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Boettiger DC, Lin TK, Almansour M, Hamza MM, Alsukait R, Herbst CH, Altheyab N, Afghani A, Kattan F. Projected impact of population aging on non-communicable disease burden and costs in the Kingdom of Saudi Arabia, 2020-2030. BMC Health Serv Res 2023; 23:1381. [PMID: 38066590 PMCID: PMC10709902 DOI: 10.1186/s12913-023-10309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The number of people aged greater than 65 years per 100 people aged 20-64 years is expected to almost double in The Kingdom of Saudi Arabia (KSA) between 2020 and 2030. We therefore aimed to quantify the growing non-communicable disease (NCD) burden in KSA between 2020 and 2030, and the impact this will have on the national health budget. METHODS Ten priority NCDs were selected: ischemic heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, dementia, depression, osteoarthritis, colorectal cancer, and breast cancer. Age- and sex-specific prevalence was projected for each priority NCD between 2020 and 2030. Treatment coverage rates were applied to the projected prevalence estimates to calculate the number of patients incurring treatment costs for each condition. For each priority NCD, the average cost-of-illness was estimated based on published literature. The impact of changes to our base-case model in terms of assumed disease prevalence, treatment coverage, and costs of care, coming into effect from 2023 onwards, were explored. RESULTS The prevalence estimates for colorectal cancer and stroke were estimated to almost double between 2020 and 2030 (97% and 88% increase, respectively). The only priority NCD prevalence projected to increase by less than 60% between 2020 and 2030 was for depression (22% increase). It is estimated that the total cost of managing priority NCDs in KSA will increase from USD 19.8 billion in 2020 to USD 32.4 billion in 2030 (an increase of USD 12.6 billion or 63%). The largest USD value increases were projected for osteoarthritis (USD 4.3 billion), diabetes (USD 2.4 billion), and dementia (USD 1.9 billion). In scenario analyses, our 2030 projection for the total cost of managing priority NCDs varied between USD 29.2 billion - USD 35.7 billion. CONCLUSIONS Managing the growing NCD burden in KSA's aging population will require substantial healthcare spending increases over the coming years.
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Grants
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
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Affiliation(s)
- David C Boettiger
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA.
| | - Tracy Kuo Lin
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA
| | | | - Mariam M Hamza
- Nutrition and Population Global Practice, World Bank, Washington, D.C, USA
| | - Reem Alsukait
- Community Health Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Nada Altheyab
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Ayman Afghani
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Faisal Kattan
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
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Jin H, Tappenden P, Ling X, Robinson S, Byford S. A systematic review of whole disease models for informing healthcare resource allocation decisions. PLoS One 2023; 18:e0291366. [PMID: 37708188 PMCID: PMC10501624 DOI: 10.1371/journal.pone.0291366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Whole disease models (WDM) are large-scale, system-level models which can evaluate multiple decision questions across an entire care pathway. Whilst this type of model can offer several advantages as a platform for undertaking economic analyses, the availability and quality of existing WDMs is unknown. OBJECTIVES This systematic review aimed to identify existing WDMs to explore which disease areas they cover, to critically assess the quality of these models and provide recommendations for future research. METHODS An electronic search was performed on multiple databases (MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database) on 23rd July 2023. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) appraisal checklist for economic evaluations. Model characteristics were descriptively summarised. RESULTS Forty-four WDMs were identified, of which thirty-two were developed after 2010. The main disease areas covered by existing WDMs are heart disease, cancer, acquired immune deficiency syndrome and metabolic disease. The quality of included WDMs is generally low. Common limitations included failure to consider the harms and costs of adverse events (AEs) of interventions, lack of probabilistic sensitivity analysis (PSA) and poor reporting. CONCLUSIONS There has been an increase in the number of WDMs since 2010. However, their quality is generally low which means they may require significant modification before they could be re-used, such as modelling AEs of interventions and incorporation of PSA. Sufficient details of the WDMs need to be reported to allow future reuse/adaptation.
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Affiliation(s)
- Huajie Jin
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Xiaoxiao Ling
- Department of Statistical Science, University College London, London, United Kingdom
| | | | - Sarah Byford
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
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3
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Jiang X, Jackson LJ, Syed MA, Avşar TS, Abdali Z. Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review. Addiction 2022; 117:2374-2392. [PMID: 35257422 DOI: 10.1111/add.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. METHODS Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. RESULTS This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. CONCLUSIONS There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings.
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Affiliation(s)
- Xiaobin Jiang
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muslim Abbas Syed
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Carvalho N, Sousa TV, Mizdrak A, Jones A, Wilson N, Blakely T. Comparing health gains, costs and cost-effectiveness of 100s of interventions in Australia and New Zealand: an online interactive league table. Popul Health Metr 2022; 20:17. [PMID: 35897104 PMCID: PMC9327210 DOI: 10.1186/s12963-022-00294-3] [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: 11/12/2021] [Accepted: 05/10/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. METHODS A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3% to 5% discount rates. RESULTS We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable diseases; overweight and obesity; physical inactivity; salt; and tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining > 10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. CONCLUSIONS League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy-makers and researchers.
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Affiliation(s)
- Natalie Carvalho
- grid.1008.90000 0001 2179 088XHealth Economics Unit, Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Parkville, VIC 3010 Australia
| | - Tanara Vieira Sousa
- grid.1008.90000 0001 2179 088XMusic Therapy, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Australia
| | - Anja Mizdrak
- grid.29980.3a0000 0004 1936 7830Burden of Disease Epidemiology, Equity, and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Amanda Jones
- grid.29980.3a0000 0004 1936 7830Burden of Disease Epidemiology, Equity, and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- grid.29980.3a0000 0004 1936 7830Burden of Disease Epidemiology, Equity, and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- grid.1008.90000 0001 2179 088XPopulation Interventions Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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5
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Cruz-Góngora VDL, Chiquete E, Gómez–Dantés H, Cahuana-Hurtado L, Cantú-Brito C. Trends in the burden of stroke in Mexico: A national and subnational analysis of the global burden of disease 1990-2019. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100204. [PMID: 36777683 PMCID: PMC9904132 DOI: 10.1016/j.lana.2022.100204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Scarce epidemiological information on stroke in Mexico impedes evidence-based decisions and debilitates the design of effective prevention programmes at the local level. Methods Ecological and secondary analysis of Global Burden of Disease national and subnational data for Mexico, from 1990 to 2019. We analysed the incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included to identify the differences in the burden of stroke in Mexico by type of stroke (ischaemic [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and state levels ordered by quartiles of Sociodemographic Index (SDI). Means and 95% uncertainty intervals are reported. Findings Reductions in all metrics of total stroke occurred during the 1990 to 2005 period; however, this declining trend was followed up by stagnation of progress from 2006 to 2019, except for premature mortality. This pattern of the declining trend was observed also for IS and to a lesser extent for ICH, while SAH showed no major changes during the 1990-2019 period. The magnitude of decline was higher in females for total stroke for incidence, prevalence and YLDs rates. The less developed states by SDI exhibited the lowest improvements during the period, particularly for ICH metrics. Interpretation The reduction in stroke burden in Mexico did not follow the same pace for all types of stroke, with regional differences by SDI and by sex. Study findings reveal the need for strengthening prevention policies to address health disparities in the burden of stroke by sex and states, within the fragmented Mexican Healthcare System. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | - Héctor Gómez–Dantés
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Cantú-Brito
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México,Corresponding author at: Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI, Tlalpan. Ciudad de México, México.
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Emmert-Fees KMF, Karl FM, von Philipsborn P, Rehfuess EA, Laxy M. Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review. Adv Nutr 2021; 12:1957-1995. [PMID: 33873201 PMCID: PMC8483966 DOI: 10.1093/advances/nmab028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 02/24/2021] [Indexed: 01/02/2023] Open
Abstract
Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.
