Ranking the disease burden of 14 pathogens in food sources in the United States using attribution data from outbreak investigations and expert elicitation.

Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens.

Measures of disease burden such as quality-adjusted life years (QALYs) are increasingly important to risk-based food safety policy. They provide a means of comparing relative risk from diverse health outcomes. We present detailed disease-outcome trees and EQ-5D scoring for 14 major foodborne pathogens representing over 95% of foodborne illnesses, hospitalizations, and deaths due to specified agents in the United States (Campylobacter spp., Clostridium perfringens, Cryptosporidium parvum, Cyclospora cayetanensis, Escherichia coli O157:H7, Shiga toxin-producing E. coli non-O157, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella, Toxoplasma gondii, Vibrio vulnificus, Vibrio parahaemolyticus and other noncholera Vibrio, and Yersinia enterocolitica). We estimate over 5800 QALYs lost per 1000 cases of L. monocytogenes and V. vulnificus, compared to 125 QALYs lost per 1000 cases of T. gondii, 26 for E. coli O157:H7, 16 for Salmonella and Campylobacter, and 14 for Y. enterocolitica. The remaining 7 pathogens are estimated to cause less than 5 QALYs lost per 1000 cases. In total, these 14 pathogens cause over 61,000 in QALY loss annually, with more than 90% due solely to acute infection being responsible for 65% of total QALY loss, with premature mortality and morbidity due to chronic and congenital illness responsible for another 28%. These estimates of the burden of chronic sequelae are likely conservative; additional epidemiological research is needed to support more accurate burden estimates. This study shows the value of using integrated metrics for comparing disease burden, and the need to consider chronic and congenital illness when prioritizing foodborne pathogens.

Purpose The goal of this study was to estimate the economic burden (EB) of smoking related premature death using willingness to pay (WTP) on quality-adjusted life years (QALYs) loss. Methods Total 35 smoking related diseases were obtained from a recent Korean economic burden of study. The population attributable fraction (PAF) of smoking for each disease was calculated using relative risk of each disease and smoking prevalence. After estimating QALY loss for premature death on each disease, we applied WTP to estimate the EB of diseases. Finally, the EB of smoking related premature death was estimated by applying the PAF. Results Total QALY loss of 35 smoking related premature death in 2013 was 137,799 QALYs. Among the assessed 35 diseases, the largest QALY loss was for bronchial and lung cancer (48,725 QALYs), followed by ischemic heart disease (13,212 QALYs), and stomach cancer (7,224 QALYs). Total cost due to smoking related premature death was 4,243 billion KRW. When estimating the cost by disease, the highest cost also was for bronchial and lung cancer (1,486 billion KRW), followed by ischemic heart disease (403 billion KRW), and stomach cancer (220 billion KRW). Conclusions The EB of smoking related premature death is substantial in Korea. It seems necessary to consider QALYs and WTP when estimating EB of premature death. Keywords: Cost of illness, Quality-Adjusted Life Years, Willingness to pay

PIN114 Estimation of Quality-Adjusted Life YEARS (QALY) Losses Associated with COVID-19 Deaths in Ukraine

Purpose: To develop a function to describe quality-adjusted life year (QALY) losses associated with visual field losses for use in cost-effectiveness models. Methods: We estimated the patient visual field defect in decibels (dBs) that corresponded to visual acuity values of 20/40, 20/70, 20/200 (US blindness), 20/400 (WHO blindness), and 20/1,000 (extreme impairment) using two methods. The first method categorized visual field defects by applying the logic of the Snellen minimum angle of resolution (MAR) acuity scale to the ability to perceive luminance adjusting for the differences in the visual acuity and luminance scales (MAR-based). The second method categorized visual field defects based on assumptions. We then assigned each visual field category the same QALY value associated with the analogous visual acuity category. Finally, for each method, we calculated a function that described QALY losses as a function of the absolute value of patient mean deviation (MD) values measured in dBs. Results: The MAR-based method estimated that MDs of –16, –18, –23, –24, and –30 or greater dBs corresponded to visual acuity values of 20/40, 20/70, 20/200, 20/400, and 20/1,000, respectively. For the same visual acuity values, the assumption-based method resulted in MD estimates of –13, –17, –22, –24, and –30. Our MAR-based method yielded the function, QALYs = 0.98991 + 0.0022 · dBs –0.00080518 · dBs, setting dBs equal to the absolute value of the mean deviation in the better-seeing eye. Our assumption-based method yielded the piece-wise function, QALYs = 1.0 – 0.0155 · dBs for dBs < 22, and 1.815 –0.0525· dBs for dBs ≥ 22. Conclusions: Results from two estimation methods suggest a convex and downward sloping relationship between dBs of visual field loss and QALY decrements. QALY losses accumulate slowly at first and then increase at an accelerating rate following an MD of approximately –10 dBs. This relationship is consistent with recent empirical findings reporting minimal QALY losses associated with small visual field defects.

