Additional Life Years Research Articles

Aging well? Exploring self-reported quality of life in the older Austrian population

Abstract Background The increase of life expectancy around the world sets an ageing society with all its challenges on the global Public Health agenda. In Austria, the additional years of life gained are not spent in good health, as the healthy life expectation is far below the European average. This study aimed to examine the change in self-reported quality of life (QoL) over time in the Austrian older-aged population and explore associated factors. Methods Repeated cross-sectional data was retrieved from three waves of the Austrian Health Interview Survey conducted in 2006, 2014 and 2019, including a total of 10 056 participants aged 65 years and above. To estimate QoL in this age group, domain scores of the WHOQOL-BREF were used. Trends in QoL were descriptively analysed across different age groups, sex and survey years. Adjusted Wald tests were conducted to compare means of older women and men. Linear regression models were estimated to explore the impact of age, sex, family status, education, income, residence and survey year on QoL domains. Results While WHOQOL-BREF domain scores increased over time, a steady decrease with age was observable in all survey waves. Mean scores were significantly higher in men than in women in all QoL domains and in each survey year except for the social domain. In the regression analyses, sex differences disappeared in most domains after adjusting for income and education. Factors associated with significantly higher QoL scores in all domains included younger age, higher education, higher income and living in Western Austria. Conclusions Observed sex differences in QoL seem to be driven mainly by income and education differences in the older-aged Austrian population. Following the WHO's and UN's 10-year global plan of action - The United Nations Decade of Healthy Ageing 2021-2030 - further efforts towards developing sustainable strategies and policies to reduce socioeconomic inequalities also with attention to sex/gender gap are strongly needed. Key messages • This study provides a first in-depth analysis of quality of life in Austrian senior citizens. • Younger age, higher education, higher income and living in Western Austria are associated with better quality of life.

Gains in life expectancy from decreasing cardiovascular disease and cancer mortality – an analysis of 28 European countries 1995–2019

BackgroundLife expectancy (LE) is an indicator of societal progress among rapidly aging populations. In recent decades, the displacement of deaths from cardiovascular disease (CVD) and cancer have been key drivers in further extending LE on the continent, though improvements vary markedly by country, sex, and over time. This study provides a comparative overview of the age-specific contributions of CVD and cancer to increasing LE in the 27 European Union member states, plus the U.K.MethodsCause-by-age decompositions of national changes in LE were conducted for the years 1995–1999 and 2015–2019 based on the standard approach of multiple decrement life tables to quantify the relative impact over time. The contributions of CVD and cancer mortality changes to differences in LE were computed by sex and age for each of the 28 countries. We examine the difference between the member states before 2004 (“founding countries”) and those which accessed the EU after 2004 (“A10 countries”).ResultsAmong men, declines in CVD mortality in the founding countries of the EU were larger contributors to increasing LE over the last decades than malignant neoplasms: 2.26 years were gained by CVD declines versus 1.07 years for cancer, with 2.23 and 0.84 years gained in A10 countries, respectively. Among women in founding countries, 1.81 and 0.54 additional life years were attributable to CVD and cancer mortality declines, respectively, while in A10 countries, the corresponding values were 2.33 and 0.37 years. Lung and stomach cancer in men, and breast cancer in women were key drivers of gains in LE due to cancer overall, though rising mortality rates from lung cancer diminished the potential impact of increasing female LE in both EU founding (e.g., France, Spain, and Sweden) and A10 countries (e.g., Croatia, Hungary, and Slovenia), notably among cohorts aged 55–70 years. Over the 25 years, the LE gap between the two sets of countries narrowed from 6.22 to 5.59 years in men, and from 4.03 to 3.12 years for women, with diminishing female mortality from CVD as a determinative contributor.ConclusionThis study underscores the continued existence of an East-West divide in life expectancy across the EU27 + 1, evident on benchmarking the founding vs. A10 countries. In EU founding countries, continuous economic growth alongside improved health care, health promotion and protection policies have contributed to steady declines in mortality from chronic diseases, leading to increases in life expectancy. In contrast, less favourable mortality trends in the EU A10 countries indicate greater economic and health care challenges, and a failure to implement effective health policies.