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Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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7
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Erfani P, Bhangdia K, Stauber C, Mugunga JC, Pace LE, Fadelu T. Economic Evaluations of Breast Cancer Care in Low- and Middle-Income Countries: A Scoping Review. Oncologist 2021; 26:e1406-e1417. [PMID: 34050590 PMCID: PMC8342576 DOI: 10.1002/onco.13841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding the cost of delivering breast cancer (BC) care in low- and middle-income countries (LMICs) is critical to guide effective care delivery strategies. This scoping review summarizes the scope of literature on the costs of BC care in LMICs and characterizes the methodological approaches of these economic evaluations. MATERIALS AND METHODS A systematic literature search was performed in five databases and gray literature up to March 2020. Studies were screened to identify original articles that included a cost outcome for BC diagnosis or treatment in an LMIC. Two independent reviewers assessed articles for eligibility. Data related to study characteristics and methodology were extracted. Study quality was assessed using the Drummond et al. checklist. RESULTS Ninety-one articles across 38 countries were included. The majority (73%) of studies were published between 2013 and 2020. Low-income countries (2%) and countries in Sub-Saharan Africa (9%) were grossly underrepresented. The majority of studies (60%) used a health care system perspective. Time horizon was not reported in 30 studies (33%). Of the 33 studies that estimated the cost of multiple steps in the BC care pathway, the majority (73%) were of high quality, but studies varied in their inclusion of nonmedical direct and indirect costs. CONCLUSION There has been substantial growth in the number of BC economic evaluations in LMICs in the past decade, but there remain limited data from low-income countries, especially those in Sub-Saharan Africa. BC economic evaluations should be prioritized in these countries. Use of existing frameworks for economic evaluations may help achieve comparable, transparent costing analyses. IMPLICATIONS FOR PRACTICE There has been substantial growth in the number of breast cancer economic evaluations in low- and middle-income countries (LMICs) in the past decade, but there remain limited data from low-income countries. Breast cancer economic evaluations should be prioritized in low-income countries and in Sub-Saharan Africa. Researchers should strive to use and report a costing perspective and time horizon that captures all costs relevant to the study objective, including those such as direct nonmedical and indirect costs. Use of existing frameworks for economic evaluations in LMICs may help achieve comparable, transparent costing analyses in order to guide breast cancer control strategies.
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Affiliation(s)
- Parsa Erfani
- Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kayleigh Bhangdia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Jean Claude Mugunga
- Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health, Boston, Massachusetts, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Temidayo Fadelu
- Harvard Medical School, Boston, Massachusetts, USA.,Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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8
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Gailey S, Bruckner TA, Lin TK, Liu JX, Alluhidan M, Alghaith T, Alghodaier H, Tashkandi N, Herbst CH, Hamza MM, Alazemi N. A needs-based methodology to project physicians and nurses to 2030: the case of the Kingdom of Saudi Arabia. HUMAN RESOURCES FOR HEALTH 2021; 19:55. [PMID: 33902617 PMCID: PMC8072319 DOI: 10.1186/s12960-021-00597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA), as part of its 2030 National Transformation Program, set a goal of transforming the healthcare sector to increase access to, and improve the quality and efficiency of, health services. To assist with the workforce planning component, we projected the needed number of physicians and nurses into 2030. We developed a new needs-based methodology since previous global benchmarks of health worker concentration may not apply to the KSA. METHODS We constructed an epidemiologic "needs-based" model that takes into account the health needs of the KSA population, cost-effective treatment service delivery models, and worker productivity. This model relied heavily on up-to-date epidemiologic and workforce surveys in the KSA. We used demographic population projections to estimate the number of nurses and physicians needed to provide this core set of services into 2030. We also assessed several alternative scenarios and policy decisions related to scaling, task-shifting, and enhanced public health campaigns. RESULTS When projected to 2030, the baseline needs-based estimate is approximately 75,000 workers (5788 physicians and 69,399 nurses). This workforce equates to 2.05 physicians and nurses per 1000 population. Alternative models based on different scenarios and policy decisions indicate that the actual needs for physicians and nurses may range from 1.64 to 3.05 per 1000 population in 2030. CONCLUSIONS Based on our projections, the KSA will not face a needs-based health worker shortage in 2030. However, alternative model projections raise important policy and planning issues regarding various strategies the KSA may pursue in improving quality and efficiency of the existing workforce. More broadly, where country-level data are available, our needs-based strategy can serve as a useful step-by-step workforce planning tool to complement more economic demand-based workforce projections.
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Affiliation(s)
- Samantha Gailey
- School of Social Ecology, University of California Irvine, Irvine, CA, USA.
| | - Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Tracy Kuo Lin
- Department of Clinical Pharmacy, Medication Outcomes Center, University of California San Francisco, San Francisco, CA, USA
| | - Jenny X Liu
- Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - Mohammed Alluhidan
- Saudi Health Council, Riyadh, Saudi Arabia
- Lancaster University, Lancashire, UK
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9
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Duan KI, Rodriguez Garza F, Flores H, Palazuelos D, Maza J, Martinez-Juarez LA, Elliott PF, Moreno Lázaro E, Enriquez Rios N, Nigenda G, Palazuelos L, McBain RK. Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study. BMJ Open 2021; 11:e046826. [PMID: 33827847 PMCID: PMC8031699 DOI: 10.1136/bmjopen-2020-046826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Diabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of a novel community-based model of diabetes care in rural Mexico, compared with usual care. DESIGN We performed time-driven activity-based costing to estimate annualised costs associated with typical diabetes care in Chiapas, Mexico, as well as a novel diabetes care model known as Compañeros En Salud Programa de Enfermedades Crónicas (CESPEC). We conducted Markov chain analysis to estimate the cost-effectiveness of CESPEC compared with usual care from a societal perspective. We used patient outcomes from CESPEC in 2016, as well as secondary data from existing literature. SETTING Rural primary care clinics in Chiapas, Mexico. PARTICIPANTS Adults with diabetes. INTERVENTIONS CESPEC is a novel, comprehensive, diabetes care model that integrates community health workers, provider education, supply chain management and active case finding. OUTCOME MEASURE The primary outcome was the incremental cost-effectiveness of CESPEC compared with care as usual, per quality-adjusted life year (QALY) gained, expressed in 2016 US dollars. RESULTS The economic cost of the CESPEC diabetes model was US$144 per patient per year, compared with US$125 for diabetes care as usual. However, CESPEC care was associated with 0.13 additional years of health-adjusted life expectancy compared with usual care and 0.02 additional years in the first 5 years of treatment. This translated to an incremental cost-effectiveness ratio (ICER) of US$2981 per QALY gained over a patient's lifetime and an ICER of US$10 444 over the first 5 years. Findings were robust to multiple sensitivity analyses. CONCLUSIONS CESPEC is a cost-effective, community-based model of diabetes care for patients in rural Mexico. Given the high prevalence and significant morbidity associated with diabetes in Mexico and other countries in Central America, this model should be considered for broader scale up and evaluation.
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Affiliation(s)
- Kevin I Duan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | | | - Hugo Flores
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
| | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
- Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Jimena Maza
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
| | | | | | | | | | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Lindsay Palazuelos
- Compañeros en Salud/Partners In Health Mexico, Ángel Albino Corzo, Chiapas, Mexico
- Partners In Health, Boston, Massachusetts, USA
| | - Ryan K McBain
- Partners In Health, Boston, Massachusetts, USA
- RAND Corp Boston Office, Boston, Massachusetts, USA
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10
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Eregata GT, Hailu A, Stenberg K, Johansson KA, Norheim OF, Bertram MY. Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:2. [PMID: 33407595 PMCID: PMC7787224 DOI: 10.1186/s12962-020-00255-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cost effectiveness was a criterion used to revise Ethiopia's essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia's EHSP. METHODS In this study, we estimate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization (WHO) CHOosing Interventions that are cost effective methodology (CHOICE) for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits. We estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1000 as references to summarise and present the ACER results. RESULTS We found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1000 per HLY. CONCLUSION The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia's disease burden if scaled up. The use of the World Health Organization's generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia's EHSP.
