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Nhac-Vu HT, Tran VTN, Nguyen TDT, Pham VT, Le T. Economic burden of Thalassemia treatment: An analysis from the Vietnam Social Security perspective. PLoS One 2023; 18:e0293916. [PMID: 38011135 PMCID: PMC10681197 DOI: 10.1371/journal.pone.0293916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Thalassemia is a genetic disorder that significantly impacts the health and well-being of individuals in Vietnam. This study aimed to assess the economic burden of Thalassemia treatment in Lam-Dong Province from the perspective of the Vietnam Social Security and to develop a model to forecast these costs. METHODS This study analyzed the medical records of all 288 health-insured Thalassemia patients who received treatment in Lam-Dong Province from 2019-2021. The annual economic burden was calculated as the total direct medical cost of treatment per patient over one year. Bayesian Model Averaging (BMA) was utilized to forecast economic burdens. The best fit model was selected based on evaluation criteria including the R2 value, the Bayesian information criterion (BIC), and posterior model probabilities. RESULTS The study found that the average annual economic burden of Thalassemia treatment was VND 9,947,000 (±6,854,000), equivalent to approximately USD 426.7 (±294.0), with blood transfusions being the main contributor to costs (63%). Using BMA, the best fit model to forecast economic burdens included variables including patient age, sex, and length of hospitalization, with age being the key factor with the greatest impact on the increase in economic burden. CONCLUSION These findings provided important information for policymakers in Vietnam, as they highlighted the significant economic burden of Thalassemia treatment in the country. By developing a model to forecast these costs, policymakers can make informed decisions on how to allocate resources and support individuals with Thalassemia and their families.
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Affiliation(s)
- Hoang-Thy Nhac-Vu
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Van Thi-Ngoc Tran
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Trong-Duy-Thuc Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Vu-Thanh Pham
- General Planning Department, Lam-Dong General Hospital, Da Lat, Lam Dong Province, Vietnam
| | - Tho Le
- Lam-Dong Children’s Hospital, Da Lat, Lam Dong Province, Vietnam
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Mulas O, Efficace F, Orofino MG, Piroddi A, Piras E, Vacca A, Barella S, Costa A, Giesinger JM, La Nasa G, Caocci G. Health-Related Quality-of-Life Profile of Pediatric Patients with β Thalassemia after Hematopoietic Stem Cell Transplantation. J Clin Med 2023; 12:6047. [PMID: 37762987 PMCID: PMC10532003 DOI: 10.3390/jcm12186047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Matched hematopoietic stem cell transplantation (HSCT) is a feasible and curative treatment in pediatric patients with beta thalassemia major (β-TM). However, little data are available regarding patients and their parents' health-related quality of life (HRQoL) after the procedure. As such, we investigated the HRQoL of pediatric patients with β-TM after HSCT compared to that of patients treated with blood transfusions and iron chelation. The health-related quality of life of 43 β-TM pediatric patients and 43 parents were evaluated using the Pediatric Quality of Life Inventory (PedsQL). A total of 25 patients underwent HSCT: 15 from a sibling and 10 from an HLA-matched donor. The median follow-up time from HSCT was 5 years (range 1-13 years). The mean ages at the survey were 10.1 years (range 5-15) and 9.6 years (range 5-15) for transfused and transplanted patients, respectively. A significant reduction in HRQoL was reported in the group of transfused patients compared with that of patients transplanted in the following PedsQL domains: children's and parents' physical functions, Δ = -15.4, p = 0.009 and Δ = -11.3, p = 0.002, respectively; children's and parents' emotional functioning, Δ = -15.2, p = 0.026 and Δ = -15.2, p = 0.045, respectively; child's and parents' school functioning, Δ = -25, p = 0.005 and Δ = -22.5, p = 0.011, respectively; total child and parents scores, Δ = -14.5, p = 0.004 and Δ = -13.2, p = 0.005, respectively. The results of a multivariable analysis showed that the HSCT procedure was significantly associated with a higher total child PedsQL score (adjusted mean difference = 15.3, p = 0.001) and a higher total parent PedsQL score (adjusted mean difference = 14.1, p = 0.006). We found no significant difference in the HRQoL measured after sibling or unrelated human leukocyte antigen (HLA)-matched HSCT. Finally, a significant positive correlation across all the PedsQL domains was found between the scores reported by the children and those reported by their parents. In conclusion, our study shows that HSCT in pediatric patients with β-TM is associated with a good overall HRQoL profile. This information further supports physicians when counseling patients and their parents before the HSCT procedure.
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Affiliation(s)
- Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, 00161 Rome, Italy;
| | - Maria Grazia Orofino
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Antonio Piroddi
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Eugenia Piras
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Adriana Vacca
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Susanna Barella
- Pediatric Clinic, Thalassemia and Rare Diseases, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy;
| | - Alessandro Costa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Johannes M. Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
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3
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Zhen X, Ming J, Zhang R, Zhang S, Xie J, Liu B, Wang Z, Sun X, Shi L. Economic burden of adult patients with β-thalassaemia major in mainland China. Orphanet J Rare Dis 2023; 18:252. [PMID: 37644448 PMCID: PMC10466866 DOI: 10.1186/s13023-023-02858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND β-thalassaemia major poses a substantial economic burden, especially in adults. We aimed to estimate the economic burden of adult patients with β-thalassaemia major from a societal perspective using the real-world data. According to the clinical guideline, we also estimated the annual medical costs for patients with the same body weight and calculated the lifetime medical costs over 50 years in mainland China. METHODS This was a retrospective cross-sectional study. An online survey with snowball sampling covering seven provinces was conducted. We extracted patient demographics, caregiver demographics, disease and therapy information, caring burden, and costs for adult patients diagnosed with β-thalassaemia major and their primary caregivers. In the real world, we estimated the annual direct medical cost, direct nonmedical cost, and indirect cost. In addition, we calculated the annual direct medical cost and lifetime direct medical cost by weight with discounted and undiscounted rates according to the clinical guideline. RESULTS Direct medical costs was the main driver of total cost, with blood transfusion and iron chelation therapy as the most expensive components of direct medical cost. In addition, adult patients with β-thalassaemia major weighing 56 kg were associated with an increase of $2,764 in the annual direct medical cost using the real-world data. The undiscounted and discounted (5% discount rate) total lifetime treatment costs were $518,871 and $163,441, respectively. CONCLUSIONS Patients with β-thalassaemia major often encounter a substantial economic burden in mainland China. Efforts must be made to help policymakers develop effective strategies to reduce the burden and pevalence of thalassaemia.
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Affiliation(s)
- Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Jing Ming
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Runqi Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Shuo Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Jing Xie
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Baoguo Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Zijing Wang
- Beijing New Sunshine Charity Foundation, No.25 Landianchangnan Road, Beijing, 100097, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University), No.44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, 70112, USA
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Suwannakhon N, Hemvuthiphan J, Pangeson T, Mahingsa K, Pingyod A, Bumrungpakdee W, Sanguansermsri T. Non-invasive prenatal screening & diagnosis of β-thalassaemia in an affected foetus. Indian J Med Res 2023; 157:447-452. [PMID: 37322635 PMCID: PMC10443724 DOI: 10.4103/ijmr.ijmr_3226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 06/17/2023] Open
Abstract
Background & objectives Non-invasive prenatal testing (NIPT) of maternally inherited alleles of β-thalassaemia (MIB) remains to be a challenge. Furthermore, current techniques are not available for use as routine tests. NIPT for β-thalassaemia disease was developed by using a specific droplet digital polymerase chain reaction (ddPCR) assay to analyze the cell-free foetal DNA (cffDNA) derived from maternal plasma. Methods Pregnant women and their spouses who are at risk of bearing an offspring with β-thalassaemia disease from common MIB mutations (CD 41/42-TCTT, CD17A>T, IVS1-1G>T and CD26G>A) were enrolled. The ddPCR assay sets were constructed for each of the four mutations. All cell-free DNA samples were first screened for the paternally inherited β-thalassaemia (PIB) mutation. The PIB-negative samples were considered as non-disease and were not further analyzed. For PIB-positive samples, DNA fragments of 50-300 base pairs in size were isolated and purified, and further analyzed for MIB mutation. The allelic ratio between the mutant and the wild-type was used to determine the presence of MIB in cffDNA. All cases underwent a prenatal diagnosis by amniocentesis for a definite diagnosis. Results Forty two couples at risk were enrolled. Twenty two samples were positive for PIBs. Among these 22 samples, there were 10 cases with allelic ratio >1.0 (MIB positive). All foetuses with over-represented mutant alleles were further diagnosed with β-thalassaemia disease; eight with compound heterozygous and two with homozygous mutations. The 20 PIB-negative and 12 MIB-negative foetuses were non-affected. Interpretation & Conclusions The results of this study suggest that NIPT utilizing the ddPCR assay can be effectively used for the screening and diagnosis of foetal β-thalassaemia in at risk pregnancies.