Estimating the Health and Economic Impact of Improved Management in Prevalent Chronic Obstructive Pulmonary Disease Populations in England, Germany, Canada, and Japan: A Modelling Study.

COPD is a leading cause of morbidity and mortality globally. Management is complex and costly. Although international quality standards for diagnosis and management exist, opportunities remain to improve outcomes, especially in reducing avoidable hospitalisations. To estimate the potential health and economic impact of improved adherence to guideline-recommended care for prevalent, on-treatment COPD populations in four high-income settings. A disease simulation model was developed to evaluate the impact of theoretical improvements to COPD management, comparing outcomes for usual care and policy scenarios for interventions that reduce avoidable hospitalisations: 1) increased attendance (50% vs 31-38%) of early follow-up review after severe exacerbation hospitalisation; 2) increased access (30% vs 5-10%) to an integrated disease management (IDM) programme that provides guideline adherent care. For cohorts of 100,000 patients, Policy 1 yielded additional life years (England: 523; Germany: 759; Canada: 1316; Japan: 512) and lifetime cost savings (-£2.89 million; -€6.58 million; -$40.08 million; -¥735.58 million). For Policy 2, additional life years (2299; 3619; 3656) and higher lifetime total costs (£38.15 million; €35.58 million; ¥1091.53 million) were estimated in England, Germany and Japan, and additional life years (4299) and cost savings (-$20.52 million) in Canada. Scenarios found that the cost impact depended on the modelled intervention effect size. Interventions that reduce avoidable hospitalisations are estimated to improve survival and may generate cost savings. This study provides evidence on the theoretical impact of policies to improve COPD care and highlights priority areas for further research to support evidence-based policy decisions.

Associations of Various Physical Activities with Mortality and Life Expectancy are Mediated by Telomere Length

ObjectivesPhysical activity (PA) and telomeres both contribute to healthy aging and longevity. To investigate the optimal dosage of various PA for longevity and the role of telomere length in PA and mortality. DesignProspective cohort study. Setting and ParticipantsA total of 333,865 adults (mean age of 56 years) from the UK Biobank were analyzed. MethodsWalking, moderate PA (MPA), and vigorous PA (VPA) were self-reported via questionnaire, and leukocyte telomere length (LTL) was measured. Cox proportional hazards regression was used to predict all-cause mortality risk. A flexible parametric Royston-Parmar survival model was used to estimate life expectancy. ResultsDuring a median follow-up of 13.8 years, 19,789 deaths were recorded. Compared with the no-walking group, 90 to 720 minutes/week of walking was similarly associated with 27% to 31% of lower mortality and about 6 years of additional life expectancy. We observed nearly major benefits for mortality and life expectancy among those meeting the PA guidelines [151-300 minutes/wk for MPA: hazard ratio (HR) 0.80, 95% CI 0.75-0.85, 3.40-3.42 additional life years; 76-150 minutes/wk for VPA: HR 0.78, 95% CI 0.75-0.82, 2.61 years (2.33-2.89)] vs the no-PA group. Similar benefits were also observed at 76-150 and 301-375 minutes/wk of MPA (18%-19% lower mortality, 3.20-3.42 gained years) or 151-300 minutes/wk of VPA (20%-26% lower mortality, 2.41-2.61 gained years). The associations between MPA, VPA, and mortality risk were slightly mediated by LTL (≈1% mediation proportion, both P < .001). Conclusions and ImplicationsOur study suggests a more flexible range of PA than the current PA guidelines, which could gain similar benefits and is easier to achieve: 90 to 720 minutes/wk of walking, 75 to 375 minutes/wk of MPA, and 75 to 300 minutes/wk of VPA. Telomeres might be a potential mechanism by which PA promotes longevity.