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Affiliation(s)
- Getachew Teshome Eregata
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway.
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia.
| | - Alemayehu Hailu
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Kjell Arne Johansson
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Melanie Y Bertram
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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Barbosa E, Gulela B, Taimo MA, Lopes DM, Offorjebe OA, Risko N. A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries. Afr J Emerg Med 2020; 10:S90-S94. [PMID: 33318909 PMCID: PMC7723908 DOI: 10.1016/j.afjem.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/11/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a leading cause of death and disability globally, with an increasing incidence in low- and middle-income countries (LMICs). The successful treatment of acute stroke requires an organized, efficient and well-resourced emergency care system. However, debate exists surrounding the prioritization of stroke treatment programs given the high costs of treatment and the increased incidence of hemorrhagic stroke in LMICs. Economic data is helpful to guide evidence-based priority setting in health systems development, particularly in low-resource settings where scarcity requires careful stewardship of resources. This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings. Methods The authors conducted a PRISMA style systematic review of economic evaluations of interventions to address acute stroke in LMICs. Five databases were systematically searched for articles, which were then reviewed for inclusion. Results Of the 153 unique articles identified, 11 met the inclusion criteria. Four studies demonstrate the heavy economic burden on patients and households due to stroke. Two studies estimate that preventive measures are more cost-effective than acute treatments. Four studies directly examine the cost-effectiveness of thrombolysis and thrombectomy in three middle-income countries (Iran, China, and Brazil) with results ranging from roughly $2578 to $34,052 (2019 USD) per quality adjusted life-year saved. These results are similar to the cost-effectiveness ratios estimated in high-income settings. Finally, one study examined a care bundle that included acute treatment elements. Conclusions The findings reinforce the need for additional research support informed decision-making. The available evidence suggests that preventive measures should be prioritized over emergency treatment for acute stroke, particularly in settings of resource scarcity. Cost-effectiveness ratios do not compare favorably to estimates for other emergency care interventions in LMICs, such as basic emergency care training, implementation of triage systems, and basic trauma care. Cost-effectiveness is also likely to vary depending on local epidemiology. Overall, decision-makers should balance the economic evidence alongside social, political and cultural priorities when making resource allocation choices.
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Blakely T, Moss R, Collins J, Mizdrak A, Singh A, Carvalho N, Wilson N, Geard N, Flaxman A. Proportional multistate lifetable modelling of preventive interventions: concepts, code and worked examples. Int J Epidemiol 2020; 49:1624-1636. [PMID: 33038892 DOI: 10.1093/ije/dyaa132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Burden of Disease studies-such as the Global Burden of Disease (GBD) Study-quantify health loss in disability-adjusted life-years. However, these studies stop short of quantifying the future impact of interventions that shift risk factor distributions, allowing for trends and time lags. This methodology paper explains how proportional multistate lifetable (PMSLT) modelling quantifies intervention impacts, using comparisons between three tobacco control case studies [eradication of tobacco, tobacco-free generation i.e. the age at which tobacco can be legally purchased is lifted by 1 year of age for each calendar year) and tobacco tax]. We also illustrate the importance of epidemiological specification of business-as-usual in the comparator arm that the intervention acts on, by demonstrating variations in simulated health gains when incorrectly: (i) assuming no decreasing trend in tobacco prevalence; and (ii) not including time lags from quitting tobacco to changing disease incidence. In conjunction with increasing availability of baseline and forecast demographic and epidemiological data, PMSLT modelling is well suited to future multiple country comparisons to better inform national, regional and global prioritization of preventive interventions. To facilitate use of PMSLT, we introduce a Python-based modelling framework and associated tools that facilitate the construction, calibration and analysis of PMSLT models.
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Affiliation(s)
- Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rob Moss
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James Collins
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anja Mizdrak
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ankur Singh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicholas Geard
- Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Abraham Flaxman
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Patient experiences in managing non-communicable diseases in Namibia. Res Social Adm Pharm 2020; 16:1550-1557. [PMID: 32919919 DOI: 10.1016/j.sapharm.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The prevalence of non-communicable diseases (NCDs) is rising in Namibia, and with it, the need for pharmacists to empower patients. This research aims to 1) identify patient-reported barriers and facilitators to managing chronic NCDs for Namibians, and 2) characterize common patient-reported medication and health-related needs of Namibians with chronic NCDs. METHODS This qualitative study used semi-structured interviews to elicit participant perspectives regarding NCDs. The study used the conceptual frameworks of the Health Belief Model, the Theory of Planned Behavior, and the Explanatory Models of Illness to identify and understand key factors necessary to develop relevant patient-centered interventions. Participants were recruited from pharmacies throughout Namibia. Data were analyzed using thematic analysis from the transcribed interviews. RESULTS A total of 23 interviews were conducted, with 20 being included in the final analysis. Themes identified included: 1) participants were motivated to seek care when they were symptomatic; 2) participants felt motivated to care for their condition to improve their own lives and their families for their family's sake; 3) participants integrated information from a variety of sources into their disease knowledge; 4) participants describe wanting to be more engaged in managing their health and wanting support to help manage their condition; 5) participants describe awareness of lifestyle changes necessary to improve health, but face many barriers to achieving them. CONCLUSION This study identified key factors that are essential for pharmacists and other health care professionals to be aware of in order to support patients who are diagnosed with an NCD. Health care providers should consider strategies to engage patients to harness their motivations, enhance health education, and create systems to reduce barriers to addressing lifestyle.
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Jain V, Crosby L, Baker P, Chalkidou K. Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review. Health Policy 2020; 124:919-931. [PMID: 32718790 DOI: 10.1016/j.healthpol.2020.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE/SETTING The extent to which distributional equity is incorporated into evaluations of the (potential or observed) impact of health taxes is unclear. This systematic review of economic and modelling evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol aims to assess the proportion that have considered distributional impact by income or socioeconomic group. Secondary aims included summarising the reported distributional impacts, for both costs and health benefits. FINDINGS Of 4656 search results, 69 studies were included. The majority were economic analyses with epidemiological modelling, with studies on SSB taxes being of the highest quality. Tobacco was most commonly investigated tax, with 37 evaluations. Of these, 12 (32 %) considered distributional equity, with six (27 %) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lowerincome groups in the distribution of costs in all identified evaluations and for health benefits in nine out of 12 evaluations (75 %). For SSBs, four evaluations (67 %) found costs to favour low-income groups, with three (50 %) for health benefits. CONCLUSIONS Despite recommendations, evaluations of health taxes do not routinely consider the distributional impact of both costs and health benefits. Evaluations for alcohol taxation are particularly weak in this regard. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, whereas the limited evidence for SSBs is mixed.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health (IGH), University College London, UK; Public Health England, London, UK.
| | - Liam Crosby
- Institute for Epidemiology and Healthcare, University College London, London, UK; Tower Hamlets Council, London, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
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Singh A, Wilson N, Blakely T. Simulating future public health benefits of tobacco control interventions: a systematic review of models. Tob Control 2020; 30:tobaccocontrol-2019-055425. [PMID: 32587112 DOI: 10.1136/tobaccocontrol-2019-055425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND To prioritise tobacco control interventions, simulating their health impacts is valuable. We undertook a systematic review of tobacco intervention simulation models to assess model structure and input variations that may render model outputs non-comparable. METHODS We applied a Medline search with keywords intersecting modelling and tobacco. Papers were limited to those modelling health outputs (eg, mortality, health-adjusted life years), and at least two of cancer, cardiovascular and respiratory diseases. Data were extracted for each simulation model with ≥3 arising papers, including: model type, untimed or with time steps and trends in business-as-usual (BAU) tobacco prevalence and epidemiology. RESULTS Of 1911 papers, 186 met the inclusion criteria, including 13 eligible simulation models. The SimSmoke model had the largest number of publications (n=46), followed by Benefits of Smoking Cessation on Outcomes (n=12) and Tobacco Policy Model (n=10). Two of 13 models only estimated deaths averted, 1 had no time steps, 5 had no future trends in BAU tobacco prevalence, 9 had no future trends in BAU disease epidemiology and 7 had no time lags from quitting tobacco to reversal of health harm. CONCLUSIONS Considerable heterogeneity exists in simulation models, making outputs substantively non-comparable between models. Ranking of interventions by one model may be valid. However, this may not be true if, for example, interventions that differentially affect age groups (eg, a tobacco-free generation policy vs increased cessation among adults) do not account for plausible future trends. Greater standardisation of model structures and outputs will allow comparison across models and countries, and for comparisons of the impact of tobacco control interventions with other preventive interventions.