BackgroundQuality-adjusted life years (QALYs) provide a means to compare injuries using a common measurement which allows quality of life and duration of life from an injury to be considered. A...

Background:Although evaluations of breast cancer screening programs frequently estimate quality-adjusted life-year (QALY) losses by stage, other breast cancer characteristics influence treatment and vary by mode of detection – i.e. whether the cancer is detected through screening (screen-detected), between screening rounds (interval-detected) or outside screening (community-detected). Here, we estimate the association between early-stage invasive breast cancer (ESIBC) characteristics and treatment-related QALY losses. Methods:Using clinicopathological and treatment information from 675 women managed for ESIBC, we estimated the average five-year treatment-related QALY loss by detection group. We then used regression analysis to estimate the extent to which known cancer characteristics and the detection mode, are associated with treatment and treatment-related QALY losses. Results:Community-detected cancers had the largest QALY loss (0.76 QALYs [95% CI 0.73;0.80]), followed by interval-detected cancers (0.75 QALYs [95% CI 0.68;0.82]) and screen-detected cancers (0.69 QALYs [95%CI 0.67;0.71]). Adverse prognostic factors more common in community-detected and interval-detected breast cancers (large tumours, lymph node involvement, high grade) were largely associated with QALY losses from mastectomies and chemotherapy. Receptor-positive subtypes, more common in screen-detected cancers, were associated with QALY losses related to endocrine therapy. Conclusions:The associations between ESIBC characteristics and treatment-related QALY losses should be considered when evaluating breast cancer screening and treatment strategies.

PIN95 - Varicella Vaccine as Post-Exposure Prophylaxis – a Cost-Effectiveness Analysis

Non-communicable diseases (NCDs), constitute a major global public health challenge and represent the primary causes of mortality and morbidity worldwide. This study aims to estimate Quality-Adjusted Life Year (QALY) losses associated with six NCDs among Iranian adults. This study quantified QALY losses associated with six NCDs, including asthma, ischemic heart disease (IHD), stroke, hypertension, diabetes mellitus, and high cholesterol. Health-related quality of life (HRQoL) scores were derived from EQ-5D-3L questionnaire data collected in 2021 from a nationally representative sample of 27,576 participants. Morbidity prevalence was obtained from the same survey, while mortality data were sourced from the Global Burden of Disease (GBD) study. Total QALY loss for each condition was calculated by summing losses attributable to both morbidity and mortality. Women experienced a greater decline in HRQoL than men across all conditions. The highest disutilities were observed for stroke, IHD, and asthma in women, and for stroke, asthma, and IHD in men. The highest QALY losses were associated with hypertension (1,399,097), IHD (1,123,053), and high cholesterol (749,136). Diabetes mellitus accounted for 428,163 QALYs lost followed by Stroke (373,365) and asthma (215,498). Given the substantial health burden posed by NCDs, there is an urgent need for prevention and management strategies that are both evidence-based and gender-sensitive. Strengthening national policies aimed at reducing the NCDs burden will not only enhance population health outcomes but also generate significant economic returns.

BackgroundThe burden of chronic diseases is rapidly rising, both in terms of morbidity and mortality. This burden is disproportionally carried by socially disadvantaged population subgroups. Quality-adjusted life years (QALYs) measure the impact of disease on mortality and morbidity into a single index. This study aims to estimate the burden of chronic diseases in terms of QALY losses and to model its social distribution for the general population.MethodsThe Belgian Health Interview Survey 2013 and 2018 provided data on self-reported chronic conditions for a nationally representative sample. The annual QALY loss per 100,000 individuals was calculated for each condition, incorporating disease prevalence and health-related quality of life (HRQoL) data (EQ-5D-5L). Socioeconomic inequalities, based on respondents’ socioeconomic status (SES), were assessed by estimating population attributable fractions (PAF).ResultsFor both years, the largest QALY losses were observed in dorsopathies, arthropathies, hypertension/high cholesterol, and genitourinary problems. QALY losses were larger in women and in older individuals. Individuals with high SES had consistently lower QALY loss when facing a chronic disease compared to those with low SES. In both years, a higher PAF was found in individuals with hip fracture and stroke. In 2013, the health inequality gap amounts to 33,731 QALYs and further expanded to 42,273 QALYs in 2018.ConclusionGiven that chronic diseases will rise in the next decades, addressing its burden is necessary, particularly among the most vulnerable (i.e. older persons, women, low SES). Interventions in these target groups should get priority in order to reduce the burden of chronic diseases.