Public preferences to trade-off gains in total health for health equality: Discrepancies between an abstract scenario versus the real-world scenario presented by COVID-19

Policymakers must ration healthcare. This necessity became salient during the COVID-19 pandemic. Some policymakers took that opportunity to reduce inequality of health outcomes at the expense of overall health gains. There is a literature that seeks to quantify the optimal trade-off between efficiency and equality in health outcomes: economists employ surveys to quantify the public’s preferred level of equity/efficiency trade-off. An odd result from these studies is that a non-trivial subsample of respondents choose to “level down” i.e., they choose as though an additional year of life delivers negative utility to society if it accrues to the most privileged. In an experiment of US and UK respondents ( n = 495), we compare equity/efficiency trade-offs across an abstract scenario along the lines of that presented in previous surveys versus a COVID-19 scenario, where it is made explicit that healthcare rationing is a real and current necessity occasioned by the pandemic. We find that preference for “levelling down” is reduced in the COVID-19 scenario relative to the abstract scenario. This result implies that, at least in the context of the COVID-19 pandemic, previous results have overestimated the public’s willingness to sacrifice overall gains in population health in order to reduce inequality of health outcomes.

Natal environmental conditions modulate senescence of antler length in roe deer

It is now broadly admitted that female reproductive senescence – a decline in reproductive performance with increasing age – occurs in most species, at least among birds and mammals. Although information is more limited, male reproductive senescence has been regularly inferred from the decline in the size or performance of phenotypic traits that underly male reproductive success, particularly secondary sexual traits. However, the degree to which environmental conditions influence the pattern of senescence in sexual traits remains largely unknown. From the analysis of two long-term studies of populations of European roe deer (Capreolus capreolus) subjected to markedly different environmental contexts in the wild, we tested the hypothesis that harsh natal and/or current conditions should lead to earlier and/or stronger rates of senescence in the length of fully-grown antlers than good natal and/or current conditions. We found evidence of similar patterns of antler length senescence in both populations, with an onset of senescence around 7 years of age and a decrease of length by about 1–1.5 cm per additional year of life from 7 years of age onwards. We found that good early-life conditions delay senescence in antler length in roe deer. Our results also revealed that senescent males seem to be unable to allocate substantially to antler growth, confirming that antler size is, therefore, an honest signal of male individual quality. By modulating age-specific allocation to secondary sexual traits, natal and current conditions could influence female mate choice and male–male competition over mates, and as a result age-specific reproductive success, and should be accounted for when studying the dynamics of sexual selection.

Cost-Effectiveness Analysis of Personalized Hypertension Prevention.

While a population-wide strategy involving lifestyle changes and a high-risk strategy involving pharmacological interventions have been described, the recently proposed personalized medicine approach combining both strategies for the prevention of hypertension has increasingly gained attention. However, a cost-effectiveness analysis has been hardly addressed. This study was set out to build a Markov analytical decision model with a variety of prevention strategies in order to conduct an economic analysis for tailored preventative methods. The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year. The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective. To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.

Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals

Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis. We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used published data on the natural history of hepatitis C, competing risk post virologic cure, HCC tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options and associated costs, and utilities of different health states. We estimated the HCC incidence above which biannual HCC surveillance using ultrasound and alpha-fetoprotein would be cost-effective. In virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis, HCC surveillance is cost-effective if HCC incidence exceeds 0.7 per 100 PY using $100,000 per quality-adjusted life year willingness-to-pay. At this HCC incidence, routine HCC surveillance would result in 2650 and 5700 additional life years per 100,000 cirrhosis and advanced fibrosis persons, respectively, compared with no surveillance. At $150,000 willingness-to-pay, surveillance is cost-effective if HCC incidence exceeds 0.4 per 100 PY. Sensitivity analysis showed that the threshold mostly remained below 1.5 per 100 PY. The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC.