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Affiliation(s)
- Ankur Singh
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nick Wilson
- Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Weliington, New Zealand
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van der Vliet N, Suijkerbuijk AW, de Blaeij AT, de Wit GA, van Gils PF, Staatsen BA, Maas R, Polder JJ. Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062160. [PMID: 32213919 PMCID: PMC7142580 DOI: 10.3390/ijerph17062160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from other sectors, should be developed and implemented. Investing in these preventive health policies is challenging as budgets have to compete with other governmental expenditures. The current study aimed to identify, compare and rank cost-effective preventive interventions targeting metabolic, environmental, occupational and behavioral risk factors. To identify these interventions, a literature search was performed including original full economic evaluations of Western country interventions that had not yet been implemented in the Netherlands. Several workshops were held with experts from different disciplines. In total, 51 different interventions (including 13 cost saving interventions) were identified and ranked based on their incremental cost-effectiveness ratio (ICER) and potential averted disability-adjusted life years (DALYs), resulting in two rankings of the most cost-effective interventions and one ranking of the 13 cost saving interventions. This approach, resulting in an intersectoral ranking, can assist policy makers in implementing cost-effective preventive action that considers not only the health sector, but also other sectors.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
- Correspondence: ; Tel.: +3130-274-3816
| | - Anita W.M. Suijkerbuijk
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Adriana T. de Blaeij
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - G. Ardine de Wit
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Paul F. van Gils
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Brigit A.M. Staatsen
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Rob Maas
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Johan J. Polder
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
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Phillimore P, Sibai AM, Rizk A, Maziak W, Unal B, Abu Rmeileh N, Ben Romdhane H, Fouad FM, Khader Y, Bennett K, Zaman S, Mataria A, Ghandour R, Kılıç B, Ben Mansour N, Fadhil I, O'Flaherty M, Capewell S, Critchley JA. Context-led capacity building in time of crisis: fostering non-communicable diseases (NCD) research skills in the Mediterranean Middle East and North Africa. Glob Health Action 2019; 12:1569838. [PMID: 30721116 PMCID: PMC6366406 DOI: 10.1080/16549716.2019.1569838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This paper examines one EC-funded multinational project (RESCAP-MED), with a focus on research capacity building (RCB) concerning non-communicable diseases (NCDs) in the Mediterranean Middle East and North Africa. By the project’s end (2015), the entire region was engulfed in crisis. Objective: Designed before this crisis developed in 2011, the primary purpose of RESCAP-MED was to foster methodological skills needed to conduct multi-disciplinary research on NCDs and their social determinants. RESCAP-MED also sought to consolidate regional networks for future collaboration, and to boost existing regional policy engagement in the region on the NCD challenge. This analysis examines the scope and sustainability of RCB conducted in a context of intensifying political turmoil. Methods: RESCAP-MED linked two sets of activities. The first was a framework for training early- and mid-career researchers through discipline-based and writing workshops, plus short fellowships for sustained mentoring. The second integrated public-facing activities designed to raise the profile of the NCD burden in the region, and its implications for policymakers at national level. Key to this were two conferences to showcase regional research on NCDs, and the development of an e-learning resource (NETPH). Results: Seven discipline-based workshops (with 113 participants) and 6 workshops to develop writing skills (84 participants) were held, with 18 fellowship visits. The 2 symposia in Istanbul and Beirut attracted 280 participants. Yet the developing political crisis tagged each activity with a series of logistical challenges, none of which was initially envisaged. The immediacy of the crisis inevitably deflected from policy attention to the challenges of NCDs. Conclusions: This programme to strengthen research capacity for one priority area of global public health took place as a narrow window of political opportunity was closing. The key lessons concern issues of sustainability and the paramount importance of responsively shaping a context-driven RCB.
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Affiliation(s)
- Peter Phillimore
- a School of Geography, Politics & Sociology , Newcastle University , Newcastle , UK
| | - Abla M Sibai
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Anthony Rizk
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Wasim Maziak
- c Department of Epidemiology , Florida International University, USA; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Belgin Unal
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | - Niveen Abu Rmeileh
- e Institute of Community and Public Health , Birzeit University , Palestine
| | | | - Fouad M Fouad
- g Department of Epidemiology & Population Health American University of Beirut , Lebanon; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Yousef Khader
- h Public Health Department , Jordan University of Science and Technology , Irbid , Jordan
| | | | | | - Awad Mataria
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Rula Ghandour
- e Institute of Community and Public Health , Birzeit University , Palestine
| | - Bülent Kılıç
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | | | - Ibtihal Fadhil
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Martin O'Flaherty
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Simon Capewell
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Julia A Critchley
- n Population Health Research Institute , St George's, University of London , London , UK
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Guaraldi G, Francesco DD, Malagoli A, Zona S, Franconi I, Santoro A, Mussini C, Mussi C, Cesari M, Theou O, Rockwood K. Compression of frailty in adults living with HIV. BMC Geriatr 2019; 19:229. [PMID: 31438859 PMCID: PMC6706922 DOI: 10.1186/s12877-019-1247-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background Contemporary HIV care may reduce frailty in older adults living with HIV (OALWH). Objective of the study was to estimate prevalence of frailty at the age of 50 and 75 years, and build a model to quantify the burden of frailty in the year 2030. Methods This study included OALWH attending Modena HIV Metabolic Clinic between 2009 and 2015. Patients are referred from more than 120 HIV clinics well distributed across Italy, therefore being country representative. Our model forecasts the new entries on yearly basis up to 2030. Changes in frailty over a one-year period using a 37-variable frailty index (FI) and death rates were modelled using a validated mathematical algorithm with parameters adjusted to best represent the changes observed at the clinic. In this study, we assessed the number of frailest individuals (defined with a FI > 0.4) at the age of 50 and at the age 75 by calendar year. Results In the period 2015–2030 we model that frailest OALWH at age 50 will decrease from 26 to 7%, and at the age of 75 years will increase from 43 to 52%. This implies a shift of the frailty prevalence at an older age. Conclusion We have presented projections of how the burden of frailty in older adults, living with HIV will change. We project fewer people aged 50+ with severe frailty, most of whom will be older than now. These results suggest a compression of age-related frailty. Electronic supplementary material The online version of this article (10.1186/s12877-019-1247-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy.
| | | | - Andrea Malagoli
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Stefano Zona
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Iacopo Franconi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Antonella Santoro
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Chiara Mussi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Olga Theou
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Kim JY, Kim SJ, Nam CM, Moon KT, Park EC. Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea. Eur J Public Health 2019; 28:209-214. [PMID: 29579210 DOI: 10.1093/eurpub/ckx168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction. Methods We used claim data from 2008 to 2013, which included 26 315 diabetes patients and 9907 hospitals. An interrupted time series study design using generalized estimating equations was used to evaluate changes in patterns of single and combination therapy, brand name drug prescriptions, cost and hospital admission following the reimbursement restriction. Results Following reimbursement restriction initiation, we found a statistically significant decrease in the average prescription rate of brand name drugs (-6.2%), whereas single therapy prescription increased (9.9%). There was also a reduction in trend change in the monthly prescription rate for combination therapy (-1.7%) and brand name drugs (-0.8%). For single therapy, the trend change in prescription rate increased after the intervention (0.8%). A reduction of trend change in pharmaceutical costs (-0.3%) was observed. However, we did not find a significant change in hospital admission for diabetes. Conclusions Reimbursement restriction affects both pharmaceutical costs and physicians' decisions to prescribe oral hypoglycemic agents. We did not observe a significant reduction in quality of care following the intervention. Collectively, these findings indicate that reimbursement restriction has improved effective drug utilization and decreased health expenditures.
