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Teigen D, Opoka RO, Kasirye P, Nabaggala C, Hume HA, Blomberg B, John CC, Ware RE, Robberstad B. Cost-Effectiveness of Hydroxyurea for Sickle Cell Anemia in a Low-Income African Setting: A Model-Based Evaluation of Two Dosing Regimens. PHARMACOECONOMICS 2023; 41:1603-1615. [PMID: 37462838 PMCID: PMC10635957 DOI: 10.1007/s40273-023-01294-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The disease burden of sickle cell anemia (SCA) in sub-Saharan African (SSA) countries is substantial, with many children dying without an established diagnosis or proper treatment. The global burden of SCA is increasing each year, making therapeutic intervention a high priority. Hydroxyurea is the only disease-modifying therapy with proven feasibility and efficacy suitable for SSA; however, no one has quantified the health economic implications of its use. Therefore, from the perspective of the health care provider, we estimated the incremental cost-effectiveness of hydroxyurea as a fixed-dose regimen or maximum tolerated dose (MTD) regimen, versus SCA care without hydroxyurea. METHODS We estimated the cost of providing outpatient treatment at a pediatric sickle cell clinic in Kampala, Uganda. These estimates were used in a discrete-event simulation model to project mean costs (2021 US$), disability-adjusted life years (DALYs), and consumption of blood products per patient (450 mL units), for patients between 9 months and 18 years of age. We calculated cost-effectiveness as the ratio of incremental costs over incremental DALYs averted, discounted at 3% annually. To test the robustness of our findings, and the impact of uncertainty, we conducted probabilistic and one-way sensitivity analyses, scenario analysis, and price threshold analyses. RESULTS Hydroxyurea treatment averted an expected 1.37 DALYs and saved US$ 191 per patient if administered at the MTD, compared with SCA care without hydroxyurea. In comparison, hydroxyurea at a fixed dose averted 0.80 DALYs per patient at an incremental cost of US$ 2. The MTD strategy saved 11.2 (95% CI 11.1-11.4) units of blood per patient, compared with 9.1 (95% CI 9.0-9.2) units of blood per patient at the fixed-dose alternative. CONCLUSIONS Hydroxyurea at MTD is likely to improve quality of life and reduce the consumption of blood products for children with SCA living in Uganda. Compared with a fixed dose regimen, treatment dosing at MTD is likely to be a cost-effective treatment for SCA, using realistic ranges of hydroxyurea costs that are relevant across SSA. Compared with no use of the drug, hydroxyurea could lead to substantial net savings per patient, while reducing the disease morbidity and mortality and increasing quality of life.
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Affiliation(s)
- David Teigen
- Health Economics, Leadership and Translational Ethics Research Group, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Phillip Kasirye
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Directorate of Paediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Catherine Nabaggala
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Heather A Hume
- Centre hospitalier universitaire Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- National Advisory Unit for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bjarne Robberstad
- Health Economics, Leadership and Translational Ethics Research Group, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
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Adigwe OP, Onoja SO, Onavbavba G. A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa. J Blood Med 2023; 14:367-376. [PMID: 37284610 PMCID: PMC10239624 DOI: 10.2147/jbm.s406196] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/21/2023] [Indexed: 06/08/2023] Open
Abstract
Sickle cell disease is caused by an abnormality of the β-globin gene and is characterised by sickling of the red blood cells. Globally, sub-Saharan African countries share the highest burden of the disease. This study aimed at critically reviewing studies focusing on challenges of sickle cell anaemia in sub-Saharan Africa. A literature search was carried out in five major databases. Articles that met the inclusion criteria were included in the bibliometric review and critical analysis. A majority of the studies were undertaken in the West African region (85.5%), followed by Central Africa (9.1%). Very few studies had been undertaken in East Africa (3.6%), whilst the Southern African region had the fewest studies (1.8%). Distribution in relation to country revealed that three quarters of the studies were carried out in Nigeria (74.5%), followed by the Democratic Republic of the Congo (9.1%). According to healthcare settings, a strong majority of the studies were undertaken in tertiary health care facilities (92.7%). Major themes that emerged from the review include interventions, cost of treatment, and knowledge about sickle cell disease. Public health awareness and promotion as well as improving the quality of sickle cell centers for prompt management of patients with sickle cell disorder was identified as a critical strategy towards reducing the burden of the disease in sub-Saharan Africa. To achieve this, governments in countries located in this region need to adopt a proactive strategy in addressing gaps that have been identified in this study, as well as instituting other relevant measures, such as continuous media engagement and public health interventions relating to genetic counselling. Reforms in other areas that can help reduce the disease burden, include training of practitioners and equipping sickle cell disease treatment centers according to World Health Organization specifications.
