Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Richard M Wardrop
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
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Wang JD, Lai WW, Yang SC, Huang WY, Hwang JS. Estimating Taiwan's QALY league table for catastrophic illnesses: Providing real-world evidence to integrate prevention with treatment for resources allocation. J Formos Med Assoc 2024:S0929-6646(24)00247-X. [PMID: 38772804 DOI: 10.1016/j.jfma.2024.05.011] [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: 12/22/2023] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND/PURPOSE Curative technologies improve patient's survival and/or quality of life but increase financial burdens. Effective prevention benefits all three. We summarize estimation methods and provide examples of how much money is spent per quality-adjusted life year (QALY) or life year (LY) on treating a catastrophic illness under a lifetime horizon and how many QALYs/LYs and lifetime medical costs (LMC) could be potentially saved by prevention. METHODS We established cohorts by interlinkages of Taiwan's nation-wide databases including National Health Insurance. We developed methods to estimate lifetime survival functions, which were multiplied with the medical costs and/or quality of life and summed up to estimate LMC, quality-adjusted life expectancy (QALE) and lifetime average cost per QALY/LY for catastrophic illnesses. By comparing with the age-, sex-, and calendar year-matched referents simulated from vital statistics, we obtained the loss-of-QALE and loss-of-life expectancy (LE). RESULTS The lifetime cost-effectiveness ratios of ventilator-dependent comatose patients, dialysis, spinal cord injury, major trauma, and cancers were US$ 96,800, 16,200-20,000, 5500-5,900, 3400-3,600, and 2900-11,900 per QALY or LY, respectively. The successful prevention of lung, liver, oral, esophagus, stomach, nasopharynx, or ovary cancer would potentially save US$ 28,000-97,000 and > 10 QALYs; whereas those for end-stage kidney disease, stroke, spinal injury, or major trauma would be US$ 55,000-300,000 and 10-14 QALYs. Loss-of-QALE and loss-of-LE were less confounded indicators for comparing the lifetime health benefits of different technologies estimated from real-world data. CONCLUSIONS Integration of prevention with treatment for resources allocation seems feasible and would improve equity and efficiency.
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Affiliation(s)
- Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Snowden A, Young J, Savinc J. Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland. BMC Health Serv Res 2024; 24:457. [PMID: 38609990 PMCID: PMC11010331 DOI: 10.1186/s12913-024-10923-2] [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: 03/22/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ. METHODS Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups. RESULTS There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups. DISCUSSION ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.
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Affiliation(s)
- Austyn Snowden
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland.
| | - Jenny Young
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
| | - Jan Savinc
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
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Krystallidou D, Temizöz Ö, Wang F, de Looper M, Di Maria E, Gattiglia N, Giani S, Hieke G, Morganti W, Pace CS, Schouten B, Braun S. Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services. Health Policy 2024; 139:104949. [PMID: 38071855 DOI: 10.1016/j.healthpol.2023.104949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. METHODS We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. RESULTS 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. CONCLUSIONS Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.
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Affiliation(s)
- Demi Krystallidou
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom.
| | - Özlem Temizöz
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Fang Wang
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Melanie de Looper
- Tilburg Social and Behavioural Sciences, Centre for Care and Wellbeing (Tranzo), University of Tilburg, the Netherlands
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa, Italy; University Unit of Medical Genetics, Galliera Hospital, Genoa, Italy
| | - Nora Gattiglia
- Department of Modern Languages and Cultures, University of Genoa, Italy
| | | | - Graham Hieke
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Wanda Morganti
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, Genoa, Italy
| | | | - Barbara Schouten
- Amsterdam School of Communication Research (ASCoR)/Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | - Sabine Braun
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
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Reynolds EL, Mizokami-Stout K, Putnam NM, Banerjee M, Albright D, Ang L, Lee J, Pop-Busui R, Feldman EL, Callaghan BC. Cost and utilization of healthcare services for persons with diabetes. Diabetes Res Clin Pract 2023; 205:110983. [PMID: 37890702 PMCID: PMC11037241 DOI: 10.1016/j.diabres.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS Describe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States. METHODS Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits. RESULTS In 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (-7.5 %) and without diabetes (-2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %). CONCLUSIONS Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.
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Affiliation(s)
- Evan L Reynolds
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
| | - Kara Mizokami-Stout
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Nathaniel M Putnam
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Dana Albright
- Department of Pediatrics, Division of Pediatric Psychology, University of Michigan, C.S. Mott Children's Hospital, Pediatric Psychology Clinic, 1540 East Medical Center Drive Level 5, Ann Arbor, MI 48109-5318, USA.
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Joyce Lee
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Medical Professional Building, Room D3202, Box: 5718, 1522 Simpson Road East, Ann Arbor, MI 48109-5718, USA.
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
| | - Eva L Feldman
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
| | - Brian C Callaghan
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
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Chiolero A, Cullati S. No magic way to curb rising healthcare costs. BMJ 2023; 381:p1283. [PMID: 37279989 DOI: 10.1136/bmj.p1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Jaskulski S, Nuszbaum C, Michels KB. Components, prospects and challenges of personalized prevention. Front Public Health 2023; 11:1075076. [PMID: 36875367 PMCID: PMC9978387 DOI: 10.3389/fpubh.2023.1075076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
Effective preventive strategies are urgently needed to address the rising burden of non-communicable diseases such as cardiovascular disease and cancer. To date, most prevention efforts to reduce disease incidence have primarily targeted populations using "one size fits all" public health recommendations and strategies. However, the risk for complex heterogeneous diseases is based on a multitude of clinical, genetic, and environmental factors, which translate into individual sets of component causes for every person. Recent advances in genetics and multi-omics enable the use of new technologies to stratify disease risks at an individual level fostering personalized prevention. In this article, we review the main components of personalized prevention, provide examples, and discuss both emerging opportunities and remaining challenges for its implementation. We encourage physicians, health policy makers, and public health professionals to consider and apply the key elements and examples of personalized prevention laid out in this article while overcoming challenges and potential barriers to their implementation.
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Affiliation(s)
- Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany
| | - Cosima Nuszbaum
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Dierckx E, Duppen D, Hoens S, Switsers L, Smetcoren AS, De Donder L, D-SCOPE. Effectiveness, satisfaction and meaningfulness of a 6-step detection and prevention program for frail community-dwelling older adults: a mixed-method evaluation. BMC Geriatr 2022; 22:966. [DOI: 10.1186/s12877-022-03504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background:
As people age, the risk of becoming frail increases, often leading to negative outcomes and less well-being. Within the light of prevention, early detection and guidance to the right care and support is crucial. This study aimed to give an overview of the descriptive results of the D-SCOPE program and evaluate the process.
Methods:
The D-SCOPE program was developed as a detection and prevention program for frail community-dwelling older adults. The program creates a continuum of care and support, consisting of 6 steps: (1) Targeted case-finding using risk profiles for purposeful selection, (2) Preventive home-visit by an older volunteer, (3) Home visits by a professional, (4), Warm referral, (5) Monthly follow-up and (6) Long-term follow-up by home visit. The effectiveness of this program, in terms of satisfaction and meaningfulness, was studied quantitatively by means of a randomized controlled trial amongst 869 people with a frailty risk profile and qualitatively by 15 focus groups interviews.
Results:
The quantitative study revealed that 83.9% of the participants found the different home visits within the D-SCOPE program useful. The focus group interviews shed light on several issues and advantages: a more efficient case finding due to the applied risk factors for frailty, a more intensive tailor-made care and support due to the warm referral, the importance of both small-scaled and larger interventions based on the wishes irrespective of the state of frailty of the older persons, the focus on a strengths-based instead of a deficit-based approach and the follow up as being one of the greatest strengths of the project. However, to fully understand the benefits of the program a shift in mind from intervention to prevention is necessary.