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Affiliation(s)
- Ji-Young Kim
- Department of Classification System Management, Health Insurance Review and Assessment Service, WonJu, Republic of Korea
| | - Seung Ju Kim
- College of Nursing, Eulji University, Seongnam, Republic of Korea
| | - Chung Mo Nam
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Tae Moon
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Arredondo A, Azar A, Recaman AL. Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico. Global Health 2018; 14:89. [PMID: 30143010 PMCID: PMC6109335 DOI: 10.1186/s12992-018-0404-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite more than 20 years of reform projects in health systems, the universal coverage strategy has not reached the expected results in most middle-income countries (MICs). Using evidence from the Mexican case on diabetes and hypertension as tracers of non-communicable diseases, the effective coverage rate barely surpasses half of the expected goals necessary to meet the challenges that these two diseases represent at the population level. Prevalence and incidence rates do not diminish either; they even grow. In terms of the economic burden, this means that lack of financial protection and catastrophic expense rates have increased, contrary to what could have been expected. DISCUSSION As any complex system, health systems present challenges and dilemmas that are difficult to solve. In terms of universal coverage, when contrasting normative coverage versus effective coverage, the epidemiological, cultural, organizational and economic challenges and barriers become evident. Such challenges have not allowed a greater effectiveness of the contributions of state of the art medicine in the resolution of health problems, particularly in relation to diabetes and hypertension. CONCLUSIONS Despite of the existence of many universal coverage projects, strategies and programs implemented in MICs, challenges remain and, far from disappearing, unresolved problems are still present, even with increasing trends. The model of care based on a curative biomedical approach was enough to respond to the health needs of the last century, but is no longer adapted to the needs of the present century. The dilemmas of continuity vs. rupture require to review and discuss the background and structure of health systems and their underlying models of care. These two elements have not allowed the different coverage schemes to guarantee greater effectiveness in the application of state of the art medicine, nor a greater health care financial protection for patients and their families. We thus can either accept the fragmented health systems and bio-medical-curative models of care approach or, instead, we can move towards integrated health systems that would be based on a socio-medical-preventive approach to health care.
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Affiliation(s)
- Armando Arredondo
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
| | - Alejandra Azar
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
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Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0286-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:22. [PMID: 29983644 PMCID: PMC6003072 DOI: 10.1186/s12962-018-0108-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation. Electronic supplementary material The online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopold Ndemnge Aminde
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,Non-communicable Diseases Unit, Clinical Research Education, Network & Consultancy, Douala, Cameroon
| | | | - Belen Zapata-Diomedi
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
| | - J Lennert Veerman
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,4School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.,5Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011 Australia
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Feeny S, Posso A, McDonald L, Chuyen TTK, Tung ST. Beyond monetary benefits of restoring sight in Vietnam: Evaluating well-being gains from cataract surgery. PLoS One 2018; 13:e0192774. [PMID: 29432447 PMCID: PMC5809077 DOI: 10.1371/journal.pone.0192774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
A more holistic understanding of the benefits of sight-restoring cataract surgery requires a focus that goes beyond income and employment, to include a wider array of well-being measures. The objective of this study is to examine the monetary and non-monetary benefits of cataract surgery on both patients as well as their caregivers in Vietnam. Participants were randomly recruited from a Ho-Chi-Minh City Hospital. A total of 82 cataract patients and 83 caregivers participated in the survey conducted for this study. Paired t-tests, Wilcoxon Signed Rank tests, and regression analysis are used to detect any statistically significant differences in various measures of well-being for patients and caregivers before and after surgery. There are statistically significant improvements in monetary and non-monetary measures of well-being for both patients and caregivers approximately three months after undergoing cataract surgery, compared with baseline assessments collected prior to surgery. Non-monetary measures of well-being include self-assessments of overall health, mental health, hope, self-efficacy, happiness and life satisfaction. For patients, the benefits included statistically significant improvements in earnings, mobility, self-care, the ability to undertake daily activities, self-assessed health and mental health, life satisfaction, hope, and self-efficacy (p<0.01). For caregivers, attendance at work improved alongside overall health, mental health, hope, self-efficacy, happiness and life satisfaction, three months post-surgery (p<0.01). Restoring sight has positive impacts for those suffering from cataracts and their caregivers. Sometimes the benefits are almost equal in their magnitude. The study has also demonstrated that many of these impacts are non-monetary in nature. It is clear that estimates of the rate of return to restoring sight that focus only on financial gains will underestimate the true returns to society of restoring sight from cataract surgeries.
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Affiliation(s)
- Simon Feeny
- International Development and Trade Research Group, RMIT University, Victoria, Australia
| | - Alberto Posso
- International Development and Trade Research Group, RMIT University, Victoria, Australia
| | - Lachlan McDonald
- International Development and Trade Research Group, RMIT University, Victoria, Australia
| | - Truong Thi Kim Chuyen
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Son Thanh Tung
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
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Economic and disease burden of breast cancer associated with suboptimal breastfeeding practices in Mexico. Cancer Causes Control 2017; 28:1381-1391. [PMID: 28983711 DOI: 10.1007/s10552-017-0965-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/16/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Exclusive breastfeeding and longer breastfeeding reduce women's breast cancer risk but Mexico has one of the lowest breastfeeding rates worldwide. We estimated the lifetime economic and disease burden of breast cancer in Mexico if 95% of parous women breastfeed each child exclusively for 6 months and continue breastfeeding for over a year. METHODS We used a static microsimulation model with a cost-of-illness approach to simulate a cohort of Mexican women. We estimated breast cancer incidence, premature mortality, disability-adjusted life years (DALYs), medical costs, and income losses due to breast cancer and extrapolated the results to 1.116 million Mexican women of age 15 in 2012. Costs were expressed in 2015 US dollars and discounted at a 3% annual rate. RESULTS We estimated that 2,186 premature deaths (95% CI 2,123-2,248), 9,936 breast cancer cases (95% CI 9,651-10,220), 45,109 DALYs (95% CI 43,000-47,217), and $245 million USD (95% CI 234-256) in medical costs and income losses owing to breast cancer could be saved over a cohort's lifetime. Medical costs account for 80% of the economic burden; income losses and opportunity costs for caregivers account for 15 and 5%, respectively. CONCLUSIONS In Mexico, the burden of breast cancer due to suboptimal breastfeeding in women is high in terms of morbidity, premature mortality, and the economic costs for the health sector and society.
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Rosselli D, Gil-Tamayo S. Costo por años de vida perdidos: una propuesta para estimar el impuesto al tabaco. Rev Salud Publica (Bogota) 2017; 19:591-594. [DOI: 10.15446/rsap.v19n5.60618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/28/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivos Determinar y justificar la carga impositiva de los cigarrillos, con base en los años de vida que se pierden por su consumo.Métodos Mediante revisión de literatura se estimó la reducción promedio de la expectativa de vida de un fumador. Se aplicó a cada año perdido el valor empleado en estudios de costo-efectividad, de tres veces el PIB per cápita (COP 16 613.951 de 2015, equivalentes a USD 6 056, aplicando tasa de 1 USD=2 743 COP). A partir de los años de consumo promedio, y de los paquetes que consume en ese lapso, se estimó el impuesto que debería tener cada paquete para que, con un interés de 3 % anual, el fumador al fallecer reuniera el valor correspondiente a los años que pierde.Resultados Dada una reducción promedio de esperanza de vida de seis años, cada fumador debería contribuirle al sistema de salud COP 299 051 115 (USD 109 008). Si en promedio consume 166 paquetes de cigarrillos anuales, durante 50 años, debería reunir COP 2.659 648 (USD 969) cada año, y cada paquete debería tener un impuesto de COP 16 022 (USD 5,84).Conclusiones Si se acepta que el sistema de salud pague hasta tres PIB per cápita por cada año de vida por intervenciones en salud que aporten años, es razonable que aquellas intervenciones que quitan años de vida hagan también un aporte equivalente.