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Affiliation(s)
- Obi Peter Adigwe
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Solomon Oloche Onoja
- Department of Medical Laboratory Sciences, University of Nigeria, Enugu, Nigeria
| | - Godspower Onavbavba
- Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
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3
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Amarachukwu CN, Okoronkwo IL, Nweke MC, Ukwuoma MK. Economic burden and catastrophic cost among people living with sickle cell disease, attending a tertiary health institution in south-east zone, Nigeria. PLoS One 2022; 17:e0272491. [PMID: 35998131 PMCID: PMC9398014 DOI: 10.1371/journal.pone.0272491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Out-of-pocket spending and lack of adequate health policy support for people living with sickle cell disease in Nigeria may predispose to high economic burden and catastrophic cost. The objective of the study was to evaluate the economic burden and catastrophic cost of sickle cell disease patients in a Nigerian tertiary health institution. In this study, a cross-sectional descriptive survey design was used to study a sample of 149 sickle cell disease patients managed at University of Nigeria Teaching hospital Enugu, South east Nigeria. A structured pre-tested interviewer-administered questionnaire was used to collect primary data from adult participants and caregivers of paediatric patients. Data collection lasted for three months. The major findings were median monthly economic burden of approximately N76, 711 (US$385) per person. Of this, outpatient cost constituted approximately 88%. Admission, drugs and blood transfusion constitute the major contributors to the economic burden experienced by the sickle cell disease patients in the study. All socio-economic status groups suffered catastrophic expenditure but the poorest quartile had the highest incidence: 61% at 40% threshold, 71% at 30% threshold and at 88% at 10% threshold. Conclusion: economic burden was high for sickle cell disease patients who also suffered high catastrophic costs due to the impact of out-of-pocket expenditure. People living with sickle cell disease need financial protection especially for the poorest since they buy from the same market and incur same costs. Policy decision making to assist the sickle cell disease patients cope with cost of care is needful in Nigeria.
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Affiliation(s)
- C. N. Amarachukwu
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
- * E-mail:
| | - I. L. Okoronkwo
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - M. C. Nweke
- Department of Physiotherapy, School of Basic Medical Sciences, College of Medicine, University of Benin, Benin City, Nigeria
| | - M. K. Ukwuoma
- Department of Medical Rehabilitation, University of Nigeria, Enugu Campus, Enugu, Nigeria
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4
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Williams TN. Undernutrition: a major but potentially preventable cause of poor outcomes in children living with sickle cell disease in Africa. BMC Med 2021; 19:17. [PMID: 33446169 PMCID: PMC7809728 DOI: 10.1186/s12916-020-01892-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Thomas N Williams
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya.
- Faculty of Medicine, Imperial College, St Mary's Hospital, London, W21NY, UK.