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Affiliation(s)
| | | | - Tanapat Pangeson
- Department of Biochemistry, School of Medical Science, University of Phayao, Phayao, Thailand
| | - Khwanruedee Mahingsa
- Thalassaemia Unit, University of Phayao Hospital, University of Phayao, Phayao, Thailand
| | - Arunee Pingyod
- Thalassaemia Unit, University of Phayao Hospital, University of Phayao, Phayao, Thailand
| | - Wanwipa Bumrungpakdee
- Thalassaemia Unit, University of Phayao Hospital, University of Phayao, Phayao, Thailand
| | - Torpong Sanguansermsri
- Thalassaemia Unit, University of Phayao Hospital, University of Phayao, Phayao, Thailand
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Knoth RL, Gupta S, Perkowski K, Costantino H, Inyart B, Ashka L, Clapp K. Understanding the Association between Red Blood Cell Transfusion Utilization and Humanistic and Economic Burden in Patients with β-Thalassemia from the Patients' Perspective. J Clin Med 2023; 12:jcm12020414. [PMID: 36675342 PMCID: PMC9861260 DOI: 10.3390/jcm12020414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
We assessed the humanistic and economic burden of chronic red blood cell (RBC) transfusions on patients with β-thalassemia. This cross-sectional, US-based study included adults (≥18 years) who self-reported a β-thalassemia physician diagnosis and had received ≥1 RBC transfusion in the past 6 months. The outcomes included the Functional Assessment of Cancer Therapy-Anemia (FACT-An), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and ad hoc questions about treatment experience, side effects, direct/indirect costs, and psychological burden. Overall, 100 patients completed the survey, of whom 70% experienced "moderate" to "extremely high" burden due to RBC transfusions, 81% reported iron overload, 42% reported compromised social lives. The mean FACT-An score was 132 (higher score indicates better outcomes; 0-188). Mean scores were 33/52 for fatigue and 20/28 for anemia symptoms in the previous 7 days. Health-related quality of life (HRQoL) temporarily improved after RBC transfusion, although patients continued to experience mild-to-severe depression and anxiety, substantial direct costs, compromised employment, and suboptimal quality of life. Over 6 months, patients dedicated a mean of 173 h to transfusion requirements and incurred out-of-pocket costs of USD 2239 for transfusions and USD 896 for additional care costs. These findings highlight the need for new treatment options to improve patient HRQoL and economic outcomes.
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Affiliation(s)
- Russell L Knoth
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ 08540, USA
| | - Shaloo Gupta
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Kacper Perkowski
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Halley Costantino
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Brian Inyart
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Lauren Ashka
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Kelly Clapp
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
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6
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Uchil A, Muranjan M, Gogtay NJ. Economic burden of beta-thalassaemia major receiving hypertransfusion therapy at a public hospital in Mumbai. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:11-16. [PMID: 37615146 DOI: 10.25259/nmji_580_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Background Treating beta-thalassaemia major may entail high costs with considerable out-of-pocket expenditure. Therefore, determination and valuation of the economic costs of a common haemoglobinopathy such as beta-thalassaemia major in India may provide insights to evolve policies for reduction or elimination of the disease. We estimated economic burden of beta-thalassaemia major in Mumbai in terms of cost to the family and the healthcare system. Methods This single-centre, prospective, cross-sectional, non-interventional study included children <12 years of age treated at the thalassaemia day care centre of a public hospital in Mumbai. The demographic data and treatment-related information was recorded. Cost of illness was studied from a societal perspective by the prevalence-based approach. Direct (medical and non-medical), indirect (loss of wages and loss of school days) and intangible costs (closed-ended iterative bidding) were calculated for each patient by interview. Results The total annual cost of treating 130 children with beta-thalassaemia major in Mumbai was ₹86 72 412 (US$ 127 535) or ₹66 710 (US$ 981) per patient per year and ₹12 82 30 412 (US$ 1 885 741) including intangible costs. Direct costs contributed to 94% of the cost of illness with chelation therapy (23%) and blood investigations (21%) being major contributors. Direct and indirect costs correlated significantly with duration of blood transfusion (p<0.05 and p=0.006, respectively), whereas indirect costs correlated with socioeconomic status (rho=0.25). Conclusion The majority (94%) of costs incurred by families for treatment of beta-thalassaemia major are direct costs, especially expenses for chelation and blood investigations. Even at subsidized rates, financial burden to the families from lower socioeconomic strata is likely to be considerable as these are out-of-pocket expenses. In consideration of the economic impact of treating beta-thalassaemia major in individual families, the healthcare system and society, it is prudent to promote and pursue long-term and short-term measures with urgent emphasis on prevention as a public health activity at the national level in India.
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Affiliation(s)
- Ashwija Uchil
- Department of Paediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Mamta Muranjan
- Department of Paediatrics, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400012, Maharashtra, India
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7
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Yousuf R, Akter S, Wasek SM, Sinha S, Ahmad R, Haque M. Thalassemia: A Review of the Challenges to the Families and Caregivers. Cureus 2022; 14:e32491. [PMCID: PMC9747324 DOI: 10.7759/cureus.32491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
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Lam TT, Nguyen DT, Le QT, Nguyen DA, Hoang DTT, Nguyen HD, Nguyen CC, Doan KPT, Tran NT, Ha TMT, Trinh THN, Nguyen VT, Lam DT, Le MT, Nguyen XT, Ho THT, Tran TH, Ho VT, Bui TV, Nguyen VT, Hoang PB, Nguyen HT, Nguyen MH, Vo TB, Le DKN, Truong TN, Dao HTT, Vo PAN, Nguyen TCV, Tran NNT, Tran QNT, Van YLT, Nguyen TTT, Huynh BNT, Nguyen TPT, Tran KVT, Nguyen CT, Doan PL, Nguyen TD, Do TTT, Truong DK, Tang HS, Cao NPT, Phan MD, Giang H, Nguyen HN. Combined Gap-Polymerase Chain Reaction and Targeted Next-Generation Sequencing Improve α- and β-Thalassemia Carrier Screening in Pregnant Women in Vietnam. Hemoglobin 2022; 46:233-239. [PMID: 35993587 DOI: 10.1080/03630269.2022.2096461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Vietnam has a high thalassemia burden. We collected blood samples from 5880 pregnant Vietnamese women during prenatal health checks to assess thalassemia carrier frequency using combined gap-polymerase chain reaction (gap-PCR) and targeted next-generation sequencing (NGS). Thalassemia carriers were identified with prevalence of 13.13% (772), including 7.82% (460) carriers of α-thalassemia (α-thal), 5.31% (312) carriers of β-thalassemia (β-thal), and 0.63% (37) concurrent α-/β-thal carriers. Deletional mutations (368) accounted for 80.0% of α-thal carriers, of which, --SEA (Southeast Asian) (n = 254; 55.0%) was most prevalent, followed by the -α3.7 (rightward) (n = 66; 14.0%) and -α4.2 (leftward) (n = 45; 9.8%) deletions. Hb Westmead (HBA2: c.369C>G) (n = 53) and Hb Constant Spring (Hb CS or HBA2: c.427T>C) (in 28) are the two most common nondeletional α-globin variants, accounting for 11.5 and 6.0% of α-thal carriers. We detected 11 different β-thal genotypes. Hb E (HBB: c.79G>A) (in 211) accounted for 67.6% of β-thal carriers. The most common β-thal genotypes were associated with mutations at codon 17 (A>T) (HBB: c.52A>T), codons 41/42 (-TTCT) (HBB: c.126_129delCTTT), and codon 71/72 (+A) (HBB: c.217_218insA) (prevalence 0.70%, 0.68%, and 0.2%, respectively). Based on mutation frequencies calculated in this study, estimates of 5021 babies in Vietnam are affected with clinically severe thalassemia annually. Our data suggest a higher thalassemia carrier frequency in Vietnam than previously reported. We established that combining NGS with gap-PCR creates an effective large-scale thalassemia screening method that can detect a broad range of mutations.
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Affiliation(s)
- Tuan-Thanh Lam
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Doan-Tu Nguyen
- General Office for Population and Family Planning, Ho Chi Minh City, Vietnam
| | | | - Duy-Anh Nguyen
- Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | | | - Huu Du Nguyen
- Can Tho Gynecology and Obstetrics Hospital, Can Tho, Vietnam
| | | | | | | | - Thi Minh Thi Ha
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | | | - Duc Tam Lam
- Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Minh Tam Le
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | | | | | | | | | | | | | | | | | - Thanh-Binh Vo
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Duy-Khang Nguyen Le
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Thao Ngoc Truong
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Hong-Thuy Thi Dao
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Phuong-Anh Ngoc Vo
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Thien-Chi Van Nguyen
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Ngoc-Nhu Thi Tran
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Quynh-Nhu Thi Tran
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Yen-Linh Thi Van
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Thanh-Thanh Thi Nguyen
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Bich-Ngoc Thi Huynh
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Thanh-Phuong Thi Nguyen
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Kim-Van Thi Tran
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Cong-Trai Nguyen
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Phuoc-Loc Doan
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Thanh-Dat Nguyen
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | | | | | - Hung Sang Tang
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Ngoc-Phuong Thi Cao
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Minh-Duy Phan
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Hoa Giang
- Gene Solutions, Ho Chi Minh City, Vietnam.,Medical Genetics Institutes, Ho Chi Minh City, Vietnam
| | - Hoai-Nghia Nguyen
- Medical Genetics Institutes, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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9
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Esmaeilzadeh F, Ahmadi B, Vahedi S, Barzegari S, Rajabi A. Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran. Int J Health Policy Manag 2022; 11:1112-1119. [PMID: 33619933 PMCID: PMC9808182 DOI: 10.34172/ijhpm.2021.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients. METHODS In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients. RESULTS In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571. CONCLUSION Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients.
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Affiliation(s)
- Firooz Esmaeilzadeh
- Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Batoul Ahmadi
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Vahedi
- Department of Healthcare Administration, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Barzegari
- Department of Health Information Technology, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolhalim Rajabi
- Department of Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
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Halim-Fikri BH, Lederer CW, Baig AA, Mat-Ghani SNA, Syed-Hassan SNRK, Yusof W, Abdul Rashid D, Azman NF, Fucharoen S, Panigoro R, Silao CLT, Viprakasit V, Jalil N, Mohd Yasin N, Bahar R, Selvaratnam V, Mohamad N, Nik Hassan NN, Esa E, Krause A, Robinson H, Hasler J, Stephanou C, Raja-Sabudin RZA, Elion J, El-Kamah G, Coviello D, Yusoff N, Abdul Latiff Z, Arnold C, Burn J, Kountouris P, Kleanthous M, Ramesar R, Zilfalil BA. Global Globin Network Consensus Paper: Classification and Stratified Roadmaps for Improved Thalassaemia Care and Prevention in 32 Countries. J Pers Med 2022; 12:jpm12040552. [PMID: 35455667 PMCID: PMC9032232 DOI: 10.3390/jpm12040552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
The Global Globin Network (GGN) is a project-wide initiative of the Human Variome/Global Variome Project (HVP) focusing on haemoglobinopathies to build the capacity for genomic diagnosis, clinical services, and research in low- and middle-income countries. At present, there is no framework to evaluate the improvement of care, treatment, and prevention of thalassaemia and other haemoglobinopathies globally, despite thalassaemia being one of the most common monogenic diseases worldwide. Here, we propose a universally applicable system for evaluating and grouping countries based on qualitative indicators according to the quality of care, treatment, and prevention of haemoglobinopathies. We also apply this system to GGN countries as proof of principle. To this end, qualitative indicators were extracted from the IthaMaps database of the ITHANET portal, which allowed four groups of countries (A, B, C, and D) to be defined based on major qualitative indicators, supported by minor qualitative indicators for countries with limited resource settings and by the overall haemoglobinopathy carrier frequency for the target countries of immigration. The proposed rubrics and accumulative scores will help analyse the performance and improvement of care, treatment, and prevention of haemoglobinopathies in the GGN and beyond. Our proposed criteria complement future data collection from GGN countries to help monitor the quality of services for haemoglobinopathies, provide ongoing estimates for services and epidemiology in GGN countries, and note the contribution of the GGN to a local and global reduction of disease burden.
