Adjusted Life Years Research Articles

Abstract 4146312: Global Burden and Trend of Atrial Fibrillation and Flutter in the 27 European Union Countries from 1990-2021: A Systematic analysis for the Global Burden of Disease Study 2021

Introduction: Atrial Fibrillation (Afib) and Flutter ranks as the fifth leading cause of death among all cardiovascular diseases (CVD). Given the scarcity of consistent previous estimates, this study is the first to assess the burden of Afib and Flutter in the European Union (EU) over the past three decades, including the initial two years of the COVID-19 pandemic. Methods: Using global burden of disease study 2021 meta tool, we estimated prevalence, incidence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to Afib and Flutter by age, sex, year and location across the 27 EU countries from 1990-2021. Results: The total number of prevalence rose from 5 million (95% uncertainty interval: 3.9-6.4 million) in 1990 to 8.6 million (7.2-10.3 million) in 2021. The total percentage of change (TPC) in deaths increased by 130% (110%-143%), and YLDs by 69% (56%-84%) from 1990-2021. Austria saw the highest increase in age-standardized incidence rates (ASIR) at 83%, followed by Czechia at 50%. Sweden experienced the largest rise in mortality rates (ASMR) at 93%, with Estonia at 35%, and in YLD rates (ASYLDR), Austria led with a 90% increase followed by Sweden at 49%. In terms of age, individuals aged 55 and older recorded the highest death toll at 70,269 (57,793-77,019) and the highest incidence at 607,960 (397,686-868,122) in 2021. Regarding gender, males showed an increased TPC in overall burden compared to females, with males observing an increase and females a decreasing trend in ASIR (5% vs -7%), ASMR (7% vs -4%), and ASYLDR (7% vs -5%) from 1990-2021. Conclusion: Deaths due to Afib and Flutter accounted for 4.26% of all CVD in EU. The escalating prevalence and mortality rates of Afib and Flutter across the EU highlight an urgent need for comprehensive healthcare strategies. Effective management should focus on bolstering preventive measures, advancing diagnostic techniques, and enhancing patient care frameworks, particularly for the aging demographic most at risk. Strategic collaboration across sectors, including innovative public health initiatives and policy reinforcement, is essential to curb this growing trend and safeguard public health.

Cost-Effectiveness of Vibrant System vs. Linaclotide in Chronic Idiopathic Constipation.

Chronic idiopathic constipation (CIC) is a common disorder that has a large unmet clinical need, affecting 8.0-12.0% of the US population and disproportionately affecting female individuals more than male individuals. Patients and physicians are equally dissatisfied with over-the-counter and prescription treatments. Physician dissatisfaction is at 78%. CIC has a significant negative impact on quality of life (QoL). The objective of this analysis was to compare the total cost and QoL of the Vibrant System vs. linaclotide, over 1-3years of treatment. Markov models were utilized to project 1-3-year US costs and health outcomes (quality adjusted life years, QALYs) comparing theVibrant System to the current standard of care pharmacologic therapy (linaclotide). One model examined direct (D) costs plus QALYs. Direct (D) costs included list price of product and medical treatment costs due to adverse events. Costs (D) were as of 2024; derived from themedical literature. A second model examined D as well as indirect (I)costs (absenteeism, presenteeism) [D + I] and QALYs. Longitudinal 12-month persistence prescription data for linaclotide was obtained from IQVIA claims data. The Vibrant System persistence data was derived from post market collection. One-way sensitivity analyses were also performed. Years1-3 direct costs were lower with Vibrant System with improved QALYs. Cumulative D + I data analysis for the Vibrant System at 12months, and for years2 and 3 show increased cost savings from $345 to $3866 with improved effectiveness. On the basis of lower costs and improved QALYs, the Vibrant System should be considered a first-line therapy for CIC and should be covered by insurers.