Conclusions:
Our quantitative data show that most participants found the home visits meaningful and were satisfied with the intervention. The qualitative findings provided more insights into the experiences of the participants with the process. Based on these insights of the 6-step model of preventive home visits, municipalities and organizations can apply this model to carry out more targeted home visits.
Trial registration:
This trial was registered at ClinicalTrials.gov, on 30/05/2017, identifier: NCT03168204.
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Pacheco‐Barrios K, Giannoni‐Luza S, Navarro‐Flores A, Rebello‐Sanchez I, Parente J, Balbuena A, de Melo PS, Otiniano‐Sifuentes R, Rivera‐Torrejón O, Abanto C, Alva‐Diaz C, Musolino PL, Fregni F. Burden of Stroke and Population‐Attributable Fractions of Risk Factors in Latin America and the Caribbean. J Am Heart Assoc 2022; 11:e027044. [DOI: 10.1161/jaha.122.027044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Stroke burden characterization studies in low‐ and middle‐income countries are scarce. We estimated the burden of stroke and its risk factors in Latin America and the Caribbean (LAC).
Methods and Results
We extracted GBD (Global Burden of Disease) study 2019 data on overall stroke and 3 subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) for 20 LAC countries. We estimated absolute and age‐standardized rates of disability‐adjusted life years, years of life lost, years lived with disability, and deaths. The population‐attributable fractions of 17 risk factors were estimated. All analyses were performed at regional and national levels by stroke subtype, sex, and age subgroups. In 2019, the LAC region had the fourth largest stroke burden worldwide (6.8 million disability‐adjusted life years), predominantly attributable to premature deaths (89.5% of disability‐adjusted life years). Intracerebral hemorrhage was the primary cause of the overall stroke burden (42% of disability‐adjusted life years), but ischemic stroke was the leading cause of disability (69% of total years lived with disability). Haiti and Honduras had the highest age‐standardized rates. Older adults and men had the largest burdens, although women had the highest rate of disability. Socioeconomic development level did not influence the burden. The major risk factor clusters were metabolic (high systolic blood pressure [population‐attributable fraction=53%] and high body mass index [population‐attributable fraction=37%]), which were more influential in hemorrhagic events, women, and older adults. Household air pollution was an important risk factor in low‐income countries in LAC.
Conclusions
The stroke burden and stroke‐related mortality in LAC are higher than the worldwide averages. However, stroke is a highly preventable disease in this region. Up to 90% of the burden could be reduced by targeting 2 modifiable factors: blood pressure and body mass index. Further research and implementation of primary and secondary prevention interventions are needed, as well as integrated national stroke care programs for acute, subacute, and rehabilitation management in LAC.
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Affiliation(s)
- Kevin Pacheco‐Barrios
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud Lima Peru
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Stefano Giannoni‐Luza
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Alba Navarro‐Flores
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- International Max Planck Research School for Neurosciences, Georg‐August‐University Göttingen Göttingen Germany
| | - Ingrid Rebello‐Sanchez
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Ana Balbuena
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | | | - Oscar Rivera‐Torrejón
- Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Carlos Alva‐Diaz
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
- Universidad Señor de Sipán Chiclayo Peru
| | - Patricia L. Musolino
- Department of Neurology Massachusetts General Hospital, Harvard Medical School Boston MA
- Center for Genomic Medicine, Center for Rare Neurological Disorders Massachusetts General Hospital, Harvard Medical School Boston
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
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Huang H, Zhu X, Wehby GL. Primary care physicians' participation in the Medicare shared savings program and preventive services delivery: Evidence from the first 7 years. Health Serv Res 2022; 57:1182-1190. [PMID: 35808929 PMCID: PMC9441290 DOI: 10.1111/1475-6773.14030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate whether primary care physicians' participation in the Medicare Shared Savings Program (MSSP) is associated with changes in their preventive services delivery. DATA SOURCES Medicare Provider Utilization and Payment Physician and Other Supplier Public Use File and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2012 to 2018. STUDY DESIGN The design was a two-way fixed effects model estimating within-provider changes in preventive services delivery over time controlling for provider time-invariant characteristics, national time trends, and characteristics of served patients. The following preventive services were evaluated: influenza vaccination, pneumococcal vaccination, clinical depression screening, colorectal cancer screening, breast cancer screening, Body Mass Index (BMI) screening and follow-up, tobacco use assessment, and annual wellness visits. Both the likelihood of providing services and the volume of services delivered were evaluated. DATA COLLECTION/EXTRACTION METHODS Secondary data linked at the provider level. PRINCIPAL FINDINGS MSSP participation was associated with an increase in the likelihood of providing influenza vaccination (0.7 percentage-points), pneumococcal vaccination (2.0 percentage-points), clinical depression screening (2.1 percentage-points), tobacco use assessment (0.3 percentage-points), and annual wellness visits (4.1 percentage-points). A similar increase was found for the volume of services delivered per 100 patients for several preventive services: influenza vaccination (0.18), pneumococcal vaccination (0.56), clinical depression screening (0.46), and annual wellness visits (1.52). MSSP participation was associated with a decrease in the likelihood (-0.4 percentage-points) and the volume of colorectal cancer screening (-0.03). CONCLUSIONS Primary care physicians' participation in MSSP was associated with an increase in the likelihood and the volume of several preventive services.
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Affiliation(s)
- Huang Huang
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Xi Zhu
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - George L. Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
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Hasan F, Rannaware A, Choudhari SG. Comparison of Public Health Investments of Various Countries Amid a Need for Greater Transparency: A Narrative Review. Cureus 2022; 14:e29687. [DOI: 10.7759/cureus.29687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
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Bocquier A, Jacquemot AF, Dubois C, Tréhard H, Cogordan C, Maradan G, Cortaredona S, Fressard L, Davin-Casalena B, Vinet A, Verger P, Darmon N, Arquier V, Briclot G, Chamla R, Cousson-Gélie F, Danthony S, Delrieu K, Dessirier J, Féart C, Fusinati C, Gazan R, Gibert M, Lamiraud V, Maillot M, Nadal D, Trotta C, Verger EO, Viriot V. Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the "ALAPAGE study"). BMC Geriatr 2022; 22:643. [PMID: 35927684 PMCID: PMC9351201 DOI: 10.1186/s12877-022-03260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions' effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the "ALAPAGE" program) on older peoples' eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention's process and (iii) its cost effectiveness. METHODS We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a "workshop" (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations' usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data). DISCUSSION This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05140330 , December 1, 2021. PROTOCOL VERSION Version 3.0 (November 5, 2021).
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Affiliation(s)
- Aurélie Bocquier
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France. .,Université de Lorraine, APEMAC, F-54000, Nancy, France.
| | - Anne-Fleur Jacquemot
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Bordeaux Population Health Research Center, University of Bordeaux, Inserm, UMR 1219, F-33000, Bordeaux, France
| | | | - Hélène Tréhard
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Chloé Cogordan
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | | | - Agnès Vinet
- Avignon Université, UPR EA4278, F-84000, Avignon, France
| | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Nicole Darmon
- MoISA, Université de Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
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15
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Jaspan O, Wysocka A, Sanchez C, Schweitzer AD. Improving the Relationship Between Confidence and Competence: Implications for Diagnostic Radiology Training From the Psychology and Medical Literature. Acad Radiol 2022; 29:428-438. [PMID: 33408052 DOI: 10.1016/j.acra.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 12/24/2022]
Abstract
The focus of diagnostic radiology training is on creating competent professionals, whereas confidence and its calibration receive less attention. Appropriate confidence is critical for patient care both during and after training. Overconfidence can adversely affect patient care and underconfidence can create excessive costs. We reviewed the psychology and medical literature pertaining to confidence and competence to collect insights and best practices from the psychology and medical literature on confidence and apply them to radiology training. People are rarely accurate in assessments of their own competence. Among physicians, the correlation between perceived abilities and external assessments of those abilities is weak. Overconfidence is more prevalent than underconfidence, particularly at lower levels of competence. On the individual level, confidence can be calibrated to a more appropriate level through efforts to increase competence, including sub-specialization, and by gaining a better understanding of metacognitive processes. With feedback, high-fidelity simulation has the potential to improve both competence and metacognition. On the system level, systems that facilitate access to follow-up imaging, pathology, and clinical outcomes can help close the gap between perceived and actual performance. Appropriate matching of trainee confidence and competence should be a goal of radiology residency and fellowship training to help mitigate the adverse effects of both overconfidence and underconfidence during training and independent practice.