Identifying disparities in brachytherapy delivery for locally advanced cervical cancer

IntroductionThe standard of care for locally advanced cervical cancer is concurrent chemotherapy and external beam radiation therapy (EBRT) followed by a brachytherapy boost. Some studies show a decreased usage of brachytherapy in cervical cancer patients despite the standard of care and known survival advantage. This study aims to characterize the utilization of brachytherapy in Oregon and identify where disparities in treatment may exist. MethodsThe Oregon State Cancer Registry database was used to identify patients diagnosed with FIGO Stage IB2-IVB cervical cancer between 2007 and 2016. Patients who received initial EBRT were categorized by whether they received brachytherapy boost or not. Age at diagnosis, county of patient residence, rural-urban status of the county, race/ethnicity, and insurance payer were studied using multivariable logistic regression to identify possible underserved populations. Survival data was compared using a Cox proportional hazard survival model. Results401 patients who received primary EBRT for FIGO stage IB2-IVB cervical cancer were identified in the 10-year span. Breakdown by stage is: 16% stage IB2, 23.9% stage II, 37.4% stage III, and 22.7% stage IV. Of those, 154 (38.4%) received brachytherapy boost treatment, 75 (18.7%) received a different boost modality, and 42.9% received no boost. Stage IV (p = 0.001) and uninsured patients (p = 0.04) were significantly less likely to receive brachytherapy. Older age was also associated with decreased brachytherapy usage, as each additional year of life decreased brachytherapy receipt by 1.8% (p = 0.04). Native American and Pacific Islander patients were the only group significantly more likely to receive brachytherapy (p=0.003). There was no significant difference in the rate of brachytherapy boost identified based on urban/rural status of the county (p = 0.63 to 0.69), other racial/ethnic categories (p = 0.66 to 0.80), or among the other stages (p=0.45 to 0.63). In Cox proportional hazard survival analysis, patients that received brachytherapy showed a 42% reduction in risk of cancer specific mortality, though this did not reach the predetermined level of statistical significance (p = 0.057). ConclusionsThe brachytherapy boost rate among locally advanced cervical cancer patients was 38.4%. The data also indicated a likely reduction in cancer specific mortality in patients receiving brachytherapy. Older patients, stage IV patients, and uninsured patients were less likely to receive brachytherapy. Given the low overall brachytherapy usage, these data indicate access and delivery of brachytherapy care needs to be improved across the state. The increased brachytherapy use in the American Indian and Pacific Islander patient population should be further studied to identify facilitators to treatment completion and potentially extrapolate to other groups.

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Association between Life's Essential 8 score and risk of premature mortality in people with and without type 2 diabetes: A prospective cohort study.

To evaluate the association of cardiovascular health (CVH), measured by Life's Essential 8 score, with the risk of premature mortality and to determine the patterns of CVH-related differences in life expectancy among people with and without type 2 diabetes (T2D). This prospective study included 309,789 participants (age 56.6±8.1years; 46% men) enroled in the UK Biobank. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (BMI, non-HDL cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH was categorised into low, moderate, and high groups. Premature death was defined as death before the age of 75. Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and life expectancy was estimated. During a median follow-up of 12.7years, 13,683 cases of premature death were documented. Compared to participants with low CVH, the multivariable HRs (95% CIs) of premature death were 0.59 (0.56-0.62) and 0.42 (0.39-0.45) for the moderate and high CVH groups, respectively. This association was stronger in participants with T2D compared with those without T2D. At the age of 50years, compared to low CVH groups, high CVH was associated with a gain of 9.79 (9.70-9.87) and 5.58 (5.48-5.67) additional life years for men with and without T2D, respectively. The corresponding life gain for women with and without T2D was 24.21 (24.13-24.27) and 10.18 (10.10-10.27), respectively. Maintaining an ideal Life's Essential 8 score may provide more benefits for people with T2D than for those without T2D, including a lower risk of premature death and an increased lifespan.

Values-based healthcare (systematic review)