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Uyoga S, Macharia AW, Mochamah G, Ndila CM, Nyutu G, Makale J, Tendwa M, Nyatichi E, Ojal J, Otiende M, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Maitland K, Scott JAG, Williams TN. The epidemiology of sickle cell disease in children recruited in infancy in Kilifi, Kenya: a prospective cohort study. Lancet Glob Health 2019; 7:e1458-e1466. [PMID: 31451441 PMCID: PMC7024980 DOI: 10.1016/s2214-109x(19)30328-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sickle cell disease is the most common severe monogenic disorder in humans. In Africa, 50-90% of children born with sickle cell disease die before they reach their fifth birthday. In this study, we aimed to describe the comparative incidence of specific clinical outcomes among children aged between birth and 5 years with and without sickle cell disease, who were resident within the Kilifi area of Kenya. METHODS This prospective cohort study was done on members of the Kilifi Genetic Birth Cohort Study (KGBCS) on the Indian Ocean coast of Kenya. Recruitment to the study was facilitated through the Kilifi Health and Demographic Surveillance System (KHDSS), which covers a resident population of 260 000 people, and was undertaken between Jan 1, 2006, and April 30, 2011. All children who were born within the KHDSS area and who were aged 3-12 months during the recruitment period were eligible for inclusion. Participants were tested for sickle cell disease and followed up for survival status and disease-specific admission to Kilifi County Hospital by passive surveillance until their fifth birthday. Children with sickle cell disease were offered confirmatory testing and care at a dedicated outpatient clinic. FINDINGS 15 737 infants were recruited successfully to the KGBCS, and 128 (0·8%) of these infants had sickle cell disease, of whom 70 (54·7%) enrolled at the outpatient clinic within 12 months of recruitment. Mortality was higher in children with sickle cell disease (58 per 1000 person-years of observation, 95% CI 40-86) than in those without sickle cell disease (2·4 per 1000 person-years of observation, 2·0-2·8; adjusted incidence rate ratio [IRR] 23·1, 95% CI 15·1-35·3). Among children with sickle cell disease, mortality was lower in those who enrolled at the clinic (adjusted IRR 0·26, 95% CI 0·11-0·62) and in those with higher levels of haemoglobin F (HbF; adjusted IRR 0·40, 0·17-0·94). The incidence of admission to hospital was also higher in children with sickle cell disease than in children without sickle cell disease (210 per 1000 person-years of observation, 95% CI 174-253, vs 43 per 1000 person-years of observation, 42-45; adjusted IRR 4·80, 95% CI 3·84-6·15). The most common reason for admission to hospital among those with sickle cell disease was severe anaemia (incidence 48 per 1000 person-years of observation, 95% CI 32-71). Admission to hospital was lower in those with a recruitment HbF level above the median (IRR 0·43, 95% CI 0·24-0·78; p=0·005) and those who were homozygous for α-thalassaemia (0·07, 0·01-0·83; p=0·035). INTERPRETATION Although morbidity and mortality were high in young children with sickle cell disease in this Kenyan cohort, both were reduced by early diagnosis and supportive care. The emphasis must now move towards early detection and prevention of long-term complications of sickle cell disease. FUNDING Wellcome Trust.
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Affiliation(s)
- Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | - John Ojal
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK; INDEPTH Network, Accra, Ghana
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene & Tropical Medicine, London, UK; INDEPTH Network, Accra, Ghana.
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Anie KA, Treadwell MJ, Grant AM, Dennis-Antwi JA, Asafo MK, Lamptey ME, Ojodu J, Yusuf C, Otaigbe A, Ohene-Frempong K. Community engagement to inform the development of a sickle cell counselor training and certification program in Ghana. J Community Genet 2016; 7:195-202. [PMID: 27090687 DOI: 10.1007/s12687-016-0267-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/10/2016] [Indexed: 12/22/2022] Open
Abstract
Sickle cell disease (SCD) and sickle cell trait (SCT) are highly prevalent in Africa. Despite public health implications, there is limited understanding of community issues for implementing newborn screening and appropriate family counseling. We conducted a 3-day workshop in Kumasi, Ghana, with community leaders as lay program development advisors to assist the development and implementation of a Sickle Cell Counselor Training and Certification Program. We employed qualitative methods to understand cultural, religious, and psychosocial dimensions of SCD and SCT, including the advisors' attitudes and beliefs in relation to developing a culturally sensitive approach to family education and counseling that is maximally suited to diverse communities in Ghana. We collated advisors' discussions and observations in order to understand community issues and potential challenges and guide strategies for advocacy in SCD family education and counseling. Results from the workshop revealed that community leaders representing diverse communities in Ghana were engaged constructively in discussions about developing a culturally sensitive counselor training program. Key findings included the importance of improved knowledge about SCD among the public and youth in particular, the value of stakeholders such as elders and religious and traditional leaders, and government expectations of reduced SCD births. We submitted a report to the Ministry of Health in Ghana with recommendations for the next steps in developing a national sickle cell counselor training program. We named the program "Genetic Education and Counseling for Sickle Cell Conditions in Ghana" (GENECIS-Ghana). The first GENECIS-Ghana Training and Certification Program Workshop was conducted from June 8 to 12, 2015.