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Cangelosi J, Damron TS, Kim D. Preventive health care information and social media: a comparison of Baby Boomer and Generation X health care consumers. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2022. [DOI: 10.1108/ijphm-04-2021-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
As consumer health-care spending increases, so does the need for effective communication of preventive health-care information (PHCI) with the potential to prompt lifestyle changes. Through proactive, effective dissemination of PHCI, health-care service providers can minimize and prevent costly health conditions while improving the efficiency of a traditionally reactive health-care system. Taking into account the considerable time consumers spend on social media and networks (SM&N) and hefty health-care spending among Baby Boomer and Generation X consumers, this study aims to address critical questions concerning the importance of SM&N for gathering PHCI, SM&N preferences for gathering PHCI and the types of behavioral changes consumers have pursued in response to PHCI.
Design/methodology/approach
Designed as a generational cohort analysis, this study is based on the responses of 936 Baby Boomer and Generation X respondents to a questionnaire containing 200 items related to PHCI and social/digital media as a vehicle for acquiring both general and preventive health information. Crosstab analysis was used to examine differences in the characteristics of the generational cohorts. Analysis of variance (ANOVA) was used to assess differences in the degree of importance Baby Boomer and Generation X health consumers assign to 28 SM&N sites as delivery systems of PHCI. The researchers used ANOVA to determine generational differences in behavioral changes associated with a healthier lifestyle as a result of exposure to PHCI.
Findings
There are significant differences in the characteristics of Baby Boomer and Generation X cohorts. Generation X health-care consumers assign greater importance to SM&N sites as PHCI delivery systems. Additionally, Generation X health-care consumers report greater behavioral change resulting from exposure to PHCI.
Research limitations/implications
New information is provided concerning health-care consumer perceptions of SM&N as a source of PHCI and the behavioral changes consumers pursue as a result of PHCI exposure.
Practical implications
This paper measures the effectiveness of interactive health-care marketing activities, explaining the role of SM&N as an effective source of PHCI and providing marketers with insights useful for PHCI content management and dissemination.
Social implications
Effective dissemination of PHCI via SM&N may help prevent illness among Baby Boomer and Generation X consumers and, accordingly, improve quality of life while easing the increasing pressure on the US health-care system.
Originality/value
Study results evidence the value of SM&N sites to health service providers as they endeavor to improve and extend consumer lives through dissemination of PHCI. Ideas and insights within this paper will inform and enhance social media marketing management practices within pharmaceutical and health-care organizations.
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Khushalani JS, Song S, Calhoun BH, Puddy RW, Kucik JE. Preventing Leading Causes of Death: Systematic Review of Cost-Utility Literature. Am J Prev Med 2022; 62:275-284. [PMID: 34736801 DOI: 10.1016/j.amepre.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke are the 5 leading causes of death in the U.S. The objective of this review is to examine the economic value of prevention interventions addressing these 5 conditions. METHODS Tufts Medical Center Cost-Effectiveness Analysis Registry data were queried from 2010 to 2018 for interventions that addressed any of the 5 conditions in the U.S. Results were stratified by condition, prevention stage, type of intervention, study sponsorship, and study perspective. The analyses were conducted in 2020, and all costs were reported in 2019 dollars. RESULTS In total, 549 cost-effectiveness analysis studies examined interventions addressing these 5 conditions in the U.S. Tertiary prevention interventions were assessed in 61.4%, whereas primary prevention was assessed in 8.6% of the studies. Primary prevention studies were predominantly funded by government, whereas industry sources funded more tertiary prevention studies, especially those dealing with pharmaceutical interventions. The median incremental cost-effectiveness ratio for the 5 conditions combined was $68,500 per quality-adjusted life year. Median incremental cost-effectiveness ratios were lowest for primary prevention and highest for tertiary prevention. DISCUSSION Primary prevention may be more cost effective than secondary and tertiary prevention interventions; however, research investments in primary prevention interventions, especially by industry, lag in comparison. These findings help to highlight the gaps in the cost-effectiveness analysis literature related to the 5 leading causes of death and identify understudied interventions and prevention stages for each condition.
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Affiliation(s)
- Jaya S Khushalani
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Suhang Song
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Brian H Calhoun
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Richard W Puddy
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James E Kucik
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Cangelosi J, Damron T, Ranelli E. Preventive health care information and social media: Consumer preferences. Health Mark Q 2021; 38:270-286. [PMID: 34672896 DOI: 10.1080/07359683.2021.1989745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The dissemination of preventive health care information (PHCI) can create social and economic value. Enhanced communication of health information depends upon the identification of effective channels and user preferences. Recognizing consumers find the internet and, increasingly, social media sites (Facebook and YouTube) to be important sources of PHCI, this research analyzed questionnaire responses from U.S. adults to identify the social media sites (SMSs), communication preferences, and sources consumers prefer when obtaining PHCI via social media.
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Affiliation(s)
| | - Terry Damron
- Austin Peay State University, Clarksville, TN, USA
| | - Ed Ranelli
- University of West Florida, Pensacola, FL, USA
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19
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Nayak S, Singer A, Greenspan SL. Cost-effectiveness of secondary fracture prevention intervention for Medicare beneficiaries. J Am Geriatr Soc 2021; 69:3435-3444. [PMID: 34343339 PMCID: PMC9291535 DOI: 10.1111/jgs.17381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 01/04/2023]
Abstract
Background Secondary fracture prevention intervention such as fracture liaison services are effective for increasing osteoporosis treatment rates, but are not currently widely used in the United States. We evaluated the cost‐effectiveness of secondary fracture prevention intervention after osteoporotic fracture for Medicare beneficiaries. Methods An individual‐level state‐transition microsimulation model was developed to evaluate the cost‐effectiveness of secondary fracture prevention intervention compared with usual care for U.S. Medicare patients aged 65 and older who experience a new osteoporotic fracture. Patients who initiated pharmacotherapy and remained adherent were assumed to be treated for 5 years. Outcome measures included subsequent fractures, average lifetime costs, quality‐adjusted life‐years (QALYs), and incremental cost‐effectiveness ratios in 2020 U.S. dollars per QALY gained. The model time horizon was lifetime, and analysis perspective was payer. Results Base‐case analysis results showed that the secondary fracture prevention intervention strategy was both more effective and less expensive than usual care—thus, it was cost‐saving. Model findings indicated that the intervention would reduce the number of expected fractures by approximately 5% over a 5‐year period, preventing approximately 30,000 fractures for 1 million patients. Secondary fracture prevention intervention resulted in an average cost savings of $418 and an increase in QALYs of 0.0299 per patient over the lifetime; for 1 million patients who receive the intervention instead of usual care, expected cost savings for Medicare would be $418 million dollars. One‐way and probabilistic sensitivity analyses supported base‐case findings of cost savings. Conclusion Secondary fracture prevention intervention for Medicare beneficiaries after a new osteoporotic fracture is very likely to both improve health outcomes and reduce healthcare costs compared with usual care. Expansion of its use for this population is strongly recommended.