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Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. PLoS One 2017; 12:e0182951. [PMID: 28797115 PMCID: PMC5552255 DOI: 10.1371/journal.pone.0182951] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Cost-effectiveness rankings of health interventions are useful inputs for national healthcare planning and budgeting. Previous comprehensive rankings for low- and middle- income countries were undertaken in 2005 and 2006, accompanying the development of strategies for the Millennium Development Goals. We update the rankings using studies published since 2000, as strategies are being considered for the Sustainable Development Goals. Methods Expert systematic searches of the literature were undertaken for a broad range of health interventions. Cost-effectiveness results using Disability Adjusted Life-Years (DALYs) as the health outcome were standardized to 2012 US dollars. Results 149 individual studies of 93 interventions qualified for inclusion. Interventions for Reproductive, Maternal, Newborn and Child Health accounted for 37% of interventions, and major infectious diseases (AIDS, TB, malaria and neglected tropical diseases) for 24%, consistent with the priorities of the Millennium Development Goals. More than half of the interventions considered cost less than $200 per DALY and hence can be considered for inclusion in Universal Health Care packages even in low-income countries. Discussion Important changes have occurred in rankings since 2006. Priorities have changed as a result of new technologies, new methods for changing behavior, and significant price changes for some vaccines and drugs. Achieving the Sustainable Development Goals will require LMICs to study a broader range of health interventions, particularly in adult health. Some interventions are no longer studied, in some cases because they have become usual care, in other cases because they are no longer relevant. Updating cost-effectiveness rankings on a regular basis is potentially a valuable exercise.
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Affiliation(s)
- Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- * E-mail:
| | - Hellen Gelband
- Center for Disease Dynamics, Economics and Policy, Washington, DC, United States of America
| | - Dean Jamison
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Rachel Nugent
- RTI International, Seattle, Washington, United States of America
| | - David Watkins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Johansson KA, Strand KB, Fekadu A, Chisholm D. Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis. Health Policy Plan 2017; 32:376-383. [PMID: 27935798 PMCID: PMC5400039 DOI: 10.1093/heapol/czw134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. METHODS A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. RESULTS The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. CONCLUSIONS The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programmes.
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Affiliation(s)
- Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva
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Hope SF, Webster J, Trieu K, Pillay A, Ieremia M, Bell C, Snowdon W, Neal B, Moodie M. A systematic review of economic evaluations of population-based sodium reduction interventions. PLoS One 2017; 12:e0173600. [PMID: 28355231 PMCID: PMC5371286 DOI: 10.1371/journal.pone.0173600] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. METHODS A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of 'excellent' reporting quality, five studies fell into the 'very good' quality category and one into the 'good' category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. CONCLUSION Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new interventions to be evaluated in the field using strong study designs and parallel economic evaluations.
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Affiliation(s)
- Silvia F. Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, Sydney, Australia
| | - Arti Pillay
- Pacific Research Centre for Prevention of Obesity and Non Communicable Diseases (C-POND)/ Fiji National University, Suva, Fiji
| | | | - Colin Bell
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- The Charles Perkins Centre, University of Sydney, Sydney, Australia
- Division of Epidemiology and Biostatistics, Imperial College, London, United Kingdom
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
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Anderson P, O'Donnell A, Kaner E, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Rehm J. Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study. F1000Res 2017; 6:311. [PMID: 29188013 PMCID: PMC5686480 DOI: 10.12688/f1000research.11173.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/27/2022] Open
Abstract
Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1
st December 2017.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6221 HA, Netherlands
| | - Amy O'Donnell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic of Barcelona, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, 08036, Spain.,Red de Trastornos Adictivo, Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, 6200, Netherlands
| | | | - Jürgen Rehm
- Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, 01187, Germany
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Xie Y, Tan X, Shao H, Liu Q, Tou J, Zhang Y, Luo Q, Xiang Q. VIA/VILI is more suitable for cervical cancer prevention in Chinese poverty-stricken region: a health economic evaluation. BMC Public Health 2017; 17:118. [PMID: 28122530 PMCID: PMC5264329 DOI: 10.1186/s12889-017-4054-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/19/2017] [Indexed: 01/01/2023] Open
Abstract
Background Screening is the main preventive method for cervical cancer in developing countries, but each type of screening has advantages and disadvantages. To investigate the most suitable method for low-income areas in China, we conducted a health economic analysis comparing three methods: visual inspection with acetic acid and Lugol’s iodine (VIA/VILI), ThinPrep cytology test (TCT), and human papillomavirus (HPV) test. Methods We recruited 3086 women aged 35–65 years using cluster random sampling. Each participant was randomly assigned to one of three cervical cancer screening groups: VIA/VILI, TCT, or HPV test. In order to calculate the number of disability-adjusted life years (DALYs) averted by each screening method, we used Markov models to estimate the natural development of cervical cancer over a 15-year period to estimate the age of onset and duration of each disease stage. The cost-effectiveness ratios (CERs), net present values (NPVs), benefit-cost ratios (BCRs), and cost-utility ratios (CURs) were used as outcomes in the health economic analysis. Results The positive detection rate in the VIA/VILI group was 1.39%, which was 4.6 and 2.0 times higher than the rates in the TCT and HPV test groups, respectively. The positive predictive value of VIA/VILI (10.53%) was highest while the rate of referral for colposcopy was lowest for those in the HPV + TCT group (0.60%). VIA/VILI performed the best in terms of health economic evaluation results, as the cost of per positive case detected was 8467.9 RMB, which was 24503.0 RMB lower than that for TCT and 5755.9 RMB lower than that for the HPV test. In addition, the NPV and BCR values were 258011.5 RMB and 3.18 (the highest), and the CUR was 2341.8 RMB (the lowest). The TCT performed the worst, since its NPV was <0 and the BCR was <1, indicative of being poorly cost-beneficial. Conclusions With the best economic evaluation results and requiring minimum medical resources, VIA/VILI is recommended for cervical cancer screening in poverty-stricken areas in China with high incidence of cervical cancer and lack of medical resources.
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Affiliation(s)
- Yu Xie
- School of Public Health, Wuhan University, Hubei, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Hubei, China.
| | - Haiyan Shao
- School of Public Health, Wuhan University, Hubei, China
| | - Qing Liu
- School of Public Health, Wuhan University, Hubei, China
| | - Jiyu Tou
- Institute of Cancer Prevention and Control, Hubei, China
| | - Yuling Zhang
- Institute of Cancer Prevention and Control, Hubei, China
| | - Qiong Luo
- Maternal and Child Health Care Hospital, Wufeng, China
| | - Qunying Xiang
- Maternal and Child Health Care Hospital, Wufeng, China
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Strand KB, Chisholm D, Fekadu A, Johansson KA. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis. Health Policy Plan 2016; 31:504-13. [PMID: 26491060 PMCID: PMC4986243 DOI: 10.1093/heapol/czv093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders. METHODS A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews. RESULTS Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457-1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168-3739 per DALY adverted). CONCLUSION This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions.
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Affiliation(s)
- Kirsten Bjerkreim Strand
- Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen,
| | | | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, University of Addis Abeba, Addis Ababa, Ethiopia and Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen
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Basu S, Bendavid E, Sood N. Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis. Circ Cardiovasc Qual Outcomes 2015; 8:541-51. [PMID: 26555122 PMCID: PMC4801228 DOI: 10.1161/circoutcomes.115.001994] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/23/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India. METHODS AND RESULTS We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective. CONCLUSIONS Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels.
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Affiliation(s)
- Sanjay Basu
- From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.).
| | - Eran Bendavid
- From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.)
| | - Neeraj Sood
- From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.)