The current demographic situation is characterized by an increase in life expectancy and gain in the number of chronic non-communicable diseases. Healthcare is faced with the task of preserving the population health in these additional years of life, which, in turn, will lead to an increase in the shortage of resources in healthcare and, in general, negatively affect the economies of states. One of the modern concepts of optimal use of resources, evaluation of the effectiveness of health systems is value-based healthcare. In the described model, the value for the patient is the result of medical care in relation to health, which is important for the patient, the criteria for achieving which are determined by the patient himself. According to the concept of the Center, measuring the results and costs for each patient is part of the strategic program for the transition to a highly efficient healthcare system. &#x0D; The purpose of the study is to investigate the features of value-based healthcare in different countries of the world.&#x0D; A systematic review was conducted according to the PRISMA guidelines.&#x0D; The literature search was performed in the electronic databases PubMed/MEDLINE, Scopus, eLibrary, CyberLeninka, and Yandex and Google systems among English and Russian-language reports. In the healthcare systems of countries that have implemented a value-based approach, the activities of medical institutions are evaluated according to indicators that reflect the value to the patient. To combine the available resources and coordinate the provision of medical care, multidisciplinary teams of specialists are being created and the patient is provided with a full range of services without delay at all stages. In such models, all processes in medical institutions are standardized, which makes it possible to reduce losses and costs at all stages of medical care and increase the results that are valuable for patients.

Pharmacoeconomic evaluation of the tixagevimab and cilgavimab combination using for pre-exposure prophylaxis of COVID-19

To evaluate pharmacoeconomic feasibility using of the tixagevimab and cilgavimab combination for pre-exposure prophylaxis of COVID-19 in immunocompromised patients. Cost-effectiveness of tixagevimab and cilgavimab in persons ≥12 years old who weigh ≥40 kg and have either a history of allergy that prevents their vaccination against COVID-19 or moderate or immunocompromised was assessed based on PROVENT phase III study results. The quantity of life years or quality-adjusted life years gained was calculated. Direct medical cost associated with prophylaxis of COVID-19, treatment of infected patients and those experiencing long COVID post infection were assessed. Results were compared with wiliness-to-pay threshold, measured as tripled gross domestic product per capita and equal to 2.69 mln RUB in 2022. Pre-exposure prophylaxis of COVID-19 results in additional 0.0287 life years or 0.0247 quality-adjusted life years. The cost of additional life year gained is equal to 1.12 mln RUB, the cost of additional quality-adjusted life years is 1.30 mln RUB. Both costs of additional life year and cost of quality-adjusted life years appeared to be significantly less compared to wiliness-to-pay threshold. Pre-exposure prophylaxis of COVID-19 with combination of tixagevimab and cilgavimab is economically feasible and may be recommended for wide use in Russian healthcare system.

Superficial soft tissue sarcomas: 10‑year survival outcomes.

Cutaneous sarcomas comprise a broad group of rare, heterogeneous mesenchymal tumours. The present report describes a single centre experience regarding the management and the outcomes of patients with superficial soft tissue sarcomas (SSTS). Key prognostic factors in predicting overall survival (OS) and local relapse-free survival were determined. Data from 66 patients with SSTS treated surgically within Edinburgh and Lothian were collected in the context of a service evaluation. Patient demographics, tumour specifics and treatment, as well as 5-year OS and local recurrence, were analysed. Kaplan-Meier analysis was applied for survival curves, and mortality rate estimation and Cox regression were used to establish independent predictors. The mean estimated OS time was 57.2 months, with a 95% CI between 55.0 and 59.5 months. The median OS time could not be estimated because there is no time point during which the survival function has a value <50%. The death risk for a person with SSTS was increased by 7.3% (odds ratio, 1.073; 95% CI, 1.012-1.138) for every additional year of life. The estimated mean local relapse time was 58.5 months, with a 95% CI between 56 and 61 months. The median local relapse time could not be estimated since there is no time point during which the local recurrence function has a value <50%. In conclusion, out of all independent variables considered, none could statistically significantly explicate local relapse recurrence time. It is important that these rare tumours are treated in the context of a multidisciplinary team with consensus guidelines to assist decision-making.

Does Children's Education Improve Parental Health and Longevity? Causal Evidence from Great Britain.

Parents with better-educated children are healthier and live longer, but whether there is a causal effect of children's education on their parents' health and longevity is unclear. First, we demonstrate an association between adults' offspring education and parental mortality in the 1958 British birth cohort study, which remains substantial-about two additional years of life-even when comparing parents with similar socioeconomic status. Second, we use the 1972 educational reform in England and Wales, which increased the minimum school leaving age from 15 to 16 years, to identify the presence of a causal effect of children's education on parental health and longevity using census-linked data from the Office for National Statistics Longitudinal Study. Results reveal that children's education has no causal effects on a wide range of parental mortality and health outcomes. We interpret these findings discussing the role of universal health care and education for socioeconomic inequality in Great Britain.