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Affiliation(s)
- Kofi A Anie
- Haematology and Sickle Cell Centre, London North West Healthcare NHS Trust, Central Middlesex Hospital, London, NW10 7NS, UK. .,Imperial College London, London, UK.
| | - Marsha J Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Althea M Grant
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jemima A Dennis-Antwi
- International Confederation of Midwives Investing in Midwives Program, Accra, Ghana.,Sickle Cell Foundation of Ghana, Kumasi, Ghana
| | - Mabel K Asafo
- Ashanti Region Health Promotion Office, Kumasi, Ghana
| | - Mary E Lamptey
- Sickle Cell Foundation of Ghana, Kumasi, Ghana.,National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Ayo Otaigbe
- Sickle Cell Foundation Nigeria, Lagos, Nigeria
| | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, Kumasi, Ghana.,National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
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7
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McGann PT, Tshilolo L, Santos B, Tomlinson GA, Stuber S, Latham T, Aygun B, Obaro SK, Olupot‐Olupot P, Williams TN, Odame I, Ware RE. Hydroxyurea Therapy for Children With Sickle Cell Anemia in Sub-Saharan Africa: Rationale and Design of the REACH Trial. Pediatr Blood Cancer 2016; 63:98-104. [PMID: 26275071 PMCID: PMC4825070 DOI: 10.1002/pbc.25705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/19/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sickle cell anemia (SCA) is an inherited hematological disorder that causes a large but neglected global health burden, particularly in Africa. Hydroxyurea represents the only available disease-modifying therapy for SCA, and has proven safety and efficacy in high-resource countries. In sub-Saharan Africa, there is minimal use of hydroxyurea, due to lack of data, absence of evidence-based guidelines, and inexperience among healthcare providers. PROCEDURE A partnership was established between investigators in North America and sub-Saharan Africa, to develop a prospective multicenter research protocol designed to provide data on the safety, feasibility, and benefits of hydroxyurea for children with SCA. RESULTS The Realizing Effectiveness Across Continents with Hydroxyurea (REACH, ClinicalTrials.gov NCT01966731) trial is a prospective, phase I/II open-label dose escalation study of hydroxyurea that will treat a total of 600 children age 1-10 years with SCA: 150 at each of four different clinical sites within sub-Saharan Africa (Angola, Democratic Republic of Congo, Kenya, and Uganda). The primary study endpoint will be severe hematological toxicities that occur during the fixed-dose treatment phase. REACH has an adaptive statistical design that allows for careful assessment of toxicities to accurately identify a safe hydroxyurea dose. CONCLUSIONS REACH will provide data that address critical gaps in knowledge for the treatment of SCA in sub-Saharan Africa. By developing local expertise with the use of hydroxyurea and helping to establish treatment guidelines, the REACH trial results will have the potential to transform care for children with SCA in Africa.
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Affiliation(s)
| | | | | | | | - Susan Stuber
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Teresa Latham
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Banu Aygun
- Cohen Children's Medical CenterNew Hyde ParkNew York
| | | | | | - Thomas N. Williams
- KEMRI/Wellcome Trust Research ProgrammeKilifiKenya,Department of MedicineImperial CollegeLondonUK
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McGann PT, Grosse SD, Santos B, de Oliveira V, Bernardino L, Kassebaum NJ, Ware RE, Airewele GE. A Cost-Effectiveness Analysis of a Pilot Neonatal Screening Program for Sickle Cell Anemia in the Republic of Angola. J Pediatr 2015; 167:1314-9. [PMID: 26477868 PMCID: PMC4662897 DOI: 10.1016/j.jpeds.2015.08.068] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/07/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a pilot newborn screening (NBS) and treatment program for sickle cell anemia (SCA) in Luanda, Angola. STUDY DESIGN In July 2011, a pilot NBS and treatment program was implemented in Luanda, Angola. Infants identified with SCA were enrolled in a specialized SCA clinic in which they received preventive care and sickle cell education. In this analysis, the World Health Organization (WHO) and generalized cost-effectiveness analysis methods were used to estimate gross intervention costs of the NBS and treatment program. To determine healthy life-years (HLYs) gained by screening and treatment, we assumed NBS reduced mortality to that of the Angolan population during the first 5 years based upon WHO and Global Burden of Diseases Study 2010 estimates, but provided no significant survival benefit for children who survive through age 5 years. A secondary sensitivity analysis with more conservative estimates of mortality benefits also was performed. The costs of downstream medical costs, including acute care, were not included. RESULTS Based upon the costs of screening 36,453 infants and treating the 236 infants with SCA followed after NBS in the pilot project, NBS and treatment program is projected to result in the gain of 452-1105 HLYs, depending upon the discounting rate and survival assumptions used. The corresponding estimated cost per HLY gained is $1380-$3565, less than the gross domestic product per capita in Angola. CONCLUSIONS These data demonstrate that NBS and treatment for SCA appear to be highly cost-effective across all scenarios for Angola by the WHO criteria.