Exploring the experiences of traditional practitioners while managing hypertension in Rwanda

BackgroundHypertension (HTN) is a major global health concern, affecting approximately 1.28 billion adults worldwide. In Rwanda, hypertension contribute to 2.81 of the disability adjusted life years (DALYs) and 1.87% of hypertensive heart disease mortality. Traditional medicine remains popular in Africa with some herbal remedies which have shown antihypertensive properties. However, no study was done to explore traditional Practitioners’ approach to hypertension in Rwanda.ObjectiveTo explore the experience of traditional Practitioners while managing hypertension in Rwanda.MethodologyThis qualitative study utilized an ethnographic approach to explore the experience of traditional Practitioners (TPs) while managing HTN in Rwanda. Semi- structure interviews were conducted with 20 traditional Practitioners from three districts known for their popular use of traditional medicine in Rwanda. Participants were purposively selected, and interviews were guided by a pretested semi-structured interview guide in local language. Thematic analysis was used to generate the key themes.ResultsThree main themes emerged from analysis: first, traditional medicine is often undervalued by modern medical providers, resulting in limited collaboration and communication between traditional Practitioners and modern medical providers. Despite this, TPs are trusted by the community, often receiving referrals from patients dissatisfied with modern treatment. Second, TPs face challenges in diagnosing HTN due to lack of diagnostic tools, often relying on their observation, patients’ description of symptoms and patient’s response to treatment. TPs expressed desire for collaboration with modern medicine and access to diagnostic tools. Third, lack of legal framework and standardized practices for traditional medicine remains a challenge.ConclusionThe study highlights the need to promote collaboration between traditional and modern medicine in Rwanda. To enhance HTN management, we recommend training of traditional Practitioners, setting standardized practice and legal framework to guide traditional Practitioners in Rwanda as well as improving their access to HTN diagnostic tools.

Cost-effectiveness of clinical decision support to improve CKD outcomes among First Nations Australians

IntroductionThe Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support tool (CDS) aims to improve diagnosis and management of CKD in remote NT, particularly amongst First Nations Australians. We model the cost-effectiveness of the CDS versus usual care. MethodsTaking a healthcare funder perspective, we modelled a cohort of people from remote NT at risk of or with CKD, as of 1 January 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017 to 2023), extrapolated to a 15-year time horizon. The CDS tool was modelled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3). ResultsThe remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was least cost-effective. The ICER per quality adjusted life years gained ranged from $3,427 (scenario 3) to $63,486 (scenario 2). ConclusionTerritory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.

Economic Evaluation of Once-Weekly Insulin Icodec from Italian NHS Perspective.

Icodec, once-weekly basal insulin, aims to simplify therapy management by reducing injection frequency for diabetic patients. The efficacy and safety of icodec were evaluated in the ONWARDS clinical development program. This study evaluates icodec economic and quality of life impact from the Italian National Healthcare System (NHS) perspective. A pharmacoeconomic study was developed to assess the once-weekly insulin icodec value, highlighting its potential to decrease needle use while improving adherence and quality of life. In the base case, a differential cost and cost-utility analysis over one year compared to once-daily insulin degludec were developed. Based on the comparison with degludec, a scenario analysis was planned between icodec and the mix of basal insulins available on the market. Economic evaluations included drug and administration costs, needles, and impact on adherence. The cost-utility analysis measured the utility associated with the weekly injection compared to the daily ones, resulting in an incremental cost-effectiveness ratio (ICER), measured as Δ€/ΔQALY (Quality Adjusted Life Years). To assess the robustness of the results, a deterministic one-way sensitivity analysis and a probabilistic sensitivity analysis were carried out. At an annual cost 25% higher than degludec, considering the economic benefits generated by the needle use reduction (-€51.10) and adherence improvement (-€54.85), once-weekly icodec grants no incremental cost and even potential savings per patient. Furthermore, icodec reported a utility advantage (0.023). It achieved a dominant incremental cost-effectiveness ratio (ICER) compared to degludec. The comparison with the mix of basal insulins also reported a cost-effectiveness profile. Sensitivity tests conducted confirmed the robustness of the findings, highlighting the key drivers of the analysis. Icodec represents a new therapeutic option to simplify basal insulin treatment. It also improves the patient's management and his quality of life, without increasing the economic burden for the Italian NHS, while guaranteeing an excellent cost-effectiveness profile.