Cost-effectiveness of idecabtagene vicleucel compared with conventional care in triple-class exposed relapsed/refractory multiple myeloma patients in Canada and France

BackgroundThe chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel (ide-cel) is approved for the treatment of adult patients with relapsed/refractory multiple myeloma (RRMM) who have already received an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody and have progressed on their last therapy. The objective of this study was to assess the cost-effectiveness of ide-cel versus conventional care in Canada and France.MethodsA partitioned survival model was used to estimate the cost-effectiveness of ide-cel (target dose 450 × 106 CAR T cells) in its approved indication in terms of life-years (LYs), quality-adjusted LYs (QALYs), and costs. Patient-level data from the KarMMa Phase II clinical trial (clinicaltrials.gov NCT03361748) and KarMMa-RW study were used to inform the model; overall and progression-free survival were extrapolated using standard parametric functions after the observed periods. The model adopted Canadian and French societal perspectives over a lifetime horizon. Costs, utilities, discounting (Canada: 1.5%, France: 2.5%), and general population mortality were country-specific.ResultsThe base case demonstrated that ide-cel was associated with more additional LYs (+2.64 and +2.51) and QALYs (+2.31 and +2.54) than conventional care at incremental costs of CAN$588,490 and €392,251 in Canada and France, respectively. The resulting incremental cost-effectiveness ratio (ICER) for ide-cel was $255,245 per QALY in Canada, and €154,593 per QALY in France.ConclusionIde-cel was associated with significant survival improvements in terms of both LYs and QALYs in patients with progressive triple-class-exposed RRMM. The ICER for ide-cel was similar to that of other approved and reimbursed RRMM therapies.

S-15-3: COST-EFFECTIVENESS OF A FULL SCOPE OF PHARMACIST CARE FOR HYPERTENSION IN AUSTRALIA

Hypertension is the single most important cause of premature morbidity and mortality in the world. Over half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has conclusively demonstrated that pharmacist care, including patient education, consultation, and/or prescribing, significantly reduces blood pressure, including a Canadian randomised trial, RxACTION, which demonstrated an 18.3 mmHg reduction in systolic blood pressure (SBP) with pharmacist prescribing and care. Objective: To evaluate the economic impact of pharmacist management of hypertension in an Australian setting. Methods: A Markov cost effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. We assumed an absolute reduction of systolic blood pressure of 18.3 mmHg (from the RxACTION trial). The model incorporated health outcomes, costs, and quality of life to estimate an overall incremental cost effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy. Results: For a SBP reduction of 18.3 mmHg, the estimated impact is 0.22 fewer cardiovascular events per person, and, discounted at 5% per year: 0.2 additional life years, 0.3 additional quality-adjusted life years, and $AU 5,348 cost savings over a lifetime per person. As such, pharmacist care in hypertension is economically dominant, i.e., both more effective and cost saving compared to usual care. At the population level, it has been reported that 34% of Australian adults have hypertension, of whom 68% are not optimally controlled. If 50% of poorly controlled hypertensives could access a full scope of pharmacist care, it is estimated that this would result in 2.1 million life years saved, and a cost saving of $AU 31.1 billion over a 30-year time horizon. Across a range of one way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost saving, indicating robustness of the model. Conclusion: Pharmacist care, including prescribing, when added to usual care by general practitioners, would lead to better BP outcomes and a net cost saving of over $AU 30 billion. If implemented, this would have important public health implications.