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Affiliation(s)
- Bin Hashim Halim-Fikri
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Carsten W. Lederer
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Atif Amin Baig
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Terengganu, Malaysia;
| | - Siti Nor Assyuhada Mat-Ghani
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Sharifah-Nany Rahayu-Karmilla Syed-Hassan
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Wardah Yusof
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Diana Abdul Rashid
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nurul Fatihah Azman
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Suthat Fucharoen
- Thalassemia Research Centre, Institute of Molecular Biosciences, Mahidol University, Nakhom Pathom 73170, Thailand;
| | - Ramdan Panigoro
- Department of Biomedical Sciences, Medical Genetics Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Catherine Lynn T. Silao
- Institute of Human Genetics, National Institutes of Health, University of the Philippines, Manila 1000, Philippines;
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila 1000, Philippines
| | - Vip Viprakasit
- Department of Paediatrics & Thalassaemia Centre, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Norunaluwar Jalil
- UKM Specialist Children’s Hospital, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Norafiza Mohd Yasin
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Rosnah Bahar
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Veena Selvaratnam
- Hospital Ampang, Jalan Mewah Utara, Taman Pandan Mewah, Ampang Jaya 68000, Selangor, Malaysia;
| | - Norsarwany Mohamad
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nik Norliza Nik Hassan
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Ezalia Esa
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service (NHLS) and School of Pathology, Faculty of Health Sciences, The University of the Witwatersrand, Watkins Pitchford Building, NHLS Braamfontein, Cnr Hospital and De Korte St, Hillbrow, P.O. Box 1038, Johannesburg 2000, South Africa;
| | - Helen Robinson
- Nossal Institute for Global Health, MDDHS, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Julia Hasler
- Global Variome, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK;
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raja-Zahratul-Azma Raja-Sabudin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Jacques Elion
- Medical School, Université Paris Diderot, 75018 Paris, France;
| | - Ghada El-Kamah
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt;
| | - Domenico Coviello
- Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, Largo Gerolamo Gaslini 5, 16147 Genova, Italy;
| | - Narazah Yusoff
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia;
| | - Zarina Abdul Latiff
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Chris Arnold
- BioGrid Australia, Hodgson Associates, 4 Hodgson St., Kew, Melbourne, VIC 3101, Australia;
| | - John Burn
- Translational and Clinical Research Institute, International Centre for Life Times Square, Newcastle upon Tyne NE1 3BZ, UK;
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raj Ramesar
- Department of Pathology, University of Cape Town City of Cape Town, Cape Town 7925, South Africa;
| | - Bin Alwi Zilfalil
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or ; Tel.: +60-9767-6531
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Healthcare resource utilization and direct costs of transfusion-dependent thalassemia patients in Dubai, United Arab Emirates: a retrospective cost-of-illness study. BMC Health Serv Res 2022; 22:304. [PMID: 35248046 PMCID: PMC8897869 DOI: 10.1186/s12913-022-07663-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/22/2022] [Indexed: 01/19/2023] Open
Abstract
Background Patients with transfusion-dependent thalassemia (TDT) require lifelong blood transfusions and iron chelation therapy. Thus, patients afflicted with TDT often have to undergo blood transfusion and iron chelation therapy, which causes a major economic burden on them. However, this topic has not been reported in Dubai, United Arab Emirates (UAE). Hence, this study aimed to evaluate healthcare resource utilization and associated direct costs related to patients with TDT in Dubai, UAE. Methods For this study, a retrospective prevalence-based cost-of-illness analysis based on the UAE healthcare system and patient perspectives was conducted among patients with TDT treated at the Dubai Thalassemia Center in 2019. Information regarding healthcare resource utilization and direct medical costs was collected from the billing system connected to the electronic medical record system. Patients and their families were interviewed for direct non-medical cost estimations. Results A total of 255 patients with TDT were included in the study. The mean annual direct medical cost was estimated at AED 131,156 (USD 35,713) (95% CI: 124,735 – 137,578). The main driver of the medical cost for the participants as iron chelation therapy AED 78,372 (95% CI: 72,671 – 84,074) (59.8%), followed by blood transfusions, which accounted for AED 34,223 (95% CI: 32,854 – 35,593) 26.1% of the total direct medical costs. The mean annual direct non-medical costs was AED 2,223 (USD 605) (95% CI: 1,946 – 2,500). Age (p < 0.001), severe serum ferritin levels (p = 0.016), the presence of complications (p < 0.001), and the type of iron chelation therapy (p < 0.001) were significant predictors of higher direct medical costs incurred by the participants. Conclusion Transfusion-dependent thalassemia poses a substantial economic burden on the healthcare system, patients, and their families. Our results show that the highest medical cost proportion was due to iron chelation therapy. In this regard, efforts must be made to improve the patients’ acceptance and satisfaction with their iron chelation therapy to increase their compliance and improve the effectiveness of treatment, which could play an essential role in controlling the economic burden of this disease. Moreover, greater support is essential for families that suffer catastrophic out-of-pocket expenses. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07663-6.
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12
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Colah RB, Seth T. Thalassemia in India. Hemoglobin 2022; 46:20-26. [PMID: 35950587 DOI: 10.1080/03630269.2021.2008958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Management and control of hemoglobinopathies are a challenge in India where 67.0% of people reside in rural regions. The GDP spent on health is one of the lowest (1.3%) resulting in high out-of-pocket expenses. The β-thalassemias are prevalent with an estimated 7500-12000 new births each year. Hb S (HBB: c.20A>T) and Hb E (HBB: c.79G>A) are also common regionally. Over 80 β-thalassemia (β-thal) mutations have been characterized in Indians. The δ gene mutations are increasingly being described and their coinheritance in β-thal carriers leads to a reduction in Hb A2 levels and a misdiagnosis of carriers. Around 15-20 centers offer prenatal diagnosis (PND) mainly in urban regions. The projected annual cost of care of β-thal patients over a decade (2016-2026) will increase from INR30,000 (US$448) million to INR55,000 (US$820) million if all patients are adequately treated. Cost comparisons are difficult to make with other international studies as the standard of care, cost of medicines and other services vary in different countries. Several centers provide hematopoietic stem cell transplants (HSCTs) for thalassemias, however, only around 250 HSCTs are done annually. Although the cost is high, financial assistance is available for a few patients. There are disparities in the quality of care and to address this a National Policy has been proposed for the management and prevention of hemoglobinopathies that will embark on a comprehensive program, providing adequate care and augmenting the existing public health care services. It will also include training, genetic counseling and easier access to preventive options and a National Registry.
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Affiliation(s)
- Roshan B Colah
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Tulika Seth
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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13
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Alshamsi S, Hamidi S, Ozgen Narci H. Productivity Loss and Associated Costs Among Patients with Transfusion-Dependent Thalassemia in Dubai, United Arab Emirates. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:853-862. [PMID: 34616164 PMCID: PMC8487795 DOI: 10.2147/ceor.s334724] [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: 08/17/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to assess the indirect burden of patients with transfusion-dependent thalassemia (TDT) in Dubai, the United Arab Emirates (UAE). Methods Adult patients with TDT were enrolled during blood transfusion sessions. Productivity loss for patients in the preceding four weeks was reported using the validated iMTA Productivity Cost Questionnaire (iPCQ). Results A total of 161 adult patients with TDT were included in the study. The annual total productivity loss cost at paid work among 79 employed patients was AED 17,230 (USD 4691) (95% CI: 12,302-22,159), out of which absenteeism contributed AED 10,328 (USD 2812) and presenteeism contributed AED 6902 (USD 1879), whereas the annual total productivity loss cost at unpaid work was AED 4053 (USD 1104) (95% CI: 3471-4661). The annual mean total indirect cost for paid and unpaid work was AED 21,283 (USD 5795). Monthly income, nationality, and having two and more disease complications were the significant predictors of higher productivity loss costs. Having previously had a splenectomy was a negative and significant predictor of productivity loss costs. Conclusion TDT was associated with substantial productivity loss and indirect costs in the UAE. Health policies that aim to control transfusion-dependent thalassemia effectively are necessary and could result in cost savings for patients and employers.