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Seuring T, Goryakin Y, Suhrcke M. The impact of diabetes on employment in Mexico. ECONOMICS AND HUMAN BIOLOGY 2015; 18:85-100. [PMID: 25985080 DOI: 10.1016/j.ehb.2015.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/04/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
This study explores the impact of diabetes on employment in Mexico using data from the Mexican Family Life Survey (MxFLS) (2005), taking into account the possible endogeneity of diabetes via an instrumental variable estimation strategy. We find that diabetes significantly decreases employment probabilities for men by about 10 percentage points (p<0.01) and somewhat less so for women - 4.5 percentage points (p<0.1)--without any indication of diabetes being endogenous. Further analysis shows that diabetes mainly affects the employment probabilities of men and women above the age of 44 and also has stronger effects on the poor than on the rich, particularly for men. We also find some indication for more adverse effects of diabetes on those in the large informal labour market compared to those in formal employment. Our results highlight--for the first time--the detrimental employment impact of diabetes in a developing country.
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Affiliation(s)
- Till Seuring
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Yevgeniy Goryakin
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK
| | - Marc Suhrcke
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK; Centre for Health Economics, University of York, York, UK
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Jakovljevic MB, Milovanovic O. Growing Burden of Non-Communicable Diseases in the Emerging Health Markets: The Case of BRICS. Front Public Health 2015; 3:65. [PMID: 25954740 PMCID: PMC4407477 DOI: 10.3389/fpubh.2015.00065] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/06/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mihajlo B. Jakovljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olivera Milovanovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Geissler KH, Leatherman S. Providing primary health care through integrated microfinance and health services in Latin America. Soc Sci Med 2015; 132:30-7. [PMID: 25792337 DOI: 10.1016/j.socscimed.2015.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic health needs, but challenges remain to ensure that health care provided is of reliable quality to predictably improve health outcomes over time.
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Affiliation(s)
- Kimberley H Geissler
- Department of Markets, Public Policy and Law, Boston University School of Management, 595 Commonwealth Avenue, Boston, MA 02215, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA.
| | - Sheila Leatherman
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA
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Salinas JJ. Preventive health screening utilization in older Mexicans before and after healthcare reform. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S70-8. [PMID: 26172237 PMCID: PMC4720260 DOI: 10.21149/spm.v57s1.7592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/27/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. MATERIALS AND METHODS Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. RESULTS Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. CONCLUSIONS While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population.
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Affiliation(s)
- Jennifer J Salinas
- School of Public Health, University of Texas, Houston, Texas, Estados Unidos de América
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Gonzalez L, Caporale JE, Elgart JF, Gagliardino JJ. The burden of diabetes in Argentina. Glob J Health Sci 2014; 7:124-33. [PMID: 25948443 PMCID: PMC4802096 DOI: 10.5539/gjhs.v7n3p124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/27/2014] [Accepted: 09/24/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs). METHODS DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD). RESULTS In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age. CONCLUSIONS Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.
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Affiliation(s)
| | | | | | - Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP - CONICET), Centro Colaborador de OPS/OMS para Diabetes, Facultad de Ciencias Médicas (UNLP), La Plata, Argentina.
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Stein AJ. Rethinking the measurement of undernutrition in a broader health context: Should we look at possible causes or actual effects? GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2014. [DOI: 10.1016/j.gfs.2014.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Niëns LM, Zelle SG, Gutiérrez-Delgado C, Rivera Peña G, Hidalgo Balarezo BR, Rodriguez Steller E, Rutten FFH. Cost-effectiveness of breast cancer control strategies in Central America: the cases of Costa Rica and Mexico. PLoS One 2014; 9:e95836. [PMID: 24769920 PMCID: PMC4000228 DOI: 10.1371/journal.pone.0095836] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50-70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40-70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible socioeconomic barriers.
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Affiliation(s)
- Laurens M. Niëns
- Institute for Medical Technology Assessment and Institute for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sten G. Zelle
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | - Frans F. H. Rutten
- Institute for Medical Technology Assessment and Institute for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Zelle SG, Vidaurre T, Abugattas JE, Manrique JE, Sarria G, Jeronimo J, Seinfeld JN, Lauer JA, Sepulveda CR, Venegas D, Baltussen R. Cost-effectiveness analysis of breast cancer control interventions in Peru. PLoS One 2013; 8:e82575. [PMID: 24349314 PMCID: PMC3859673 DOI: 10.1371/journal.pone.0082575] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/25/2013] [Indexed: 11/24/2022] Open
Abstract
Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.
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Affiliation(s)
- Sten G. Zelle
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Tatiana Vidaurre
- Directorio Médico del INEN, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Julio E. Abugattas
- Directorio Médico del INEN, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Javier E. Manrique
- Directorio Ejecutivo de Promoción de la Salud, Prevención y Control Nacional del Cáncer, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Gustavo Sarria
- Directorio Médico del INEN, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
- Departamento de Radioterapia, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - José Jeronimo
- Programa Comunitario de Salud Mamaria, PATH a catalyst for global health, Seattle, Washington, United States of America
| | | | - Jeremy A. Lauer
- Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland
| | - Cecilia R. Sepulveda
- Cancer Control, Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Diego Venegas
- Dirección General de Salud de las Personas, Ministerio de Salud (MINSA), Lima, Peru
| | - Rob Baltussen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Pérez-Zepeda MU, Arango-Lopera VE, Wagner FA, Gallo JJ, Sánchez-García S, Juárez-Cedillo T, García-Peña C. Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study. Int J Geriatr Psychiatry 2013; 28:1260-9. [PMID: 23585359 PMCID: PMC3797168 DOI: 10.1002/gps.3953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/15/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.
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Affiliation(s)
| | | | - Fernando A. Wagner
- Center for Health Disparities Solutions, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health and Policy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Teresa Juárez-Cedillo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Carmen García-Peña
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
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García-Peña C, Wagner FA, Sánchez-García S, Espinel-Bermúdez C, Juárez-Cedillo T, Pérez-Zepeda M, Arango-Lopera V, Franco-Marina F, Ramírez-Aldana R, Gallo J. Late-life depressive symptoms: prediction models of change. J Affect Disord 2013; 150:886-94. [PMID: 23731940 PMCID: PMC3759587 DOI: 10.1016/j.jad.2013.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/03/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS The study has not included clinical evaluations and nutritional assessments.
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Affiliation(s)
- Carmen García-Peña
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico, DF, Mexico.
| | - Fernando A. Wagner
- Prevention Sciences Research Center and School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Sergio Sánchez-García
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | - Claudia Espinel-Bermúdez
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiological and Health Research Unit, Ageing Area, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico
| | | | | | | | | | - Joseph Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, USA
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Zelle SG, Baltussen RM. Economic analyses of breast cancer control in low- and middle-income countries: a systematic review. Syst Rev 2013; 2:20. [PMID: 23566447 PMCID: PMC3651267 DOI: 10.1186/2046-4053-2-20] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/04/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To support the development of global strategies against breast cancer, this study reviews available economic evidence on breast cancer control in low- and middle-income countries (LMICs). METHODS A systematic article search was conducted through electronic scientific databases, and studies were included only if they concerned breast cancer, used original data, and originated from LMICs. Independent assessment of inclusion criteria yielded 24 studies that evaluated different kinds of screening, diagnostic, and therapeutic interventions in various age and risk groups. Studies were synthesized and appraised through the use of a checklist, designed for evaluating economic analyses. RESULTS The majority of these studies were of poor quality, particularly in examining costs. Studies demonstrated the economic attractiveness of breast cancer screening strategies, and of novel treatment and diagnostic interventions. CONCLUSIONS This review shows that the evidence base to guide strategies for breast cancer control in LMICs is limited and of poor quality. The limited evidence base suggests that screening strategies may be economically attractive in LMICs - yet there is very little evidence to provide specific recommendations on screening by mammography versus clinical breast examination, the frequency of screening, or the target population. These results demonstrate the need for more economic analyses that are of better quality, cover a comprehensive set of interventions and result in clear policy recommendations.