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Affiliation(s)
- Smita Nayak
- Berkeley Madonna, Inc., Albany, California, USA
| | - Andrea Singer
- MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Susan L Greenspan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Grosse SD, Kemper AR, Prosser LA. Data Needs for Economic Evaluations of Screening in Pediatric Primary Care: A Research Framework. Pediatrics 2021; 148:s45-s50. [PMID: 34210848 PMCID: PMC8312553 DOI: 10.1542/peds.2021-050693j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex R. Kemper
- Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lisa A. Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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21
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Roblin DW, Segel JE, McCarthy RJ, Mendiratta N. Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:2021-2029. [PMID: 33742306 PMCID: PMC8298622 DOI: 10.1007/s11606-021-06676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel. OBJECTIVE Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP. DESIGN Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients. SETTING Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017-2018. PARTICIPANTS Nine hundred twenty-nine CCP patients empaneled January 2017-June 2018, 929 matched control patients for the same period. INTERVENTIONS The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations. MAIN OUTCOMES Time to death and time to first hospital admission in the 180 days following empanelment or eligibility. RESULTS Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084). LIMITATIONS Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions. CONCLUSION The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.
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Affiliation(s)
- Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
| | - Joel E Segel
- The Pennsylvania State University, University Park, PA, USA
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Mis-spending on information security measures: Theory and experimental evidence. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2021. [DOI: 10.1016/j.ijinfomgt.2020.102291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Agostoni C, Boccia S, Banni S, Mannucci PM, Astrup A. Sustainable and personalized nutrition: From earth health to public health. Eur J Intern Med 2021; 86:12-16. [PMID: 33640245 DOI: 10.1016/j.ejim.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
Sustainable nutrition, equaling earth health, involves a personalized approach designed in terms of precision and avoidance of still cogent but unjustified dogmas, equaling public health. For instance, current dietary recommendations continue to dwell on the need to limit as much as possible the intake of saturated fatty acids (SFA), notwithstanding the mounting evidence that the effects of food on health cannot be predicted from the content of single nutrients without considering the overall macronutrient composition and the role of the food matrix. The traditional recommendation to restrict SFA ignores that their effects on health depend on the interaction between naturally occurring food components and those introduced by food processing. It is warranted to modify the still widely promoted dietary guidelines based upon such single nutrients as SFA and instead personalize dietary habits on the basis of the whole pattern of the food matrix. Accordingly, the double edge of malnutrition, that involves deficiency as well as excess and materializes in many individuals throughout their life course, might be tackled by implementing sustainability, with the additional effect of overcoming global inequalities. Within this context SFA may regain their position of tasty and cheap sources of energy to be adapted to each individual lifestyle.
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Affiliation(s)
- C Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Banni
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - P M Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
| | - A Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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Dynamic changes in marital status and survival in women with breast cancer: a population-based study. Sci Rep 2021; 11:5421. [PMID: 33686220 PMCID: PMC7940486 DOI: 10.1038/s41598-021-84996-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/28/2021] [Indexed: 01/24/2023] Open
Abstract
Marital status proved to be an independent prognostic factor for survival in patients with breast cancer. We therefore strove to explore the impact of dynamic changes in marital status on the prognosis of breast cancer patients. We selected patients meeting the eligibility criteria from the Surveillance, Epidemiology, and End Results cancer database. We then used multivariate Cox proportional hazard regression model to analyze the effect of dynamic changes in marital status on the prognosis of overall survival (OS) and breast cancer-specific special survival (BCSS). Compared with the patients in the Single–Single group and the divorced/separated/widowed–divorced/separated/widowed (DSW–DSW) group, patients in the Married–Married group were significantly associated with better BCSS (HR 1.13, 95% CI: 1.03–1.19, P < 0.001; HR 1.19, 95% CI: 1.14–1.25, P < 0.001, respectively) and OS (HR 1.25, 95% CI: 1.20–1.30, P < 0.001; HR 1.49, 95% CI: 1.45–1.54, P < 0.001, respectively). In contrast to the DSW–DSW group, the Single–Single group and the DSW–Married group showed similar BCSS (HR 0.98, 95% CI: 0.92–1.05, P = 0.660; HR 1.06, 95% CI: 0.97–1.15, P = 0.193, respectively) but better OS (HR 1.14, 95% CI: 1.09–1.19, P < 0.001; HR 1.32, 95% CI: 1.25–1.40, P < 0.001, respectively). Compared with the Single–Single group, the Single–Married group showed significantly better BCSS (HR 1.21, 95% CI: 1.07–1.36, P = 0.003) but no difference in OS (HR 1.08, 95% CI: 0.98–1.18, P = 0.102); In contrast to the Married–DSW group, the Married–Married group exhibited better BCSS (HR 1.11, 95% CI: 1.05–1.18, P < 0.001) and OS (HR 1.27, 95% CI: 1.22–1.32, P < 0.001). Our study demonstrated that, regardless of their previous marital status, married patients had a better prognosis than unmarried patients. Moreover, single patients obtained better survival outcomes than DSW patients. Therefore, it is necessary to proactively provide single and DSW individuals with appropriate social and psychological support that would benefit them.
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Campbell-Salome G, Buchanan AH, Hallquist MLG, Rahm AK, Rocha H, Sturm AC. Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers. PATIENT EDUCATION AND COUNSELING 2021; 104:403-412. [PMID: 32782180 DOI: 10.1016/j.pec.2020.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine the uncertainty management process of individuals with Lynch syndrome (LS). METHODS 19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes. RESULTS Qualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support. CONCLUSION Healthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences. PRACTICE IMPLICATIONS Findings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.
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Affiliation(s)
| | | | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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Rosas S, Gwam CU, Araiza ET, Roche MW, Emory CL, Carroll EA, Halvorson JJ, Plate JF. Economic impact of orthopaedic care for non-fatal gunshot wounds: analysis of a public health crisis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:210. [PMID: 33708837 PMCID: PMC7940913 DOI: 10.21037/atm-20-1064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to perform an epidemiological evaluation and an economic analysis of 90-day costs associated with non-fatal gunshot wounds (GSWs) to the extremities, spine and pelvis requiring orthopaedic care in the United States. Methods A retrospective epidemiological review of the Medicare national patient record database was conducted from 2005 to 2014. Incidence, fracture location and costs associated where evaluated. Those patients identified through International Classification of Disease (ICD)-9 revision codes and Current Procedural Terminology (CPT) Codes who sustained a fracture secondary to a GSW. Any type of surgical intervention including incision and drainage, open reduction with internal fixation, closed reduction and percutaneous fixation, etc. were identified to analyze, and evaluate costs of care as seen by charges and reimbursements to the payer. The 90-day period after initial fracture care was queried. Results A total of 9,765 patients required surgical orthopaedic care for GSWs. There was a total of 2,183 fractures due to GSW treated operatively in 2,201 patients. Of these, 22% were femur fractures, 18.3% were hand/wrist fractures and 16.7% were ankle/foot fractures. A majority of patients were male (83.3%) and under 65 years of age (56.3%). Total charges for GSW requiring orthopedic care were $513,334,743 during the 10-year study period. Total reimbursement for these patients were $124,723,068. Average charges per patient were highest for fracture management of the spine $431,021.33, followed by the pelvis $392,658.45 and later by tibia/fibula fractures $342,316.92. Conclusions The 90-day direct charges and reimbursements of orthopedic care for non-fatal GSWs are of significant amounts per patient. While the number of fatal GSWs has received much attention, non-fatal GSWs have a large economic and societal impact that warrants further research and consideration by the public and policy makers.