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Affiliation(s)
- Shaikha Alshamsi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Samer Hamidi
- School of Health and Environment Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Hacer Ozgen Narci
- Department of Health Management, Istinye University, Istanbul, Turkey
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Shafie AA, Wong JHY, Ibrahim HM, Mohammed NS, Chhabra IK. Economic burden in the management of transfusion-dependent thalassaemia patients in Malaysia from a societal perspective. Orphanet J Rare Dis 2021; 16:157. [PMID: 33827621 PMCID: PMC8028190 DOI: 10.1186/s13023-021-01791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transfusion-dependent thalassaemia (TDT) is a hereditary blood disorder in which blood transfusion is the mainstay treatment to prolong survival and improve quality of life. Patients with this disease require blood transfusion at more than 100 ml/kg annually and iron-chelating therapy (ICT) to prevent iron overload (IOL) complications. There are substantial numbers of TDT patients in Malaysia, but limited data are available regarding the economic burden associated with this disease. The purpose of this study was to determine the lifetime cost of TDT from a societal perspective and identify potential factors increasing patient and family expenditures among thalassaemia populations. METHODS The total lifetime cost per TDT patient (TC1) is the sum of lifetime healthcare cost (TC2) and lifetime patient and family healthcare expenditure (TC3). TC2 was simulated using the Markov model, taking into account all costs subsidized by the government, and TC3 was estimated through a cross-sectional health survey approach. A survey was performed using a two-stage sampling method in 13 thalassaemia centres covering all regions in Malaysia. RESULTS A TDT patient is expected to incur TC2 of USD 561,208. ICT was the main driver of cost and accounted for 56.9% of the total cost followed by blood transfusion cost at 13.1%. TC3 was estimated to be USD 45,458. Therefore, the estimated TC1 of a TDT patient was USD 606,665. Sensitivity analyses showed that if all patients were prescribed oral ICT deferasirox for their lifetime, the total healthcare cost would increase by approximately 65%. Frequency of visits to health facilities for blood transfusion/routine monitoring and patients who were prescribed desferrioxamine were observed to be factors affecting patient and family monthly expenses. CONCLUSION The lifetime cost per TDT patient was USD 606,665, and this result may be useful for national health allocation planning. An estimation of the economic burden will provide additional information to decision makers on implementing prevention interventions to reduce the number of new births and medical service reimbursement.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.
| | - Jacqueline Hui Yi Wong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.,Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Hishamshah Mohd Ibrahim
- Division of Research and Technical Support, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Noor Syahireen Mohammed
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.,Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Kedah Darul Aman, Alor Setar, Malaysia
| | - Irwinder Kaur Chhabra
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
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Chen X, Lin Z, Hu J, Chen S, Wen S, Wu A, Wu H, Huang J, Wang H, Sun J, Peng Z, Sun Y, Fu S. Report of Two Novel Thalassemia Variants, HBB: c.181delG and HBA1: c.121_126delAAGACC, in Chinese Individuals. Hemoglobin 2021; 45:52-55. [PMID: 33792470 DOI: 10.1080/03630269.2021.1883646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study, we report two novel thalassemia variants detected in Chinese individuals using targeted NGS technology. We detected a novel frameshift variant, HBB: c.181delG, in a 32-year-old Chinese individual. This novel variant [a single nucleotide deletion at nucleotide 181 of codon 60 (-G)], was detected by targeted next generation sequencing (NGS), resulting in a stop codon at codon 60 in exon 2 of the HBB gene. The impact of this novel variant was further analyzed by an in vitro model. We also identified a novel in-frame variant, HBA1: c.121_126delAAGACC [codons 40/41 (-AAGACC)], in another Chinese individual in this study. We named these two novel variants, HBB: c.181delG and HBA1: c.121_126delAAGACC according to the Human Genome Variation Society (HGVS), which were detected by the first author. These two novel variants have expanded the mutation spectrum of thalassemia and it would be beneficial for carrier screening, genetic counseling and prenatal diagnosis (PND) of thalassemia.
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Affiliation(s)
- Xinping Chen
- Central Laboratory, Hainan General Hospital, Hainan Hospital Affiliated to The Hainan Medical College, Hainan Provincial Key Laboratory of Cell and Molecular Genetic Translational Medicine, Haikou, Hainan Province, People's Republic of China
| | - Zhangli Lin
- Inspection Department of People's Hospital of Li Miao Autonomous County, Qiongzhong, Hainan Province, People's Republic of China
| | - Junjie Hu
- Central Laboratory, Hainan General Hospital, Hainan Hospital Affiliated to The Hainan Medical College, Hainan Provincial Key Laboratory of Cell and Molecular Genetic Translational Medicine, Haikou, Hainan Province, People's Republic of China
| | - Shiping Chen
- BGI Genomics, BGI-Shenzhen, Shenzhen, Guangdong Province, People's Republic of China
| | - Shu Wen
- Inspection Department of People's Hospital of Li Miao Autonomous County, Qiongzhong, Hainan Province, People's Republic of China
| | - Aizhu Wu
- Central Laboratory, Hainan General Hospital, Hainan Hospital Affiliated to The Hainan Medical College, Hainan Provincial Key Laboratory of Cell and Molecular Genetic Translational Medicine, Haikou, Hainan Province, People's Republic of China
| | - Hong Wu
- Family Planning Service Center of Qiongzhong Li Miao Autonomous County, Qiongzhong, Hainan Province, People's Republic of China
| | - Jiali Huang
- Inspection Department of People's Hospital of Li Miao Autonomous County, Qiongzhong, Hainan Province, People's Republic of China
| | - Hanqiang Wang
- Inspection Department of People's Hospital of Li Miao Autonomous County, Qiongzhong, Hainan Province, People's Republic of China
| | - Jun Sun
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, Hebei Province, People's Republic of China.,Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, Hebei Province, People's Republic of China
| | - Zhiyu Peng
- BGI Genomics, BGI-Shenzhen, Shenzhen, Guangdong Province, People's Republic of China
| | - Yan Sun
- BGI Genomics, BGI-Shenzhen, Shenzhen, Guangdong Province, People's Republic of China
| | - Shengmiao Fu
- Central Laboratory, Hainan General Hospital, Hainan Hospital Affiliated to The Hainan Medical College, Hainan Provincial Key Laboratory of Cell and Molecular Genetic Translational Medicine, Haikou, Hainan Province, People's Republic of China
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Epidemiology of Thalassemia in Gulf Cooperation Council Countries: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1509501. [PMID: 33178817 PMCID: PMC7644312 DOI: 10.1155/2020/1509501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 01/11/2023]
Abstract
Background Thalassemia has a burden on the healthcare systems of many countries. About 56000 conceptions result in thalassemia, globally. Objective To assess the epidemiological profile of thalassemia in the Gulf Cooperation Council (GCC) countries. Methods A systematic search was conducted in MEDLINE/PubMed (National Library of Medicine), CINAHL, and Embase. Relevant observational studies reporting the epidemiology of thalassemia among the GCC population were selected. Data on the prevalence, frequency, and complications of thalassemia were extracted. The quality of the retrieved studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale. Results Eighteen studies (14 cross-sectional studies, two retrospective observational studies, and two retrospective analysis) with a total of 3343042 participants were included in this systematic review. Of the 18 studies, 11 studies were conducted in Saudi Arabia, two in the Kingdom of Bahrain, one in Kuwait, three in the United Arab Emirates (UAE), and one in Qatar. The prevalence of thalassemia among children below five years of age ranged from 0.25% to 33%, while it was 0.9% in children above five years and from 0.035% to 43.3% among adult thalassemia patients. The most-reported risk factors were consanguineous marriage and high-risk marriage. There was a lack of data regarding mortality rates in thalassemia. Conclusions Despite the premarital screening and genetic counseling (PMSGC) program for thalassemia, the incidence of high-risk couple marriages in GCC countries cannot be effectively diminished. This study suggested that the PMSGC program should adopt more attention for the high-risk areas, to enhance the level of consciousness about the hemoglobinopathy diseases and the consequences of consanguinity among the at-risk couple.
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Patient- and Caregiver-Reported Burden of Transfusion-Dependent β-Thalassemia Measured Using a Digital Application. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:197-208. [PMID: 33123986 PMCID: PMC7884594 DOI: 10.1007/s40271-020-00473-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
Background and Objective Transfusion-dependent β-thalassemia (TDT) is a rare genetic disease characterized by a deficiency of functional β-globin, ultimately leading to lifelong dependence on blood transfusions. There is little patient- and caregiver-reported data with which to understand the holistic and societal impact of TDT. The objective of this study was to evaluate the patient- and caregiver-reported disease-management, symptom, and quality-of-life burden of TDT. Methods We conducted a prospective, observational, real-world study of adults with TDT and caregivers of adolescents with TDT, in Italy, the UK, and the USA. Over 90 days, participants used a smartphone application to respond to surveys about their or their dependent’s TDT, including bespoke background and disease-management surveys, the Brief Fatigue Inventory (BFI), the Transfusion-dependent Quality of life questionnaire (TranQol), and the Brief Pain Inventory Short Form (BPI-SF). Results Eighty-five individuals participated. Mean BFI and TranQol scores on enrollment were 5.0 (0–10 scale; 10 = worst symptoms) and 51 (0–100 scale; 100 = best quality of life), respectively. Mean transfusion frequency was every 3.2 weeks. Mean time spent on TDT management was 592 min on transfusion days and 91 min on non-transfusion days (11 h per week). Mean BFI and BPI-SF “worst fatigue” and “worst pain” scores were higher in the 5 days pre-transfusion than in the 5 days post-transfusion (fatigue 5.05 vs 4.29; pain 4.33 vs 3.85; 0–10 scale; 10 = worst symptoms). Conclusions The patient- and caregiver-reported burden of TDT is high, influenced by disease-management time, fatigue, pain, and quality-of-life impairment. Electronic supplementary material The online version of this article (10.1007/s40271-020-00473-0) contains supplementary material, which is available to authorized users.
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18
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Abstract
β-thalassemia is caused by mutations in the β-globin gene which diminishes or abolishes β-globin chain production. This reduction causes an imbalance of the α/β-globin chain ratio and contributes to the pathogenesis of the disease. Several approaches to reduce the imbalance of the α/β ratio using several nucleic acid-based technologies such as RNAi, lentiviral mediated gene therapy, splice switching oligonucleotides (SSOs) and gene editing technology have been investigated extensively. These approaches aim to reduce excess free α-globin, either by reducing the α-globin chain, restoring β-globin expression and reactivating γ-globin expression, leading a reduced disease severity, treatment necessity, treatment interval, and disease complications, thus, increasing the life quality of the patients and alleviating economic burden. Therefore, nucleic acid-based therapy might become a potential targeted therapy for β-thalassemia.