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Affiliation(s)
- Patrick T. McGann
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brigida Santos
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Vysolela de Oliveira
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Luis Bernardino
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Nicholas J. Kassebaum
- Institute for Health Metrics and Evaluation, Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital and University of Washington, Seattle, WA
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Gladstone E. Airewele
- Texas Children’s Cancer and Hematology Centers and Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Williams TN. An accurate and affordable test for the rapid diagnosis of sickle cell disease could revolutionize the outlook for affected children born in resource-limited settings. BMC Med 2015; 13:238. [PMID: 26399886 PMCID: PMC4580219 DOI: 10.1186/s12916-015-0483-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 12/16/2022] Open
Abstract
Each year, at least 280,000 children are born with sickle cell disease (SCD) in resource-limited settings. For cost, logistic and political reasons, the availability of SCD testing is limited in such settings and consequently 50-90 % of affected children die undiagnosed before their fifth birthday. The recent development of a point of care method for the diagnosis of SCD - the Sickle SCAN™ device - could afford such children the prompt access to appropriate services that has transformed the outlook for affected children in resource-rich areas. In research published in BMC Medicine, Kanter and colleagues describe a small but carefully conducted study involving 208 children and adults, in which they found that by using Sickle SCAN™ it was possible to diagnose the common forms of SCD with 99 % sensitivity and 99 % specificity, in under 5 minutes. If repeatable both in newborn babies and under real-life conditions, and if marketed at an affordable price, Sickle SCAN™ could revolutionize the survival prospects for children born with SCD in resource-limited areas.Please see related article: http://dx.doi.org/10.1186/s12916-015-0473-6.
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Affiliation(s)
- Thomas N Williams
- Department of Medicine, Imperial College, St Mary's Hospital, London, W2 1NY, UK. .,KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya.
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10
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Lopez AD, Williams TN, Levin A, Tonelli M, Singh JA, Burney PGJ, Rehm J, Volkow ND, Koob G, Ferri CP. Remembering the forgotten non-communicable diseases. BMC Med 2014; 12:200. [PMID: 25604462 PMCID: PMC4207624 DOI: 10.1186/s12916-014-0200-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 12/15/2022] Open
Abstract
The forthcoming post-Millennium Development Goals era will bring about new challenges in global health. Low- and middle-income countries will have to contend with a dual burden of infectious and non-communicable diseases (NCDs). Some of these NCDs, such as neoplasms, COPD, cardiovascular diseases and diabetes, cause much health loss worldwide and are already widely recognised as doing so. However, 55% of the global NCD burden arises from other NCDs, which tend to be ignored in terms of premature mortality and quality of life reduction. Here, experts in some of these 'forgotten NCDs' review the clinical impact of these diseases along with the consequences of their ignoring their medical importance, and discuss ways in which they can be given higher global health priority in order to decrease the growing burden of disease and disability.
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Affiliation(s)
- Alan D Lopez
- School of Population and Global Health, The University of Melbourne, Building 379, 207 Bouverie St, Carlton, Melbourne, VIC, 3053, Australia.
| | - Thomas N Williams
- Department of Medicine, Imperial College, St Mary's Hospital, London, W21NY, UK.
- KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya.
| | - Adeera Levin
- University of British Columbia, St Paul's Hospital, 1081 Burrard Street Rm 6010 A, Vancouver, BC, V6Z1Y8, Canada.
| | - Marcello Tonelli
- , 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions, VA Medical Center, 510, 20th street South, Birmingham, AL, FOT 805B, USA.
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College, London, UK.
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada.
- Clinical Psychology and Psychotherapy, Technical Universität Dresden, Dresden, Germany.
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Toronto, Canada.
- Department of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada.
- Institute of Medical Science, UofT, Toronto, Canada.
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA.
| | - George Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892-9304, USA.
| | - Cleusa P Ferri
- Institute of Education and Health Sciences, Hospital Alemao Oswaldo Cruz, Rua João Julião, 245 - Bloco D CEP 01323-903, São Paulo, SP, Brazil.
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 862- 1o andar, São Paulo, CEP, 04023-062, Brazil.
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