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Affiliation(s)
- Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Chukwuweike U Gwam
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Edgar T Araiza
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Martin W Roche
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Cynthia L Emory
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Eben A Carroll
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Jason J Halvorson
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Johannes F Plate
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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Abstract
Despite the recognized need to change the emphasis of health services by
shifting the balance from treatment to prevention, limited progress
has been made in many settings. This is true in oral health, where
evidence for preventive interventions that work has not been
systematically exploited in oral health services. While reorienting
health services is complex and context specific, economics can bring a
helpful perspective in understanding and predicting the impact of
changes in resource allocation, provider remuneration systems, and
patient payments. There is an increasing literature on the economics
of different prevention approaches. However, much of this literature
focuses on the costs and potential savings of alternative approaches
and fails to take into account benefits. Even where benefits are taken
into account, these tend to be narrowly focused on clinical outcomes
using cost-effectiveness analysis, which may be of little relevance to
the policy maker, patient, and the public. Some commonly used economic
approaches (such as quality-adjusted life years and incremental
cost-effectiveness ratios) may also not be appropriate to oral health.
Using alternative techniques, including wider measures of benefit and
employing priority setting and resource allocation tools, may provide
more comprehensive information on economic impact to decision makers
and stakeholders. In addition, it is important to consider the effects
of provider remuneration in reorienting services. While there is some
evidence about traditional models of remuneration (fee for service and
capitation), less is known about pay for performance and blended
systems. This article outlines areas in which economics can offer an
insight into reorientation of health systems toward prevention,
highlighting areas for further research and consideration.
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Affiliation(s)
- C R Vernazza
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - S Birch
- Centre for the Business and Economics of Health, University of Queensland, Saint Lucia, Queensland, Australia.,Centre for Health Economics, University of Manchester, Manchester, UK
| | - N B Pitts
- Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, UK
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Pratiti R, Sud P. A Call for epidemic assessment questionnaire. ENVIRONMENTAL RESEARCH 2020; 191:110150. [PMID: 32888952 PMCID: PMC7462929 DOI: 10.1016/j.envres.2020.110150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
Epidemic outbreaks are a part of population and public health. The epidemiological triad of host, agent and environment are changing in their interaction with each other in the recent years. As health care professionals lack training and time to assess risk factors of epidemic, important information about epidemic source identification may be missed. Newer biological and chemical agents are continually being added in our environment with potential to cause acute or subacute epidemic of diseases. These factors should motivate us to draft and implement an accessible universal epidemic outbreak questionnaire with a good online database for early epidemic source identification. We have tried to formulate a universal questionnaire that, if needed may be used by providers if they suspect unusual occurrence of cluster of cases.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA.
| | - Parul Sud
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
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Agrawal S, Gołębiowska J, Bartoszewicz B, Makuch S, Mazur G. Clinical preventive services to reduce pandemic deaths. Prev Med Rep 2020; 20:101249. [PMID: 33251094 PMCID: PMC7687404 DOI: 10.1016/j.pmedr.2020.101249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 01/10/2023] Open
Abstract
High utilization of clinical preventive services reduces mortality during outbreaks. The prevention of comorbidities can reduce the COVID-19 death toll. Prevention of hypertension bears the highest potential to decrease COVID-19 deaths.
The recent COVID-19 pandemic has highlighted inadequacies in both national and international preparedness. The outbreak has resulted in an overburdening and incapacitation of health systems worldwide, as well as numerous deaths of individuals with comorbidities. We have performed a simulation study to examine the effect of comorbidities and their prevention on the clinical outcome and mortality of patients during the COVID-19 pandemic. The data from past and present outbreaks indicate that individuals with comorbidities are significantly more susceptible to infections and yield poorer clinical outcomes. Our simulation study revealed that the prevention of morbidities like hypertension, diabetes, and cardiovascular disease bears an enormous potential to decrease the COVID-19 death toll. The accumulating evidence emphasizes our ability to reduce both the susceptibility of uninfected individuals to pathogenic factors, as well as the mortality of infected individuals during pandemics, by adopting a more comprehensive approach to disease prevention. Higher utilization of clinical preventive services is critical to reduce pandemic deaths and increase our preparedness for future outbreaks.
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Affiliation(s)
- Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland
- Department of Cancer Prevention and Therapy, Wroclaw Medical University, Poland
- Department of Pathology, Wroclaw Medical University, Poland
- Corresponding author at: Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland.
| | - Justyna Gołębiowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland
| | - Bartłomiej Bartoszewicz
- Department of Econometrics and Operational Research, Wroclaw University of Economics and Business, Poland
| | | | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland
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Sarraj A, Pizzo E, Lobotesis K, Grotta JC, Hassan AE, Abraham MG, Blackburn S, Day AL, Dannenbaum MJ, Hicks W, Vora NA, Budzik RF, Sharrief AZ, Martin-Schild S, Sitton CW, Pujara DK, Lansberg MG, Gupta R, Albers GW, Kunz WG. Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study. J Neurointerv Surg 2020; 13:875-882. [DOI: 10.1136/neurintsurg-2020-016766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022]
Abstract
BackgroundIt is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.MethodsIn the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS<6 or computed tomography perfusion (CTP) ischemic core volume (rCBF<30%) ≥50 cc. A Markov model estimated costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) of EVT compared with medical management (MM) over lifetime. The willingness to pay (WTP) per QALY was set at $50 000 and $100 000 and the net monetary benefits (NMB) were calculated. Probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEAC) for EVT were assessed in SELECT and other pivotal trials.ResultsFrom 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected lifetime of patients presenting with large core, EVT led to incremental costs of $33 094 and a gain of 1.34 QALYs per patient, resulting in ICER of $24 665 per QALY. EVT has a higher NMB compared with MM at lower (EVT -$42 747, MM -$76 740) and upper (EVT $155 041, MM $57 134) WTP thresholds. PSA confirmed the results and CEAC showed 77% and 92% acceptability of EVT at the WTP of $50 000 and $100 000, respectively. EVT was associated with an increment of $29 225 in societal costs. The pivotal EVT trials (HERMES, DAWN, DEFUSE 3) were dominant in a sensitivity analysis at the same inputs, with societal cost-savings of $37 901, $86 164 and $22 501 and a gain of 1.62, 2.36 and 2.21 QALYs, respectively.ConclusionsIn a non-randomized prospective cohort study, EVT resulted in better outcomes in large core patients with higher QALYs, NMB and high cost-effectiveness acceptability rates at current WTP thresholds. Randomized trials are needed to confirm these results.Clinical trial registrationNCT02446587
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Davillas A, Pudney S. Using biomarkers to predict healthcare costs: Evidence from a UK household panel. JOURNAL OF HEALTH ECONOMICS 2020; 73:102356. [PMID: 32663637 DOI: 10.1016/j.jhealeco.2020.102356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
We investigate the extent to which healthcare service utilisation and costs can be predicted from biomarkers, using the UK Understanding Society panel. We use a sample of 2314 adults who reported no history of diagnosed long-lasting health conditions at baseline (2010/11), when biomarkers were collected. Five years later, their GP, outpatient (OP) and inpatient (IP) utilisation was observed. We develop an econometric technique for count data observed within ranges and a method of combining administrative reference cost data with the survey data without exact individual-level matching. Our composite biomarker index (allostatic load) is a powerful predictor of costs: for those with a baseline allostatic load of at least one standard deviation (1-s.d.) above mean, a 1-s.d. reduction reduces GP, OP and IP costs by around 18%.
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Affiliation(s)
- Apostolos Davillas
- Health Economics Group, Norwich Medical School, University of East Anglia, Institute for Social and Economic Research, University of Essex, United Kingdom
| | - Stephen Pudney
- School of Health and Related Research, University of Sheffield, United Kingdom.