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Affiliation(s)
- Annette d'Arqom
- Graduate Program in Molecular Medicine, Faculty of Science, Mahidol University, Bangkok, Thailand.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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19
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Xu X, Wu G, Liu Y, Zhang L. Effects of propofol on hippocampal neuron viability. Childs Nerv Syst 2020; 36:1995-2002. [PMID: 32179983 DOI: 10.1007/s00381-020-04548-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE In this study, we investigated the effects of different concentration of propofol on cell viability of hippocampal neurons and explored the possible mechanism. PATIENTS AND METHODS Primary hippocampal neurons were cultured in vitro and treated with different concentration of propofol. MTT was used to examine the survival of neurons. Flow cytometry was used to detect the neuronal apoptosis. Western-blot analysis was used to examine the expression level of p-p38MAPK and p38MAPK. RESULTS We found that low concentration propofol (0.5 μM and 1 μM) promoted the cell survival rate; however, high concentration of propofol (10 μM,50 μM,100 μM,150 μM, and 200 μM) decreased the cell survival rate (P < 0.05). Flow cytometry showed that the neuronal apoptosis rate was decreased in 1 μM propofol group (P < 0.05), but was significantly higher in10μM, 100 μM and 200 μM groups in a concentration-dependent manner (P < 0.05 or P < 0.01). Western blot revealed that the propofol induced the phosphorylation of p38MAPK concentration-dependently and time-dependently. SB203580, one inhibitor of p38MAPK, increased the cell survival rate and decreased the cell apoptosis induced by high concentration of propofol. CONCLUSION Low concentration of propofol improved the survival rate of neurons, while high concentration of propofol promoted the cell apoptosis and decreased the cell viability. p38MAPK pathway is involved the effect of high concentration of propofol promoted on primary hippocampal neurons viability and apoptosis.
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Affiliation(s)
- Xiaodong Xu
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Guohua Wu
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Yong Liu
- Deparment of Neurology, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu District, Chengdu, 610500, People's Republic of China
| | - Liangcheng Zhang
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Gulou District, Fuzhou, 350001, People's Republic of China.
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20
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Reed-Embleton H, Arambepola S, Dixon S, Maldonado BN, Premawardhena A, Arambepola M, Khan JAM, Allen S. A cost-of-illness analysis of β-Thalassaemia major in children in Sri Lanka - experience from a tertiary level teaching hospital. BMC Pediatr 2020; 20:257. [PMID: 32460774 PMCID: PMC7251920 DOI: 10.1186/s12887-020-02160-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Sri Lanka has a high prevalence of β-thalassaemia major. Clinical management is complex and long-term and includes regular blood transfusion and iron chelation therapy. The economic burden of β-thalassaemia for the Sri Lankan healthcare system and households is currently unknown. Methods A prevalence-based, cost-of-illness study was conducted on the Thalassaemia Unit, Department of Paediatrics, Kandy Teaching Hospital, Sri Lanka. Data were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel. Results Thirty-four children aged 2–17 years with transfusion dependent thalassaemia major and their parent/guardian were included in the study. The total average cost per patient year to the hospital was $US 2601 of which $US 2092 were direct costs and $US 509 were overhead costs. Mean household expenditure was $US 206 per year with food and transport per transfusion ($US 7.57 and $US 4.26 respectively) being the highest cost items. Nine (26.5%) families experienced catastrophic levels of healthcare expenditure (> 10% of income) in the care of their affected child. The poorest households were the most likely to experience such levels of expenditure. Conclusions β-thalassaemia major poses a significant economic burden on health services and the families of affected children in Sri Lanka. Greater support is needed for the high proportion of families that suffer catastrophic out-of-pocket costs.
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Affiliation(s)
| | | | | | | | - Anuja Premawardhena
- Hemal's Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. .,Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | | | | | - Stephen Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
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21
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Pornprasert S, Surajinda S, Pongpunyayuen P, Punyamung M, Ruengdit C, Intasai N. Proficiency Testing Program for Hb E ( HBB: c.79G>A) Screening in Thailand Using Lyophilized Hb E Control Materials. Hemoglobin 2020; 44:82-85. [DOI: 10.1080/03630269.2020.1734612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sirithorn Surajinda
- Associated Medical Sciences-Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Panida Pongpunyayuen
- Associated Medical Sciences-Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Manoo Punyamung
- Associated Medical Sciences-Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Chedtapak Ruengdit
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Nutjeera Intasai
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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22
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Cai W, Xiong Q, Tong J, Dai X, Zhou B, Shen S, Hu X. Prevalence and genetic analysis of thalassemia in neonates in Wuhan area: a national megacity in central China. J Matern Fetal Neonatal Med 2019; 34:2240-2247. [PMID: 31505961 DOI: 10.1080/14767058.2019.1662780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Thalassemia is one of the most common genetic diseases in southern China. Accurate population frequency data regarding the occurrence and distribution of thalassemia is important for designing appropriate prevention strategies of thalassemia. OBJECTIVE The aim of this study is to reveal the prevalence and the mutation spectrum of thalassemia in neonates in the Wuhan region of central China. METHODS About 3796 neonates in Wuhan area of China were analyzed by hematological and genetic analysis. RESULTS About 2174 subjects were genetically diagnosed as thalassemia carriers or patients, including 1415 cases of α-thalassemia (65.89%), 731 cases of β-thalassemia (33.62%), and 28 cases of α-composite β-thalassemia (1.29%). A total of 11 genotypes and 6 gene mutations were identified in α-thalassemia anomalies, with -SEA/deletion (50.72%), -α3.7/deletion (36.36%), and -α4.2/deletion (7.38%) being the most common α-thalassemia mutations. β-thalassemia anomalies were associated with 17 genotypes and 12 gene mutations; IVS-2-654 mutation was the most common (41.18%), followed by CD41-42 (23.14%), CD17 (14.64%), CD26 (7.32%), and CD27-28 (4.58%) mutations. In addition, 13 genotypes were identified in α-composite β-thalassemia in thalassemia carrier, with the top six genotypes being IVS-2-654/N/-SEA/αα (17.86%), CD17/N/-α3.7/αα (17.86%), IVS-2-654/N/-α3.7/αα (14.29%), CD41-42/N/-SEA/αα (10.71%), CD71-72/N/-α3.7/αα (7.14%), and Cap/N/-SEA/αα (7.14%). CONCLUSION There was high heterogeneity and extensive spectrum of thalassemia in the neonates in Wuhan populations. The findings will be useful for genetic counseling and prenatal diagnosis of thalassemia in the Wuhan region.
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Affiliation(s)
- Wenqian Cai
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Qian Xiong
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Jing Tong
- Center of Reproduction Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Xiang Dai
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Bin Zhou
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Shanshan Shen
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Xijiang Hu
- Eugenic Genetics Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
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23
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Shangaris P, Loukogeorgakis SP, Subramaniam S, Flouri C, Jackson LH, Wang W, Blundell MP, Liu S, Eaton S, Bakhamis N, Ramachandra DL, Maghsoudlou P, Urbani L, Waddington SN, Eddaoudi A, Archer J, Antoniou MN, Stuckey DJ, Schmidt M, Thrasher AJ, Ryan TM, De Coppi P, David AL. In Utero Gene Therapy (IUGT) Using GLOBE Lentiviral Vector Phenotypically Corrects the Heterozygous Humanised Mouse Model and Its Progress Can Be Monitored Using MRI Techniques. Sci Rep 2019; 9:11592. [PMID: 31406195 PMCID: PMC6690943 DOI: 10.1038/s41598-019-48078-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
In utero gene therapy (IUGT) to the fetal hematopoietic compartment could be used to treat congenital blood disorders such as β-thalassemia. A humanised mouse model of β-thalassemia was used, in which heterozygous animals are anaemic with splenomegaly and extramedullary hematopoiesis. Intrahepatic in utero injections of a β globin-expressing lentiviral vector (GLOBE), were performed in fetuses at E13.5 of gestation. We analysed animals at 12 and 32 weeks of age, for vector copy number in bone marrow, peripheral blood liver and spleen and we performed integration site analysis. Compared to noninjected heterozygous animals IUGT normalised blood haemoglobin levels and spleen weight. Integration site analysis showed polyclonality. The left ventricular ejection fraction measured using magnetic resonance imaging (MRI) in treated heterozygous animals was similar to that of normal non-β-thalassemic mice but significantly higher than untreated heterozygous thalassemia mice suggesting that IUGT ameliorated poor cardiac function. GLOBE LV-mediated IUGT normalised the haematological and anatomical phenotype in a heterozygous humanised model of β-thalassemia.
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Affiliation(s)
- Panicos Shangaris
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK.