Função sexual e sua associação com a sexualidade e a qualidade de vida de mulheres idosas

Abstract Objective to analyze the sexual function and its association with the sexuality and quality of life of elderly women. Methods this is a cross-sectional web survey study developed with 166 elderly women. Four self-administered instruments were used to obtain biosociodemographic, sexual function, sexuality and quality of life data. The analysis was performed using the Mann-Whitney test, Spearman correlation and linear regression, considering a 95% confidence interval. Results the greatest influence of sexual function was observed in the sexual act dimension of sexuality (β=0.524; [95%CI=0.451-0.597]; p&lt;0.001; R2=54.8%) and between the intimacy facet of quality of life (β =0.501; [95%CI=0.380-0.622]; p&lt;0.001; R2=29.0%). In general, the regression model showed that sexual function remained associated with sexuality (β=0.888; [CI95%=0.749-1.028]; p&lt;0.001; R2=49.1%) and the quality of life of the participants (β=0.352; [CI95%=0.264-0.439]; p&lt;0.001; R2=27.7%). Conclusion and implications for the practice sexual function is associated with the sexuality and quality of life of older women, assuming a directly proportional behavior which, in turn, can become a strategy to add quality to the additional years of life of this population.

Экономический эффект от вакцинации как аргумент в разъяснительной работе по вакцинопрофилактике

There is no doubt about the economic effect of vaccination. However, the relevant assessments have not yet become a convincing argument for the need for vaccination. P u r p o s e o f t h e s t u d y . Based on the results of the inventory of the existing domestic and foreign experience in determining the economic effect of vaccination, identifying management problems in the relevant explanatory work, propose other approaches on how to calculate the economic effect of vaccination and how to use this argument in explanatory work on vaccination. M a t e r i a l s a n d m e t h o d s . A comparative analytical assessment of domestic and foreign experience in the field of calculating the economic effect of vaccination has been carried out. It is analyzed what place the economic effect of vaccination has in explanatory work of state bodies on vaccination. R e s u l t s . It has been established that the insufficient effectiveness of explanatory work on vaccination is largely the result of an incorrect delineation of functions at different levels of government (municipal, regional, federal). Unreasonably large tasks in this area are assigned to the municipal level, while the federal level, on the contrary, turned out to be actually unreasonably exempted from solving the substantive tasks in the field of explanatory work on vaccine prevention. The analysis of foreign and domestic experience in determining the economic effect of vaccination confirmed the significance of the results, calculations, and estimates. The necessity of presenting the results of the assessment of the economic effect of vaccination in a simpler and more understandable form is substantiated. For this purpose, an assessment was made of what can give the economy in value terms 25 years of additional human life, which he received in the 20th century thanks, according to experts, to vaccination. The calculation of GDP per capita (according to Rosstat for 2021, in purchasing power parity) for 25 years of extra human life due to vaccination was carried out. The need to consider the issue of the advisability of paying people for vaccination is substantiated. F i n d i n g s . It is necessary to reconsider the traditional approaches to assessing the economic effect of vaccination. State and municipal authorities should update the tasks in the field of vaccination in order to increase its effectiveness.

The competence in health issues of population of circumpolar region of the Russian Federation

The health literacy of citizen is determined by a set of demographic and social factors. The deficiency of health literacy of population in the Russian Arctic Zone conditions delay in indicators characterizing population health from their all-Russian values and menaces ability to achieve the targets of the National Strategy of Development of Russian Arctic Zone and Ensuring National Security up to 2035.The purpose of the study is to assess level of health literacy of patients and healthy population residing in circumpolar territories of Russia (Arkhangelsk Oblast).The level of general health literacy in the subgroups of respondents varied in narrow range of 26.9-36.3 points. The most significant difference was established between scores of interactive health literacy (Δ = 4.1 points) and critical health literacy (Δ = 3.4 points), which were higher in group of healthy respondents. The predictors of level of general health literacy are clinical status (value of dependent variables in healthy respondents was on average higher on 0.75-1.73 points), self-assessment of one's positioning in society (every additional point increases average level of general health literacy by 0.47-0.79 points) and age (every additional year of life reduces level of general health literacy by 0.08 - 0.09 points). The results of the study indicate on dependency between clinical status and the level of health literacy, determine social characteristics of risk group with low health literacy as object of additional preventive measures directed at citizen residing in in circumpolar terrotories of The Russian Federation.