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Ferrier C, Khoshnood B, Dhombres F, Randrianaivo H, Perthus I, Jouannic JM, Durand-Zaleski I. Cost and outcomes of the ultrasound screening program for birth defects over time: a population-based study in France. BMJ Open 2020; 10:e036566. [PMID: 32690745 PMCID: PMC7375504 DOI: 10.1136/bmjopen-2019-036566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess trends in the average costs and effectiveness of the French ultrasound screening programme for birth defects. DESIGN A population-based study. SETTING National Public Health Insurance claim database. PARTICIPANTS All pregnant women in the 'Echantillon Généraliste des Bénéficiaires', a permanent representative sample of 1/97 of the individuals covered by the French Health Insurance System. MAIN OUTCOMES MEASURES Trends in the costs and in the average cost-effectiveness ratio (ACER) of the screening programme (in € per case detected antenatally), per year, between 2006 and 2014. incremental cost-effectiveness ratio (ICER) from 1 year to another were also estimated. We assessed costs related to the ultrasound screening programme of birth defects excluding the specific screening of Down's syndrome. The outcome for effectiveness was the prenatal detection rate of birth defects, assessed in a previous study. Linear and logistic regressions were used to analyse time trends. RESULTS During the study period, there was a slight decrease in prenatal detection rates (from 58.2% in 2006 to 55.2% in 2014; p=0.015). The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). We found a 61% increase in the ACER for ultrasound screening during the study period. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). ICERs had an erratic pattern, with a strong tendency to show that any increment in the cost of screening was highly cost ineffective. CONCLUSION Even if the increase in costs may be partly justified, we observed a diminishing returns for costs associated with the prenatal ultrasound screening of birth defects, in France, between 2006 and 2014.
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Affiliation(s)
- Clément Ferrier
- Fetal Medecine Department, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, UK
| | - Babak Khoshnood
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), DHU Risks in Pregnancy, INSERM UMR 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Ferdinand Dhombres
- Fetal Medecine Department, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, UK
| | - Hanitra Randrianaivo
- Medical genetics, Reunion Registry of Congenital Anomalies, St Pierre, Saint Pierre de la Réunion, France
| | - Isabelle Perthus
- Medical genetics, Study Center for Congenital Anomalies, CEMC-Auvergne, Clermont-Ferrand, France
| | | | - Isabelle Durand-Zaleski
- AP-HP Health economics research unit & Department of Public Health, Henri Mondor Hospital,CRESS-UMR1153 - INSERM & UPEC, Paris, France
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Kirkpatrick D, Dunn M, Tuttle R. Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act. Am Surg 2020. [DOI: 10.1177/000313482008600327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.
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Affiliation(s)
- Dan Kirkpatrick
- Department of Surgery, Boonschoft School of Medicine, Wright State University, Dayton, Ohio; and
- General Surgery, 88th Medical Group, Wright Patterson Air Force Base, Dayton, Ohio
| | - Margaret Dunn
- Department of Surgery, Boonschoft School of Medicine, Wright State University, Dayton, Ohio; and
| | - Rebecca Tuttle
- Department of Surgery, Boonschoft School of Medicine, Wright State University, Dayton, Ohio; and
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Aguiar M, Högler W. Prevention of vitamin D deficiency improves population health, social inequalities and health care budgets. Eur J Public Health 2020; 30:392-393. [PMID: 32531037 DOI: 10.1093/eurpub/ckz207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Magda Aguiar
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver V6T 1Z4, Canada.,Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
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35
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Boccia S, Ricciardi W. Personalized prevention and population health impact: how can public health professionals be more engaged? Eur J Public Health 2020; 30:391-392. [PMID: 32531037 PMCID: PMC7292346 DOI: 10.1093/eurpub/ckaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stefania Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Walter Ricciardi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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36
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Ofoli JNT, Ashau-Oladipo T, Hati SS, Ati L, Ede V. Preventive healthcare uptake in private hospitals in Nigeria: a cross-sectional survey (Nisa premier hospital). BMC Health Serv Res 2020; 20:273. [PMID: 32238153 PMCID: PMC7114808 DOI: 10.1186/s12913-020-05117-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background Understanding the features of preventive care uptake is critical for assessing the performance and viability of primary care in any healthcare system. There are gaps in previous studies that focused on primary healthcare features, challenges and way forward in Nigeria but were mainly public sector focused and do not characterize the features of preventive care. Since private healthcare sector remains the most accessed and utilized in Nigeria, this study sought to characterize the features of uptake of preventive care to better understand the current preventive healthcare landscape. Method A descriptive cross-sectional study, using survey questionnaire were randomly administered to adult patients attending the Family Medicine Out-Patient Department (OPD) at Nisa Premier Hospital, Jabi Abuja. The study was conducted over a three-month period. (January to June 2017). Data collected were analyzed using SPSS version 23 (IBM SPSS, Chicago, IL, USA). Descriptive statistics in the form of frequency and percentage were used to report the results. Results A total of 381 participants completed the survey. The results revealed that while an over overwhelming majority (> 90%) of participants indicated knowledge of benefits of preventive care, and preferred interventions aimed at preventing a disease before they occur, 48% preferred interventions aimed at reducing disease or injury impact or interventions aimed at ameliorating the impact of ongoing disease or injury with long lasting effect (43%). Unfortunately, less than 40% of respondents would visit the hospital when their health condition is not serious. Important barriers to uptake of preventive care were revealed as cost (45%), distance to the healthcare provider (36%) and lack of health insurance (33%), whereas poor education (19%), social norms (13%) as well as cultural and religious beliefs (10%) towards accessing certain health services appeared to be lesser barriers. Conclusion Although people are aware of the benefits of preventive care, its uptake will greatly be enhanced through improved health insurance coverage, refocusing primary healthcare functions on preventive rather than curative care and instituting policies that mandatorily prescribe uptake for the insured, both at the individual and the insurer’s level.
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Affiliation(s)
- Joshua N T Ofoli
- Department of Family and Specialty Medicine, Nisa Premier Hospital, Abuja, Nigeria
| | - Timi Ashau-Oladipo
- Department of Family and Specialty Medicine, Nisa Premier Hospital, Abuja, Nigeria
| | - Stephen S Hati
- Research and Development, Nisa Premier Hospital, Abuja, Nigeria.,Center for Research, Institute of Medical Sciences Africa, Abuja, Nigeria
| | - Lile Ati
- Research and Development, Nisa Premier Hospital, Abuja, Nigeria
| | - Victor Ede
- Medical Audit Department, Nisa Premier Hospital, Abuja, Nigeria.
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Jazieh AR, Ibrahim N, Abdulkareem H, Maraiki F, Alsaleh K, Thill M. Expert-Based Strategies to Improve Access to Cancer Therapeutics at the Hospital Level. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/jqsh.jqsh_4_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Background: Challenges related to access to cancer medications is an increasing global problem that has far-reaching impact on patients and healthcare systems. In this article, we are enlisting suggested solutions at the hospital or practice level to maximize the access to these important treatment modalities. Methods: An expert panel of practicing oncologists, clinical pharmacists, and health economists convened using a framework approach. The panelists identified individuals and entities that impact the use of cancer therapeutics and how they can improve the utilization and access to them. They enlisted the potential actions that hospital management and staff can take to enhance access to cancer therapeutics, then they grouped them into specific categories. Results: List of potential strategies and related action items were compiled into different categories including hospital leadership, drug evaluation entities, pharmacy, physicians, patients and families, and other parties. Recommendations included various actions to be considered by each group to achieve set goals. Conclusion: Our expert panel recommend multiple strategies and approaches to reduce the cost of cancer medications and improve patients' access to them. These recommendations can be adapted by the decision-makers and staff of the hospitals to their own settings and the current circumstances.