- UCL Institute of Child Health, UCL, London, United Kingdom.
| | | | | | - Christina Flouri
- Department of Medical and Molecular Genetics, KCL, London, United Kingdom
| | | | - Wei Wang
- Department of Translational Oncology, National Centre for Tumour Diseases, Heidelberg, Germany
| | | | - Shanrun Liu
- Biochemistry and Molecular Genetics, UAB, Birmingham, Alabama, United States
| | - Simon Eaton
- UCL Institute of Child Health, UCL, London, United Kingdom
| | - Nahla Bakhamis
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK
| | | | | | - Luca Urbani
- UCL Institute of Child Health, UCL, London, United Kingdom
| | - Simon N Waddington
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ayad Eddaoudi
- UCL Institute of Child Health, UCL, London, United Kingdom
| | - Joy Archer
- Central Diagnostic Services, Queen's Vet School Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, KCL, London, United Kingdom
| | - Daniel J Stuckey
- Centre for Advanced Biomedical Imaging, UCL, London, United Kingdom
| | - Manfred Schmidt
- Department of Translational Oncology, National Centre for Tumour Diseases, Heidelberg, Germany
| | | | - Thomas M Ryan
- Biochemistry and Molecular Genetics, UAB, Birmingham, Alabama, United States
| | - Paolo De Coppi
- UCL Institute of Child Health, UCL, London, United Kingdom
| | - Anna L David
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK
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24
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Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in β-thalassemia. Blood Rev 2019; 37:100588. [PMID: 31324412 DOI: 10.1016/j.blre.2019.100588] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 01/28/2023]
Abstract
Patients with β-thalassemia major (BTM) require regular blood transfusions, supported by appropriate iron chelation therapy (ICT), throughout their life. β-thalassemia is a global disease that is most highly prevalent in Southeast Asia, Africa, and Mediterranean countries. However, the global distribution of patients with β-thalassemia is changing due to population migration, and Northern European countries now have significant thalassemia populations. Globally, many patients with BTM have limited access to regular and safe blood transfusions. A lack of voluntary nonremunerated blood donors, poor awareness of thalassemia, a lack of national blood policies, and fragmented blood services contribute to a significant gap between the timely supply of, and demand for, safe blood. In many centers, there is inadequate provision of antigen testing, even for common red cell antigens such as CcEe and Kell. Policies to raise awareness and increase the use of red blood cell antigen testing and requesting of compatible blood in transfusion centers are needed to reduce alloimmunization (the development of antibodies to red blood cell antigens), which limits the effectiveness of transfusions and the potential availability of blood. Patients with BTM are also at risk of transfusion-transmitted infections unless appropriate blood screening and safety practices are in place. Hence, many patients are not transfused or are undertransfused, resulting in decreased health and quality-of-life outcomes. Hemovigilance, leukoreduction, and the ability to thoroughly investigate transfusion reactions are often lacking, especially in resource-poor countries. ICT is essential to prevent cardiac failure and other complications due to iron accumulation. Despite the availability of potentially inexpensive oral ICT, a high proportion of patients suffer complications of iron overload and die each year due to a lack of, or inadequate, ICT. Increased awareness, training, and resources are required to improve and standardize adequate blood transfusion services and ICT among the worldwide population of patients with BTM. ICT needs to be available, affordable, and correctly prescribed. Effective, safe, and affordable new treatments that reduce the blood transfusion burden in patients with β-thalassemia remain an unmet need.
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Affiliation(s)
| | - Farzana Sayani
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Sara Trompeter
- University College London Hospitals, NHS Foundation Trust, London, UK; NHS Blood and Transplant, Bristol, UK.
| | - Emma Drasar
- Whittington Health NHS Trust, London, UK; University College London Hospitals, NHS Foundation Trust, London, UK.
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25
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Agarwal RK, Sedai A, Ankita K, Parmar L, Dhanya R, Dhimal S, Sriniwas R, Gowda A, Gujjal P, H P, Jain S, Ramaiah JD, Jali S, Tallur NR, Ramprakash S, Faulkner L. Information Technology-Assisted Treatment Planning and Performance Assessment for Severe Thalassemia Care in Low- and Middle-Income Countries: Observational Study. JMIR Med Inform 2019; 7:e9291. [PMID: 30672740 PMCID: PMC6364210 DOI: 10.2196/medinform.9291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.
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Affiliation(s)
- Rajat Kumar Agarwal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Amit Sedai
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Kumari Ankita
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Lalith Parmar
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | | | - Sunil Dhimal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India
| | | | - Ashwini Gowda
- Project Samraksha, Rashtrotthana Parishat, Bangalore, India
| | - Pooja Gujjal
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Pushpa H
- Sankalp India Foundation, Bangalore, India.,Indira Gandhi Institute of Child Health, Bangalore, India
| | - Suman Jain
- Thalassemia and Sickle Cell Society, Hyderabad, India
| | | | - Sujata Jali
- Jawaharlal Nehru Medical College, Belgaum, India
| | | | - Stalin Ramprakash
- Sankalp-People Tree Centre for Pediatric Bone Marrow Transplant, People Tree Hospitals, Bangalore, India
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India.,Cure2Children Foundation, Florence, Italy
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26
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He S, Qin Q, Lin L, Zuo Y, Chen Q, Wei H, Zheng C, Chen B, Qiu X. First Identification of the 3.5 kb Deletion (NC_000011.10: g.5224302-5227791del3490bp) on the β-Globin Gene Cluster in a Chinese Family. Hemoglobin 2019; 42:272-275. [PMID: 30612499 DOI: 10.1080/03630269.2018.1531018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sheng He
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Qian Qin
- Prenatal Diagnostic Centre, Baise Women and Children Care Hospital, Baise, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Li Lin
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Yangjin Zuo
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Qiuli Chen
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Honghwei Wei
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Chenguang Zheng
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Biyan Chen
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
| | - Xiaoxia Qiu
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China
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27
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Yeh AC, Khan MA, Harlow J, Biswas AR, Akter M, Ferdous J, Ara T, Islam M, Caron M, Barron AM, Moran J, Brezina M, Nazneen H, Kamruzzaman M, Saha A, Marshall A, Afrose S, Stowell C, Preffer F, Bangsberg D, Goodman A, Attar E, McAfee S, Spitzer TR, Dey BR. Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh. J Glob Oncol 2018; 4:1-10. [PMID: 30241180 PMCID: PMC6223381 DOI: 10.1200/jgo.2016.006460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Treatment of malignant and nonmalignant hematologic diseases with hematopoietic stem-cell transplantation (HSCT) was first described almost 60 years ago, and its use has expanded significantly over the last 20 years. Whereas HSCT has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and health care provider training that are required to provide such a service have prohibited it from being widely adopted, particularly in developing countries. METHODS Over the past two decades, however, efforts to bring HSCT to the developing world have increased, and several institutions have described their efforts to establish such a program. We aim to provide an overview of the current challenges and applications of HSCT in developing countries as well as to describe our experience in developing an HSCT program at Dhaka Medical College and Hospital in Bangladesh via a partnership with health care providers at Massachusetts General Hospital. RESULTS AND CONCLUSION We discuss key steps of the program, including the formation of a collaborative partnership, infrastructure development, human resource capacity building, and financial considerations.
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Affiliation(s)
- Albert C Yeh
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mohiuddin A Khan
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jason Harlow
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Akhil R Biswas
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mafruha Akter
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jannatul Ferdous
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Tasneem Ara
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Manirul Islam
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Martin Caron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anne-Marie Barron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jenna Moran
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mark Brezina
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Humayra Nazneen
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Md Kamruzzaman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anup Saha
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Ariela Marshall
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Salma Afrose
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Christopher Stowell
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Frederic Preffer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - David Bangsberg
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Annekathryn Goodman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Eyal Attar
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Steven McAfee
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Thomas R Spitzer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Bimalangshu R Dey
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
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Sii-Felice K, Giorgi M, Leboulch P, Payen E. Hemoglobin disorders: lentiviral gene therapy in the starting blocks to enter clinical practice. Exp Hematol 2018; 64:12-32. [PMID: 29807062 DOI: 10.1016/j.exphem.2018.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 01/19/2023]
Abstract
The β-hemoglobinopathies, transfusion-dependent β-thalassemia and sickle cell disease, are the most prevalent inherited disorders worldwide and affect millions of people. Many of these patients have a shortened life expectancy and suffer from severe morbidity despite supportive therapies, which impose an enormous financial burden to societies. The only available curative therapy is allogeneic hematopoietic stem cell transplantation, although most patients do not have an HLA-matched sibling donor, and those who do still risk life-threatening complications. Therefore, gene therapy by one-time ex vivo modification of hematopoietic stem cells followed by autologous engraftment is an attractive new therapeutic modality. The first proof-of-principle of conversion to transfusion independence by means of a lentiviral vector expressing a marked and anti-sickling βT87Q-globin gene variant was reported a decade ago in a patient with transfusion-dependent β-thalassemia. In follow-up multicenter Phase II trials with an essentially identical vector (termed LentiGlobin BB305) and protocol, 12 of the 13 patients with a non-β0/β0 genotype, representing more than half of all transfusion-dependent β-thalassemia cases worldwide, stopped red blood cell transfusions with total hemoglobin levels in blood approaching normal values. Correction of biological markers of dyserythropoiesis was achieved in evaluated patients. In nine patients with β0/β0 transfusion-dependent β-thalassemia or equivalent severity (βIVS1-110), median annualized transfusion volume decreased by 73% and red blood cell transfusions were stopped in three patients. Proof-of-principle of therapeutic efficacy in the first patient with sickle cell disease was also reported with LentiGlobin BB305. Encouraging results were presented in children with transfusion-dependent β-thalassemia in another trial with the GLOBE lentiviral vector and several other gene therapy trials are currently open for both transfusion-dependent β-thalassemia and sickle cell disease. Phase III trials are now under way and should help to determine benefit/risk/cost ratios to move gene therapy toward clinical practice.
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Affiliation(s)
- Karine Sii-Felice
- UMR E007, Service of Innovative Therapies, Institute of Biology François Jacob and University Paris Saclay, CEA Paris Saclay, Fontenay-aux-Roses, France
| | - Marie Giorgi
- UMR E007, Service of Innovative Therapies, Institute of Biology François Jacob and University Paris Saclay, CEA Paris Saclay, Fontenay-aux-Roses, France
| | - Philippe Leboulch
- UMR E007, Service of Innovative Therapies, Institute of Biology François Jacob and University Paris Saclay, CEA Paris Saclay, Fontenay-aux-Roses, France; Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Emmanuel Payen
- UMR E007, Service of Innovative Therapies, Institute of Biology François Jacob and University Paris Saclay, CEA Paris Saclay, Fontenay-aux-Roses, France; INSERM, Paris, France.