Respiratory syncytial virus (RSV) is one of the most frequent etiological factors of lower respiratory tract infections in children, potentially affecting patients' quality of life (QoL). We aimed to asses QoL in children under 2 years of age hospitalized due to laboratory-confirmed RSV infection. A QoL was assessed by parents/tutors with the use of the 100-point visual analog scale and compared against a disease-free period. We evaluated the median utility, QoL loss (reported in days), and quality-adjusted life years (QALY) loss in relation to RSV hospitalization. We included 132 patients aged from 17 days to 24 months (median 3.8 months). The mean utility during the hospitalization varied between 0.418 and 0.952, with a median of 0.679 (95%CI: 0.6-0.757) and median loss of 0.321 [0.243-0.4], which further translated into a loss of 2.2 days (95%CI: 1.6-3.1). The QALY loss varied between 0.526 × 10-3 and 24.658 × 10-3, with a median of 6.03 × 10-3 (95%CI: 4.38-8.48 × 10-3). Based upon the final diagnoses, the highest QALY loss was 6.99 × 10-3 (95%CI: 5.29-13.7 × 10-3) for pneumonia, followed by bronchiolitis-5.96 × 10-3 (4.25-8.41 × 10-3) and bronchitis-4.92 × 10-3 (2.93-6.03 × 10-3); significant differences were observed only between bronchitis and pneumonia (p = 0.0171); the QALY loss was not age-dependent. Although an increasing tendency in the utility score was observed, a strong cumulative effect related to the length of stay was noted until day 13. RSV contributes significantly to the utility deterioration and QALY loss in the case of RSV hospitalization, and the patient-reported data should be used in pharmacoeconomic assessments of the impact of RSV.

PIN20 Predicting the IMPACT of Vaccination Strategies in the COVID-19 Pandemic Using a Susceptible-Exposed-Infectious-Removed (SEIR) MODEL

Early initiation of antifungal treatment for invasive candidiasis is associated with change in mortality. Beta-D-glucan (BDG) is a fungal cell wall component and a serum diagnostic biomarker of fungal infection. Clinical findings suggested an association between reduced invasive candidiasis incidence in intensive care units (ICUs) and BDG-guided preemptive antifungal therapy. We evaluated the potential cost-effectiveness of active BDG surveillance with preemptive antifungal therapy in patients admitted to adult ICUs from the perspective of Hong Kong healthcare providers. A Markov model was designed to simulate the outcomes of active BDG surveillance with preemptive therapy (surveillance group) and no surveillance (standard care group). Candidiasis-associated outcome measures included mortality rate, quality-adjusted life year (QALY) loss, and direct medical cost. Model inputs were derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of model results. In base-case analysis, the surveillance group was more costly (1387 USD versus 664 USD) (1 USD = 7.8 HKD), with lower candidiasis-associated mortality rate (0.653 versus 1.426 per 100 ICU admissions) and QALY loss (0.116 versus 0.254) than the standard care group. The incremental cost per QALY saved by the surveillance group was 5239 USD/QALY. One-way sensitivity analyses found base-case results to be robust to variations of all model inputs. In probabilistic sensitivity analysis, the surveillance group was cost-effective in 50% and 100% of 10,000 Monte Carlo simulations at willingness-to-pay (WTP) thresholds of 7200 USD/QALY and ≥27,800 USD/QALY, respectively. Active BDG surveillance with preemptive therapy appears to be highly cost-effective to reduce the candidiasis-associated mortality rate and save QALYs in the ICU setting.

Impact of Vision Loss on Health-Related Quality of Life in Trinidad and Tobago

Health Burden Associated with Visual Impairment in Singapore: The Singapore Epidemiology of Eye Disease Study