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Affiliation(s)
- Sten G Zelle
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101 Internal Postal Code 117, 6500HB Nijmegen, the Netherlands
| | - Rob M Baltussen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101 Internal Postal Code 117, 6500HB Nijmegen, the Netherlands
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Knaul FM, González-Pier E, Gómez-Dantés O, García-Junco D, Arreola-Ornelas H, Barraza-Lloréns M, Sandoval R, Caballero F, Hernández-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Sepúlveda J, Tapia R, Soberón G, Chertorivski S, Frenk J. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet 2012; 380:1259-79. [PMID: 22901864 DOI: 10.1016/s0140-6736(12)61068-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.
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Baltussen R, Smith A. Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344:e615. [PMID: 22389341 PMCID: PMC3292524 DOI: 10.1136/bmj.e615] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the relative costs, effects, and cost effectiveness of selected interventions to control cataract, trachoma, refractive error, hearing loss, meningitis and chronic otitis media. DESIGN Cost effectiveness analysis of or combined strategies for controlling vision and hearing loss by means of a lifetime population model. SETTING Two World Health Organization sub-regions of the world where vision and hearing loss are major burdens: sub-Saharan Africa and South East Asia. DATA SOURCES Biological and behavioural parameters from clinical and observational studies and population based surveys. Intervention effects and resource inputs based on published reports, expert opinion, and the WHO-CHOICE database. MAIN OUTCOME MEASURES Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS Treatment of chronic otitis media, extracapsular cataract surgery, trichiasis surgery, treatment for meningitis, and annual screening of schoolchildren for refractive error are among the most cost effective interventions to control hearing and vision impairment, with the cost per DALY averted <$Int285 in both regions. Screening of both schoolchildren (annually) and adults (every five years) for hearing loss costs around $Int1000 per DALY averted. These interventions can be considered highly cost effective. Mass treatment with azithromycin to control trachoma can be considered cost effective in the African but not the South East Asian sub-region. CONCLUSIONS Vision and hearing impairment control interventions are generally cost effective. To decide whether substantial investments in these interventions is warranted, this finding should be considered in relation to the economic attractiveness of other, existing or new, interventions in health.
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Affiliation(s)
- Rob Baltussen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, PO Box 9101 6500HB Nijmegen, The Netherlands.
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Ginsberg GM, Lauer JA, Zelle S, Baeten S, Baltussen R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344:e614. [PMID: 22389347 PMCID: PMC3292522 DOI: 10.1136/bmj.e614] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the costs and health effects of interventions to combat breast, cervical, and colorectal cancers in order to guide resource allocation decisions in developing countries. SETTING Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). DESIGN Cost effectiveness analysis of prevention and treatment strategies for breast, cervical, and colorectal cancer, using mathematical modelling based on a lifetime population model. DATA SOURCES Demographic and epidemiological data were taken from the WHO mortality and global burden of disease databases. Estimates of intervention coverage, effectiveness, and resource needs were based on clinical trials, treatment guidelines, and expert opinion. Unit costs were taken from the WHO-CHOICE price database. MAIN OUTCOME MEASURES Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS In both regions certain interventions in cervical cancer control (screening through cervical smear tests or visual inspection with acetic acid in combination with treatment) and colorectal cancer control (increasing the coverage of treatment interventions) cost <$Int2000 per DALY averted and can be considered highly cost effective. In the sub-Saharan African region screening for colorectal cancer (by colonoscopy at age 50 in combination with treatment) costs $Int2000-6000 per DALY averted and can be considered cost effective. In both regions certain interventions in breast cancer control (treatment of all cancer stages in combination with mammography screening) cost $Int2000-6000 per DALY averted and can also be considered cost effective. Other interventions, such as campaigns to eat more fruit and vegetable or subsidies in colorectal cancer control, are not cost effective according to the criteria defined. CONCLUSION Highly cost effective interventions to combat cervical and colorectal cancer are available in the African and Asian sub-regions. In cervical cancer control, these include screening through smear tests or visual inspection in combination with treatment. In colorectal cancer, increasing treatment coverage is highly cost effective (screening through colonoscopy is cost effective in the African sub-region). In breast cancer control, mammography screening in combination with treatment of all stages is cost effective.
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Affiliation(s)
- Gary M Ginsberg
- Department of Medical Technology Assessment, Ministry of Health, Ben Tbai 2, San Simone, Jerusalem, Israel.
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Ortegón M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344:e607. [PMID: 22389337 PMCID: PMC3292537 DOI: 10.1136/bmj.e607] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the relative costs and health effects of interventions to combat cardiovascular disease, diabetes, and tobacco related disease in order to guide the allocation of resources in developing countries. DESIGN Cost effectiveness analysis of 123 single or combined prevention and treatment strategies for cardiovascular disease, diabetes, and smoking by means of a lifetime population model. SETTING Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE) and countries in South East Asia with high adult and high child mortality (SearD). DATA SOURCES Demographic and epidemiological data were taken from the WHO databases of mortality and global burden of disease. Estimates of intervention coverage, effectiveness, and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from the WHO-CHOICE (Choosing Interventions that are Cost-Effective) price database. MAIN OUTCOME MEASURES Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS Most of the interventions studied were considered highly cost effective, meaning they generate one healthy year of life at a cost of <$Int2000 (which is the gross domestic product per capita of the two regions considered here). Interventions that offer particularly good monetary value, and which could be considered for prioritised implementation or scale up, include demand reduction strategies of the Framework Convention for Tobacco Control (<$Int950 and <$Int200 per DALY averted in AfrE and SearD respectively); combination drug therapy for people with a >25% chance of experiencing a cardiovascular event over the next decade, either alone or together with specific multidrug regimens for the secondary prevention of post-acute ischaemic heart disease and stroke (<$Int150 and <$Int230 per DALY averted in AfrE and SearD respectively); and retinopathy screening and glycaemic control for patients with diabetes (<$Int2100 and <$Int950 per DALY averted in AfrE and SearD respectively). CONCLUSION This comparative economic assessment has identified a set of population-wide and individual strategies for prevention and control of cardiovascular disease that are inexpensive and cost effective in low resource settings.
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Affiliation(s)
- Mónica Ortegón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
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Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344:e609. [PMID: 22389339 PMCID: PMC3292519 DOI: 10.1136/bmj.e609] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the comparative costs and effects of interventions to combat five neuropsychiatric conditions (schizophrenia, bipolar disorder, depression, epilepsy, and heavy alcohol use). DESIGN Cost effectiveness analysis based on an epidemiological model. SETTING Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). DATA SOURCES Published studies, costing databases. MAIN OUTCOME MEASURES Cost per capita and cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS Across 44 assessed intervention strategies for the five neuropsychiatric conditions, cost effectiveness values differed by as much as two orders of magnitude (from $Int100-250 to $Int10,000-25,000 for a year of healthy life gained). In both sub-regions, inpatient based treatment of schizophrenia with newer antipsychotic drugs was the most costly and least cost effective strategy. The most cost effective strategies in the African sub-region related to population based alcohol control, while in the South East Asian sub-region the most cost effective intervention was drug treatment of epilepsy in primary care. The cumulative cost per capita of the most cost effective set of interventions covering all five conditions was estimated at $Int4.90-5.70. This package comprises interventions for epilepsy (older first line antiepileptic drugs); depression (generically produced newer antidepressants and psychosocial treatment); bipolar disorder (mood stabiliser drug lithium); schizophrenia (neuroleptic antipsychotic drugs and psychosocial treatment); and heavy alcohol use (increased taxation and its enforcement, reduced access, and, in the African sub-region, advertising bans and brief advice to heavy drinkers in primary care). CONCLUSIONS Reallocation of resources to cost effective intervention strategies would increase health gain, save money and help implement much needed expansion of services for neuropsychiatric conditions in low resource settings.
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Affiliation(s)
- Dan Chisholm
- Department of Health Systems Financing, World Health Organization, 1211 Geneva, Switzerland.
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