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Suwannakhon N, Pongsawatkul K, Seeratanachot T, Mahingsa K, Pingyod A, Bumrungpakdee W, Sanguansermsri T. The shortcut strategy for beta thalassemia prevention. Hematol Rep 2018; 10:7530. [PMID: 30046413 PMCID: PMC6036980 DOI: 10.4081/hr.2018.7530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
We propose antenatal blood tests using high-resolution DNA melting (HRM) analysis for beta thalassemia mutation detection after hemoglobin A2 estimation as a modified strategy for the identification of beta thalassemia at-risk couples. Antenatal blood samples of 1,115 couples were transferred from the antenatal care clinic. Hemoglobin A2 was quantified, and proportions ≥3.5% were further assessed for beta thalassemia mutation using HRM analysis. Twelve types of beta thalassemia mutations, including hemoglobin E, were identified. There were 23 couples who were detected as at-risk. All at-risk couples were identified within 7 working days after sample receipt. Prenatal diagnosis revealed 6 affected fetuses. One fetus was homozygous CD17 (AT), and five fetuses exhibited beta0 – thalassemia/hemoglobin E disease. These results were consistent with the outcomes calculated using the Hardy-Weinberg equation. Antenatal blood tests for mutation detection using high-resolution DNA melting analysis after hemoglobin A2 estimation is a feasible laboratory method for the recruitment of couples with a fetus that is at risk for beta thalassemia. This modified strategy is cost-effective and may be beneficial for use in a beta thalassemia prevention program.
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Abstract
Available and flexible choice of methods for screening and detecting β-thalassemia (β-thal) can promote control of thalassemia in developing countries. In this study, two methods, the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and reverse dot-blot hybridization assays were developed to detect common β-thal mutations in 244 thalassemia patients and 152 healthy people in North Vietnam. The most common mutation was codon 26 (G>A), also known as Hb E (HBB: c.79G>A), accounting for 26.4% of the total studied chromosomes, followed by codons 41/42 (-TCTT) (HBB: c.126_129delCTTT) and codon 17 (A>T) (HBB: c.c.52A>T), accounting for 19.4 and 16.4%, respectively. In addition, codon 95 (+A) (HBB: c.c.287_288insA) that is known as the Vietnamese mutation, accounted for 0.6%. Moreover, the heterozygous state of the four mutations was also found in healthy people, of which Hb E was again the most common mutation with a frequency 3.0%. The results of this study provide available methods and indicative data for preventive and control strategies concerning the genetic diagnosis of thalassemia.
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Affiliation(s)
- Lan Thi Thuong Vo
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
| | - Trang Thu Nguyen
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
| | - Hai Xuan Le
- b National Institute of Hematology and Blood Transfusion , Cau Giay , Hanoi , Vietnam
| | - Ha Thi Thu Le
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
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Socio-demographic Profile and Economic Burden of Treatment of Transfusion Dependent Thalassemia. Indian J Pediatr 2018; 85:102-107. [PMID: 29119463 DOI: 10.1007/s12098-017-2478-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compile the socio-demographic profile and estimate the economic burden of transfusion dependent thalassemia. METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in north India. Transfusion dependent thalassemia patients on regular blood transfusion for at least a year were selected. Thalassemia diagnosis was based on HPLC and/or mutation analysis results. Clinical and laboratory parameters were collected from electronic health records. Information regarding socio-economic profile and costs incurred, including indirect costs were collected by interviewing patients' guardians. The data was analyzed as a whole cohort and also in subgroups based on age. RESULTS The data of 261 patients with a median age of 127 mo was collected. The median age at diagnosis was 9.8 mo. The total treatment expenses of a patient per year ranged from US$ 629 (INR 41,514) to US$ 2300 (INR 151,800), in the different age groups, at an average of US$ 1135 (INR 74,948). More than half (53%) of this was spent on medications. On an average, 38.8% of the family income was spent on the treatment of a thalassemia patient annually. Only 19 of 262 cases had an average pre-BT Hb ≥ 9 g/dl and serum ferritin ≤1500 ng/dl. CONCLUSIONS The treatment for transfusion dependent thalassemia is costly and mostly borne by the families in India. This study provides a realistic magnitude of this burden and will be useful in planning a thalassemia management program at the state or national level.
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Parmar L, Sedai A, Ankita K, Dhanya R, Agarwal RK, Dhimal S, Shriniwas R, Iyer HV, Gowda A, Gujjal P, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Jali S, Tallur NR, Ramprakash S, Faulkner L. Can inequity in healthcare be bridged in LMICs – Multicentre experience from thalassemia day care centres in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ravangard R, Mirzaei Z, Keshavarz K, Haghpanah S, Karimi M. Blood transfusion versus hydroxyurea in beta-thalassemia in Iran: a cost-effectiveness study. ACTA ACUST UNITED AC 2017; 23:417-422. [PMID: 29157136 DOI: 10.1080/10245332.2017.1404262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Thalassemia intermedia is a type of anemia which has several treatments modalities. We aimed to study the cost effectiveness of two treatments, including blood transfusion and hydroxyurea, in patients with beta-thalassemia intermedia in south of Iran referred to a referral center affiliated to Iran, Shiraz University of Medical Sciences in 2015. MATERIALS AND METHODS This was a cost-effectiveness study which was conducted on 122 patients with beta-thalassemia intermedia. The indicator of effectiveness in this study was the reduction of growth disorder (normal BMI). Data analysis was done using SPSS 21, Excel 2010 and Treeage 2011. Finally, the one-way sensitivity analysis was performed to determine the robustness of the results. RESULTS The average annual costs of blood transfusion and the use of hydroxyurea in 2015 were 20733.27 purchasing power parity (PPP)$ and 7040.29 PPP$, respectively. The effectiveness of blood transfusion was57.4% while in hydroxyurea group was 60.7%. CONCLUSION The results showed that the cost effectiveness of using hydroxyurea was more than that of blood transfusion. Therefore, it is recommended that the use of hydroxyurea in the treatment of patients with beta-thalassemia intermedia would become the first priority, and more basic and supplementary insurance coverage for treating such patients using hydroxyurea should be considered.
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Affiliation(s)
- Ramin Ravangard
- a Department of Health Services Management, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran.,b Health Human Resource Research Center, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Zahra Mirzaei
- a Department of Health Services Management, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran.,c Student Research Committee , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Khosro Keshavarz
- b Health Human Resource Research Center, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Sezaneh Haghpanah
- d Hematology Research Center , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mehran Karimi
- d Hematology Research Center , Shiraz University of Medical Sciences , Shiraz , Iran
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Pienthai N, Pornprasert S. Lyophilized hemoglobin E control material for the dichlorophenol-indophenol (DCIP) test. Clin Chem Lab Med 2017; 55:e108-e109. [PMID: 27718483 DOI: 10.1515/cclm-2016-0652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Nattasit Pienthai
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai
| | - Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai
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ATG vs thiotepa with busulfan and cyclophosphamide in matched-related bone marrow transplantation for thalassemia. Blood Adv 2017; 1:792-801. [PMID: 29296723 DOI: 10.1182/bloodadvances.2016004119] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/15/2017] [Indexed: 01/19/2023] Open
Abstract
Matched-related bone marrow transplantation (BMT) may cure >80% of low-risk children with severe thalassemia (ST). Very long-term follow-up studies have shown how the standard busulfan-cyclophosphamide (BuCy) regimen may be associated with normalization of health-related quality of life, no second malignancies in the absence of chronic graft-versus-host disease, and fertility preservation in many patients. However, because BuCy may be associated with high rejection rates, some centers incorporate thiotepa (Tt) in busulfan- or treosulfan-based regimens, a combination that may increase the risk of permanent infertility. This study retrospectively compares matched-related BMT outcomes in 2 groups of low-risk ST patients conditioned with either Tt or anti-thymocyte globulin (ATG) in addition to BuCy. A total of 81 consecutive first BMTs were performed in 5 collaborating startup BMT centers in the Indian subcontinent between January 2009 and January 2016; 30 patients were transplanted after conditioning with Tt-BuCy between January 2009 and July 2013, whereas between August 2013 and January 2016, 51 patients received ATG-BuCy. All patients were <15 years and had no hepatomegaly (liver ≤2 cm from costal margin). Actuarial overall survival in the Tt-BuCy and ATG-BuCy groups was 87% and 94% and thalassemia-free survival was 80% and 85% at a median follow-up of 37 and 17 months, respectively, with no significant differences by log-rank statistics. Substituting Tt with ATG in the standard BuCy context seems safe and effective and may decrease transplant-related mortality. Higher fertility rates are expected for patients who received ATG-BuCy.
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Rezaei S, Karami Matin B, Hajizadeh M. Comment on: "Economic Burden of Thalassemia Major in Iran, 2015". J Res Health Sci 2016; 16:233-234. [PMID: 28087858 PMCID: PMC7189930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Satar Rezaei
- a Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Behzad Karami Matin
- a Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mohammad Hajizadeh
- b School of Health Administration, Faculty of Health Professions, Dalhousie University, Halifax, Canada
,Correspondence to: Mohammad Hajizadeh (PhD) E-mail:
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Economic Burden of Thalassemia Major in Iran, 2015. J Res Health Sci 2016; 16:111-115. [PMID: 27840337 PMCID: PMC7191027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Major Thalassemia is an autosomal recessive disease with complications, mortality and serious pathology. Today, the life expectancy of patients with major thalassemia has increased along with therapeutic advances. Therefore, they need lifelong care, and caring for them would incur many costs. Being aware of the patients' costs can be effective for controlling and managing the costs and providing efficient treatments for the care of patients. Hence, this study was conducted to estimate the economic burden of the patients with major thalassemia. METHODS Totally, 198 patients with major thalassemia were randomly selected from among the patients with major thalassemia in Tehran, Iran in 2015. The economic burden of the patients was estimated from a social perspective and through a bottom-up, prevalence-based approach. RESULTS The average annual cost per patient was estimated $ 8321.8 regardless of the cost of lost welfare. Of this amount, $ 7286.8 was related to direct medical costs, $ 461.4 to direct non-medical costs, and $ 573.5 to indirect costs. In addition, the annual cost per patient was estimated $ 1360.5 due to the distress caused by the disease CONCLUSIONS: Considering the high costs of the treatment of patients with major thalassemia, adopting new policies to reduce the costs that patients have to pay seems necessary. In addition, making new decisions regarding thalassemia screening, even with higher costs than the usual screening costs, can be useful since the costs of treatment are high.