Health impact and cost-effectiveness of vaccination using potential next-generation influenza vaccines in Thailand: a modelling study

IntroductionThailand was one of the first low- and middle-income countries to publicly fund seasonal influenza vaccines, but the lack of predictability in the timing of epidemics and difficulty in predicting the dominant influenza subtypes present a challenge for existing vaccines. Next-generation influenza vaccines (NGIVs) are being developed with the dual aims of broadening the strain coverage and conferring longer-lasting immunity. However, there are no economic evaluations of NGIVs in Thailand.MethodsWe estimated the health impact and cost-effectiveness of NGIVs in Thailand between 2005 and 2009 using a combined epidemiological and economic model. We fitted the model to data on laboratory-confirmed influenza cases and then simulated the number of influenza infections, symptomatic cases, hospitalisations and deaths under different vaccination scenarios based on WHO-preferred product characteristics for NGIVs. We used previous estimates of costs and disability adjusted life years (DALYs) for influenza health outcomes to estimate incremental net monetary benefit, vaccine threshold prices and budget impact.ResultsWith the current vaccine programme, there were an estimated 61 million influenza infections. Increasing coverage to 50% using improved vaccines reduced infections to between 23 and 57 million, and with universal vaccines to between 21 and 49 million, depending on the age groups targeted. Depending on the comparator, threshold prices for NGIVs ranged from US$2.80 to US$12.90 per dose for minimally improved vaccines and US$24.60 to US$69.90 for universal vaccines.ConclusionInfluenza immunisation programmes using NGIVs are anticipated to provide considerable health benefits and be cost-effective in Thailand. However, although NGIVs might even be cost-saving in the long run, there could be significant budget implications for the Thai government even if the vaccines can be procured at a substantial discount to the maximum threshold price.

Trends in disability adjusted life years of anxiety disorders from 1990 to 2019 in Indonesia: Evidence from joinpoint regression analysis

In 2019, anxiety disorders constituted a significant share of the disability adjusted life years (DALYs) lost as a result of mental disorders. This study sought to examine the gender and age-specific distribution pattern and the trends of DALYs in anxiety disorders. Using descriptive methods, the study examined the trends in the DALYs of anxiety disorders in Indonesia from 1990 to 2019. The initial step was to extract age-standardized DALYs rates (ASR) data from the Global Health Data Exchange (GHDx) covering the period from 1990 to 2019. Trend data analysis used the joinpoint regression analysis. The results indicate that DALYs rate due to anxiety were higher in women as compared to men. The highest anxiety rate in Indonesia in both 1990 and 2019 was between 25-49 years old. Anxiety rates are important to monitor for stakeholders, particularly for women and those in the reproductive age groups.

Trends in disability adjusted life years of anxiety disorders from 1990 to 2019 in Indonesia: Evidence from joinpoint regression analysis

In 2019, anxiety disorders constituted a significant share of the disability adjusted life years (DALYs) lost as a result of mental disorders. This study sought to examine the gender and age-specific distribution pattern and the trends of DALYs in anxiety disorders. Using descriptive methods, the study examined the trends in the DALYs of anxiety disorders in Indonesia from 1990 to 2019. The initial step was to extract age-standardized DALYs rates (ASR) data from the Global Health Data Exchange (GHDx) covering the period from 1990 to 2019. Trend data analysis used the joinpoint regression analysis. The results indicate that DALYs rate due to anxiety were higher in women as compared to men. The highest anxiety rate in Indonesia in both 1990 and 2019 was between 25-49 years old. Anxiety rates are important to monitor for stakeholders, particularly for women and those in the reproductive age groups.

Cost-effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-COVID-19 condition after hospitalisation for COVID-19: the REGAIN RCT

BackgroundFollowing the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised.MethodsWe conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane.ResultsOver a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%.ConclusionThe within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile.Trial registrationISRCTN registry ISRCTN11466448 23rd November 2020.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Multiple myeloma: What is the most cost-effective imaging strategy for initial detection of bone lesions?