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Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
| | - Nagwa Ibrahim
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Pharmacy, Prince Sultan Military Medical City,
| | - Hana Abdulkareem
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs,
| | - Fatma Maraiki
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Pharmacy, King Faisal Specialist Hospital and Research Center,
| | - Khalid Alsaleh
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia,
| | - Marc Thill
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of OB and GYN, Certified Breast Cancer Center, Certified Cancer Center, Certified Endometriosis Center, Certified Dysplastic Unit, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
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Yamashita K, Yamashita T, Sato M, Inoue M, Takase Y. The Effects of an 18-Month Walking Habit Intervention on Reducing the Medical Costs of Diabetes, Hypertension, and Hyperlipidemia—A Prospective Study. ADVANCED BIOMEDICAL ENGINEERING 2020. [DOI: 10.14326/abe.9.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Boccia S, Pastorino R, Ricciardi W, Ádány R, Barnhoorn F, Boffetta P, Cornel MC, De Vito C, Gray M, Jani A, Lang M, Roldan J, Rosso A, Sánchez JM, Van Dujin CM, Van El CG, Villari P, Zawati MH. How to Integrate Personalized Medicine into Prevention? Recommendations from the Personalized Prevention of Chronic Diseases (PRECeDI) Consortium. Public Health Genomics 2019; 22:208-214. [PMID: 31805565 DOI: 10.1159/000504652] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 11/19/2022] Open
Abstract
Medical practitioners are increasingly adopting a personalized medicine (PM) approach involving individually tailored patient care. The Personalized Prevention of Chronic Diseases (PRECeDI) consortium project, funded within the Marie Skłodowska Curie Action (MSCA) Research and Innovation Staff Exchange (RISE) scheme, had fostered collaboration on PM research and training with special emphasis on the prevention of chronic diseases. From 2014 to 2018, the PRECeDI consortium trained 50 staff members on personalized prevention of chronic diseases through training and research. The acquisition of skills from researchers came from dedicated secondments from academic and nonacademic institutions aimed at training on several research topics related to personalized prevention of cancer and cardiovascular and neurodegenerative diseases. In detail, 5 research domains were addressed: (1) identification and validation of biomarkers for the primary prevention of cardiovascular diseases, secondary prevention of Alzheimer disease, and tertiary prevention of head and neck cancer; (2) economic evaluation of genomic applications; (3) ethical-legal and policy issues surrounding PM; (4) sociotechnical analysis of the pros and cons of informing healthy individuals on their genome; and (5) identification of organizational models for the provision of predictive genetic testing. Based on the results of the research carried out by the PRECeDI consortium, in November 2018, a set of recommendations for policy makers, scientists, and industry has been issued, with the main goal to foster the integration of PM approaches in the field of chronic disease prevention.
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Affiliation(s)
- Stefania Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy, .,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Róza Ádány
- Department of Preventive Medicine, Debrecen University, Debrecen, Hungary
| | | | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Martina C Cornel
- Department of Clinical Genetics and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Muir Gray
- Better Value Health Care, Oxford, United Kingdom
| | - Anant Jani
- Value Based Healthcare Programme, Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Lang
- Centre of Genomics and Policy, McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Jim Roldan
- Linkcare Health Services S.L., Barcelona, Spain
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Cornelia M Van Dujin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carla G Van El
- Department of Clinical Genetics and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University Faculty of Medicine, Montreal, Québec, Canada
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Ladabaum U, Mannalithara A, Mitani A, Desai M. Clinical and Economic Impact of Tailoring Screening to Predicted Colorectal Cancer Risk: A Decision Analytic Modeling Study. Cancer Epidemiol Biomarkers Prev 2019; 29:318-328. [PMID: 31796524 DOI: 10.1158/1055-9965.epi-19-0949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/26/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Global increases in colorectal cancer risk have spurred debate about optimal use of screening resources. We explored the potential clinical and economic impact of colorectal cancer screening tailored to predicted colorectal cancer risk. METHODS We compared screening tailored to predicted risk versus uniform screening in a validated decision analytic model, considering the average risk population's actual colorectal cancer risk distribution, and a risk-prediction tool's discriminatory ability and cost. Low, moderate, and high risk tiers were identified as colorectal cancer risk after age 50 years of ≤3%, >3 to <12%, and ≥12%, respectively, based on threshold analyses with willingness-to-pay <$50,000/quality-adjusted life-year (QALY) gained. Tailored colonoscopy (once at age 60 years for low risk, every 10 years for moderate risk, and every 5 years for high risk) was compared with colonoscopy every 10 years for all. Tailored fecal immunochemical testing (FIT)/colonoscopy (annual FIT for low and moderate risk, colonoscopy every 5 years for high risk) was compared with annual FIT for all. RESULTS Assuming no colorectal cancer risk misclassification or risk-prediction tool costs, tailored screening was preferred over uniform screening. Tailored colonoscopy was minimally less effective than uniform colonoscopy, but saved $90,200-$889,000/QALY; tailored FIT/colonoscopy yielded more QALYs/person than annual FIT at $10,600-$60,000/QALY gained. Relatively modest colorectal cancer risk misclassification rates or risk-prediction tool costs resulted in uniform screening as the preferred approach. CONCLUSIONS Current risk-prediction tools may not yet be accurate enough to optimize colorectal cancer screening. IMPACT Uniform screening is likely to be preferred over tailored screening if a risk-prediction tool is associated with even modest misclassification rates or costs.
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Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California. .,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aya Mitani
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manisha Desai
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Yan C, Rittenbach K, Souri S, Silverstone PH. Cost-effectiveness analysis of a randomized study of depression treatment options in primary care suggests stepped-care treatment may have economic benefits. BMC Psychiatry 2019; 19:240. [PMID: 31382932 PMCID: PMC6683422 DOI: 10.1186/s12888-019-2223-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The stepped-care pathway (SCP) model has previously been found to be clinically effective for depressive disorder in some studies, but not all. Several groups have suggested that a stepped-care approach is the most appropriate in primary care. There is relatively little information, however, regarding which specific stepped-care pathway may be best. This analysis aimed to determine cost-effectiveness of a stepped-care pathway for depression in adults in primary care versus standard care (SC), treatment-as-usual (TAU), and online cognitive behavioural therapy (CBT). METHODS We conducted a randomized trial with 1400 participants and 12-week follow-up to assess the impact of the four treatment options on health-related quality of life and depression severity. Costs for the groups were calculated on the basis of physician, outpatient, and inpatient services using administrative data. We then calculated the incremental cost-effectiveness ratios using this information. Cost-effectiveness acceptability curves and incremental cost-effectiveness scatterplots were created using Monte Carlo simulation with 10,000 replications. A subgroup analysis was conducted for participants who screened as depressed at baseline. RESULTS For all participants, TAU was the most expensive followed by CBT, SC, and SCP. QALYs were highest in SCP, followed by SC, CBT, and TAU. In the depressed subgroup, TAU was still the most expensive, followed by SC, SCP, and CBT, while QALYs were still highest in SCP, followed by SC, CBT, and TAU. The cost-effectiveness acceptability curves suggested that SCP had a higher probability for cost-effectiveness than the other three alternatives in all participants. In the depressed subgroup, CBT was associated with the highest probability of cost-effectiveness for a willingness-to-pay cut-off of less than approximately $50,000, while SCP was the highest at a cut-off higher than $50,000. There is considerable uncertainty around the cost-effectiveness estimates. CONCLUSIONS Our analysis showed that even where there are no clinically significant differences in health outcomes between treatment approaches, there may be economic benefit from implementing the stepped-care model. While more work is required to identify the most clinically effective versions of a stepped-care pathway, our findings suggest that the care pathway may have potential to improve health care system value. TRIAL REGISTRATION NCT01975207 . The trial was prospectively registered on 4 November 2013.