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Tang W, Zhang C, Lu F, Tang J, Lu Y, Cui X, Qin X, Li S. Spectrum of α-thalassemia and β-thalassemia mutations in the Guilin Region of southern China. Clin Biochem 2015; 48:1068-72. [DOI: 10.1016/j.clinbiochem.2015.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/26/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
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High prevalence of thalassemia in migrant populations in Guangdong Province, China. BMC Public Health 2014; 14:905. [PMID: 25183384 PMCID: PMC4161880 DOI: 10.1186/1471-2458-14-905] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/26/2014] [Indexed: 12/02/2022] Open
Abstract
Background The objectives of this study were to estimate the prevalence of thalassemia and to analyze the need for public health services for migrant populations in different cities in Guangdong Province, China. Methods A cross-sectional survey was conducted in 21 cities of Guangdong Province. Twenty-three types of a- and β-globin gene mutations were detected in a total of 14,230 pregnant women and 14,249 husbands. Results There was a 16.45% prevalence of thalassemia among the 28,479 individuals, and the prevalences of α-, β-, and combined α-/β- thalassemia were 12.03%, 3.80%, and 0.63%, respectively. Compared with the native city residents in the province, the migrants from within the province and the immigrants from outside the province had lower prevalences of thalassemia, but the prevalence values were >11%. Conclusions The prevalence values for thalassemia gene mutations were high in all three population groups studied in Guangdong Province. The results indicate that all segments of the Guangdong population should be screened for thalassemia.
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Ladis V, Karagiorga-Lagana M, Tsatra I, Chouliaras G. Thirty-year experience in preventing haemoglobinopathies in Greece: achievements and potentials for optimisation. Eur J Haematol 2013; 90:313-22. [DOI: 10.1111/ejh.12076] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
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Sruamsiri R, Chaiyakunapruk N, Pakakasama S, Sirireung S, Sripaiboonkij N, Bunworasate U, Hongeng S. Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program. BMC Health Serv Res 2013; 13:45. [PMID: 23379888 PMCID: PMC3583808 DOI: 10.1186/1472-6963-13-45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 01/22/2013] [Indexed: 11/11/2022] Open
Abstract
Background Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT) has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for adolescent and young adult with severe thalassemia in Thailand. Methods A Markov model was used to estimate the relevant costs and health outcomes over the patients’ lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in US ($) per QALY gained. One-way and probabilistic sensitivity analyses (PSA) were conducted to investigate the effect of parameter uncertainty. Results In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $ 3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita), approximately US $ 4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. Conclusion At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT.
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Affiliation(s)
- Rosarin Sruamsiri
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Geographical variations in current clinical practice on transfusions and iron chelation therapy across various transfusion-dependent anaemias. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 11:108-22. [PMID: 22871821 DOI: 10.2450/2012.0012-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/14/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Many patients with chronic anaemia require blood transfusions as part of their treatment regimen. As a result, iron overload will inevitably develop if not adequately managed by iron chelation therapy. There are many guidelines relating to transfusion and chelation practices for patients with transfusion-dependent anaemia; however, there is a lack of information on how treatment practices differ around the world. The objective of this manuscript is to highlight key features of current transfusion and chelation management, including similarities and differences across various anaemias and between geographical regions worldwide. MATERIALS AND METHODS Data collected at study entry to the multicentre Evaluation of Patients' Iron Chelation with Exjade (EPIC) study, which recruited 1,744 patients with a variety of transfusion-dependent anaemias across 23 countries from three geographic regions, were assessed. These analyses compared transfusion and chelation treatment prior to the start of study treatment, together with iron burden assessed at study entry by serum ferritin, liver iron concentration and labile plasma iron levels. RESULTS AND CONCLUSIONS Data show that transfusion and iron chelation practices differ between anaemias and between geographical regions; this may be linked to availability and accessibility of transfusion and chelation therapy, patients' compliance, physicians' attitudes, costs and use of treatment guidelines. Approximately 60% of these transfusion-dependent patients were severely iron overloaded with a serum ferritin level over 2,500 ng/mL, indicating that the risks of iron burden may have been underestimated and current iron chelation therapy, if considered, may not have been adequate to control iron burden.
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Sivalingam M, Looi ML, Zakaria SZS, Hamidah NH, Alias H, Latiff ZA, Ibrahim H, Jamal R. Molecular study and genotype/phenotype correlation of β Thalassemia in Malaysia. Int J Lab Hematol 2012; 34:377-82. [PMID: 22335963 DOI: 10.1111/j.1751-553x.2012.01405.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To study the ß-gene mutations spectrum, the genotype/phenotype correlation, the modulatory effect of co-inherited factors such as α-gene mutations and of Xmn1 polymorphism in a large cohort of Malaysian patients. METHODS A total of 264 cases clinically diagnosed as Thalassemia major (TM) (111), Thalassemia intermedia (21), HbE-β Thalassemia (131), and 1 HbE homozygous were studied. The detection of α and ß gene mutations and characterization of Xmn1 polymorphism were performed by multiplex PCR, amplification refractory mutation system (ARMS), DNA sequencing, and restriction fragment length polymorphism (RFLP)-PCR. RESULTS A total of 19 ß Thalassemia mutations were characterized. CD26 and CD41/42 were the most common found in the Malay and Chinese population, respectively. The sensitivity of the clinical diagnosis for β TM, thalassemia intermedia, and HbE/β thalassemia was 94.0%, 15.2%, and 89.2%, respectively. Patients with Xmn1 heterozygosity [+/-] required less frequent transfusion compared with those without the polymorphism. Co-inheritance of α-thalassemia alleviates the severity of HbE-β thalassemia in our cohort. CONCLUSION Molecular analysis should be used for a better diagnosis and management of β thalassemia.
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Affiliation(s)
- M Sivalingam
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Cheras, Malaysia
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Luangasanatip N, Chaiyakunapruk N, Upakdee N, Wong P. Iron-chelating therapies in a transfusion-dependent thalassaemia population in Thailand: a cost-effectiveness study. Clin Drug Investig 2011; 31:493-505. [PMID: 21627338 DOI: 10.2165/11587120-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE β-Thalassaemia is a major public health problem in Thailand. Use of appropriate iron-chelating agents could prevent thalassaemia-related complications, which are costly to the healthcare system. This study aimed to evaluate the cost effectiveness of deferoxamine (DFO), deferiprone (DFP) and deferasirox (DFX) in Thai transfusion-dependent β-thalassaemia patients from the societal perspective. METHODS A Markov model was used to project the life-time costs and outcomes represented as quality-adjusted life-years (QALYs). Data on the clinical efficacy and safety of all therapeutic options were obtained from a systematic review and clinical trials. Transition probabilities were derived from published studies. Costs were obtained from the Thai Drug and Medical Supply Information Center, Thai national reimbursement rate information and other Thai literature sources. A discount rate of 3% was used. Incremental cost-effectiveness ratios (ICERs) were presented as year 2009 values. A base-case analysis was performed for thalassaemia patients requiring regular blood transfusion therapy, while a separate analysis was performed for patients requiring low (i.e. symptom-dependent, less frequent) blood transfusion therapy. A series of sensitivity analysis and cost-effectiveness acceptability curves were constructed. RESULTS Compared with DFO, using DFP was dominant with lifetime cost savings of $US91 117. Comparing DFX with DFO, the incremental cost was $US522 863 and incremental QALY was 5.77 with an ICER of $US90 648 per QALY. When compared with DFP, the ICER of DFX was $US106 445 per QALY. A cost-effectiveness analysis curve showed the probability of DFX being cost effective was 0% when compared with either DFO or DFP, based on the cost-effectiveness cut-off value of $US2902 per QALY. When compared with DFP, DFX was cost effective only if the DFX cost was as low as $US1.68 per 250 mg tablet. The results of the analysis in patients requiring low blood transfusion therapy were not different from those of the base-case analysis. CONCLUSIONS Our findings suggest that using DFP is cost saving when compared with conventional therapy, while using DFX is not cost effective compared with either DFO or DFP in Thai patients with transfusion-dependent β-thalassaemia. Policy-makers and clinicians may consider using such information in their decision-making process in Thailand.
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Affiliation(s)
- Nantasit Luangasanatip
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Pornprasert S, Sukunthamala K. SYTO9 and SYBR GREEN1 with a high-resolution melting analysis for prenatal diagnosis of β⁰-thalassemia/hemoglobin-E. Eur J Haematol 2010; 85:424-9. [PMID: 20722700 DOI: 10.1111/j.1600-0609.2010.01512.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The β⁰-thalassemia/Hb-E causes a wide range of severe conditions. A high medical cost is incurred in severe cases. Thus, the prevention of new cases of β⁰-thalassemia/Hb-E is required. The aim of this study is to use the SYTO9 and SYBR GREEN1 high-resolution melting (HRM) analysis for prenatal diagnosis of β⁰-thalassemia/Hb-E. DNA samples were extracted from amniotic fluid or cord blood of 11 pregnancies whose fetuses were at risk for β-thalassemia/Hb-E. PCR products from multiplex amplification refractory mutation system PCR for the detection of β⁰-thalassemia mutations at codons 17(A>T), 41/42(-TCTT), and 71/72(+A) and from amplification refractory mutation system PCR for the detection of Hb-E were characterized by SYTO9 HRM analysis. Moreover, β⁰-thalassemia 3.5- kb deletion was detected using real-time PCR with SYBR GREEN1 HRM analysis. Seven of 11 fetuses (64%) were diagnosed as β⁰-thalassemia/Hb-E (4 fetuses with mutation at codon 17, 2 with mutation at codon 41/42, and 1 with 3.5- kb deletion). Results from HRM analysis were completely consistent with those from fetal blood samplings analyzed at the time of delivery or pregnancy termination using HPLC. Therefore, the HRM analysis is easy to use. It is simple, flexible, non-destructive and has superb sensitivity and specificity. This approach might facilitate the laboratory diagnosis and genetic counseling for regions with a high prevalence of β⁰-thalassemia/Hb-E.
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