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Affiliation(s)
- Charles Yan
- Institute of Health Economics, 1200 - 10405 Jasper Avenue, Edmonton, Alberta, T5J 3N4, Canada.
| | - Katherine Rittenbach
- grid.17089.37Department of Psychiatry, Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, University of Alberta, 10030 107 St, NW, Edmonton, Alberta T5J 3E4 Canada
| | - Sepideh Souri
- 0000 0004 1936 7697grid.22072.35Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1 Canada
| | - Peter H. Silverstone
- grid.17089.37Department of Psychiatry, University of Alberta, 8440 112 St NW, Edmonton, Alberta T6G 2B7 Canada
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Wilson N, Davies A, Brewer N, Nghiem N, Cobiac L, Blakely T. Can cost-effectiveness results be combined into a coherent league table? Case study from one high-income country. Popul Health Metr 2019; 17:10. [PMID: 31382954 PMCID: PMC6683509 DOI: 10.1186/s12963-019-0192-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Doubts exist around the value of compiling league tables for cost-effectiveness results for health interventions, primarily due to methods differences. We aimed to determine if a reasonably coherent league table could be compiled using published studies for one high-income country: New Zealand (NZ). METHODS Literature searches were conducted to identify NZ-relevant studies published in the peer-reviewed journal literature between 1 January 2010 and 8 October 2017. Only studies with the following metrics were included: cost per quality-adjusted life-year or disability-adjusted life-year or life-year (QALY/DALY/LY). Key study features were abstracted and a summary league table produced which classified the studies in terms of cost-effectiveness. RESULTS A total of 21 cost-effectiveness studies which met the inclusion criteria were identified. There were some large methodological differences between the studies, particularly in the time horizon (1 year to lifetime) but also discount rates (range 0 to 10%). Nevertheless, we were able to group the incremental cost-effectiveness ratios (ICERs) into general categories of being reported as cost-saving (19%), cost-effective (71%), and not cost-effective (10%). The median ICER (adjusted to 2017 NZ$) was ~ $5000 per QALY/DALY/LY (~US$3500). However, for some interventions, there is high uncertainty around the intervention effectiveness and declining adherence over time. CONCLUSIONS It seemed possible to produce a reasonably coherent league table for the ICER values from different studies (within broad groupings) in this high-income country. Most interventions were cost-effective and a fifth were cost-saving. Nevertheless, study methodologies did vary widely and researchers need to pay more attention to using standardised methods that allow their results to be included in future league tables.
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Affiliation(s)
- Nick Wilson
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Anna Davies
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Naomi Brewer
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Nhung Nghiem
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Linda Cobiac
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Blakely
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Hatch BA, Tillotson CJ, Huguet N, Hoopes MJ, Marino M, DeVoe JE. Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care. Am J Prev Med 2019; 57:241-249. [PMID: 31326008 PMCID: PMC6684138 DOI: 10.1016/j.amepre.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery. METHODS This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014-2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care. RESULTS Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%-50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services. CONCLUSIONS Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.
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Affiliation(s)
- Brigit A Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Biostatistics Group, Portland State University School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
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Graf S, Cecchini M. Identifying patterns of unhealthy diet and physical activity in four countries of the Americas: a latent class analysis. Rev Panam Salud Publica 2019; 42:e56. [PMID: 31093084 PMCID: PMC6385803 DOI: 10.26633/rpsp.2018.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/11/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine clusters of individuals who present similar health behaviors in terms of diet, physical activity, and sedentarism, in four countries of the Americas: Brazil (2013), Chile (2009), Mexico (2012), and the United States of America (2013). This makes it possible to determine which of these behaviors occur simultaneously, as well as the demographic and sociodemographic characteristics associated with each cluster. Methods The individual-level data analyzed were drawn from national health interviews and health examination surveys in Brazil, Chile, Mexico, and the United States, for different time periods. Using international physical activity guidelines and national dietary guidelines, the health behaviors of each individual were assessed. A latent class analysis was conducted to classify individuals into clusters based on these behaviors, and was followed by multinomial regressions to determine the characteristics of those in each class. Results Overall, most individuals belonged to the classes characterized by average or unhealthy diets but sufficient amounts of physical activity. However, large differences exist across countries and population groups. Men with higher socioeconomic characteristics were globally more likely to belong to the least healthy class in each country. Conclusions Findings from this analysis support the implementation of more refined policy actions to target specific unhealthy behaviors in different population groups, defined by gender, age group, socioeconomic status, and, to some extent, place of residence. The at-risk populations identified through this paper are those that should be targeted by upcoming interventions.
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Affiliation(s)
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development, Health Division, Paris, France
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Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, Grauer A, Arellano J, Lemay J, Harmon AL, Broder MS, Singer AJ. Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States. JBMR Plus 2019; 3:e10192. [PMID: 31667450 PMCID: PMC6808223 DOI: 10.1002/jbm4.10192] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/05/2022] Open
Abstract
In the United States, osteoporosis affects over 10 million adults, has high societal costs ($22 billion in 2008), and is currently being underdiagnosed and undertreated. Given an aging population, this burden is expected to rise. We projected the fracture burden in US women by modeling the expected demographic shift as well as potential policy changes. With the anticipated population aging and growth, annual fractures are projected to increase from 1.9 million to 3.2 million (68%), from 2018 to 2040, with related costs rising from $57 billion to over $95 billion. Policy‐driven expansion of case finding and treatment of at‐risk women could lower this burden, preventing 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion. Increasing use of osteoporosis‐related interventions can reduce fractures and result in substantial cost‐savings, a rare and fortunate combination given the current landscape in healthcare policy. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | | | | | - Amanda L Harmon
- Partnership for Health Analytic Research, LLC Beverly Hills CA USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC Beverly Hills CA USA
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Kennedy GJ. The Trifecta of Benefits in Depression Care for Patients With Advanced Chronic Obstructive Pulmonary Disease. Am J Geriatr Psychiatry 2019; 27:512-513. [PMID: 30709615 DOI: 10.1016/j.jagp.2018.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Gary J Kennedy
- Department of Geriatric Psychiatry (GJK), Montefiore Medical Center, Bronx, NY.
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47
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Affiliation(s)
- Andrea Mombelli
- Division of Periodontology School of Dental Medicine University of Geneva Geneva Switzerland
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48
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Cao YJ, Noyes K, Homish GG. Life Partner Influence on Uptake of Preventive Services: Evidence From Flu Vaccine Adoption Among the Aging Population. J Aging Health 2019; 32:441-452. [PMID: 30793640 DOI: 10.1177/0898264319829979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study examines how the patterns of life partner concordance on preventive health service uptake vary by a partner's previous behavioral history and between genders. Method: This study uses 2008 and 2012 waves of Health and Retirement Study (HRS), a nationally representative sample of U.S. aging population, to examine one's decision to receive a preventive service as a function of the partner's decision changes over time (N = 2,680). Results: Life partner concordance on preventive service use is different by the partner's previous use history and gender. Positive partner preventive engagement showed greater association than negative ones. Women are more responsive to the positive health behaviors (of their partners), and men are more sensitive to the negative partner health behaviors. Conclusion: The asymmetric partner concordance by gender and the partner's previous usage experience provide implications to develop efficient and culturally acceptable interventions to increase the uptake of preventive health services.
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Individuals’ adoption of smart technologies for preventive health care: a structural equation modeling approach. Health Care Manag Sci 2019; 23:203-214. [DOI: 10.1007/s10729-019-09468-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
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50
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Comparison of Costs and Outcomes for In-Office and Operating Room Excision of Nonmelanoma Skin Cancer. Ann Plast Surg 2019; 83:78-81. [DOI: 10.1097/sap.0000000000001744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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