To determine the cost-effectiveness of different imaging modalities for initial detection of multiple myeloma (MM)-defining bone lesions. A Markov model from the health care system perspective for patients with MGUS was used to evaluate the incremental cost-effectiveness of five imaging techniques: skeletal survey (SS), low-dose computed tomography (LDCT), positron emission computed tomography (PETCT), and whole-body magnetic resonance imaging (WBMRI) with and without diffusion (DIFF). Model inputs, including probabilities, utilities, and costs were obtained from comprehensive literature review. Costs were estimated in 2024 U.S. dollars, effectiveness was measured in quality adjusted life years (QALYs), willingness-to-pay (WTP) threshold was set to $100,000/QALY, and timeframe of the simulation was 20years. Model analyses included Monte Carlo microsimulation and probabilistic sensitivity analysis (PSA). The most cost-effective imaging strategy was dependent on the number of patient risk factors for progression from MGUS to myeloma. At a WTP threshold of $100,000, for patients with no risk factors for progression, LDCT amassed the greatest net monetary benefit (NMB) ($1,030,913.57) while incurring the second lowest costs ($44,870.73). For patients with 1 or 2 risk factors for progression, WBMRI + DIFF amassed the greatest NMB (1 risk factor: $802,637.30, 2 risk factors: $664,430.36). WBMRI and PETCT were absolutely dominated in all cases. PSA also found that the most cost-effective strategy was dependent on the WTP threshold. Our model suggests that LDCT and WBMRI + DIFF can be the most cost-effective imaging strategies for the initial diagnosis of MM in patients, depending on the number of risk factors for progression.

Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies

Abstract Background The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states. Methods A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes. Results The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97). Conclusions Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes. Key messages • Primary care plays an important role in the prevention of type 2 diabetes. • Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.

The Short Form 6 Dimensions (SF-6D): Development and Evolution.

This paper considers the development and evolution of the short-form 6 dimensions (SF-6D), a generic preference-weighted measure consisting of a health classification with accompanying value set that was developed from one of the widest used health related quality of life measures, the SF-36 health survey. This enabled health state utility values to be directly generated from SF-36 and SF-12 data for a range of purposes, including to produce quality adjusted life years for use in economic evaluation of healthcare interventions across a range of different conditions and treatments. This paper considers the rationale for the development of the measure, the development process, performance and how the SF-6D has evolved since its conception. This includes the development of an updated version, SF-6D version 2 (SF-6Dv2), which was generated to deal with some criticisms of the first version, and now includes a standalone version for inclusion in studies without relying on use of SF-36 or SF-12. Valuation methods have also evolved, from standard gamble in-person interviews to online discrete choice experiment surveys. International work related to the SF-6Dv1 and SF-6Dv2 is considered. We also consider recommendations for use, highlighting key psychometric evidence and reimbursement agency recommendations.

Cost-Effectiveness of Perinatal Depression Screening: A Scoping Review.

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value. A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively. A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women "at risk". Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies. Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.

A Welfare Test for Sharing Health Data

AbstractMachine learning and artificial intelligence methods are being increasingly used in the analysis of patient level and other health data, resulting in new insights and significant societal benefits. However, researchers are often denied access to sensitive health data due to concerns on privacy and security breaches. A key reason for reluctance in data sharing by data custodians is the lack of a specific legislative or other methodological framework in balancing societal benefits against costs from potential privacy breaches. Consistent with traditional cost–benefit analysis and the use of Quality Adjusted Life Years (QALYs), this study proposes an economic test that would enable Research Ethics Boards (REBs) to assess the benefits versus risks of data sharing. Our test can also be used to assess whether REBs employ reasonable effort to protect individual privacy and avoid tort liability. Constructing an acceptable welfare test for health data sharing will also lead to a better understanding of the value of data.

Analysis of disease burden and trends of noise-induced hearing loss in China from 1990 to 2019

Objective: To analyze the disease burden of Noise-Induced Hearing Loss (NIHL) in China from 1990 to 2019, forecast the disease burden of NIHL from 2020 to 2030, and provide data support for the prevention and control of NIHL. Methods: In July 2022, the disease burden data of NIHL in different age groups and genders in China during 1990-2019 were selected from the GBD database. The Jointpoint regression model was established to analyze the trend of the disease burden of NIHL in China. An age-period-cohort model was constructed to analyze the changing trend of NIHL in terms of age, period, and cohort, and a Bayesian age-period-cohort model was developed to predict the disease burden of NIHL in China from 2020 to 2030. Results: From 1990 to 2019, the disability adjusted life year (DALY) of China's NIHL increased from 1361600 to 2327700 years. The coarse rate of DALY increased from 115.03/100000 to 163.65/100000 (AAPC=1.23, P<0.001), and the normalization rate of DALY decreased from 127.67/100000 to 119.83/100000 (AAPC=-0.21, P<0.001). It is predicted that from 2020 to 2030, the DALYs of China's NIHL will increase from 2412900 in 2020 to 2655000 in 2030, and the DALY normalization rate will decrease from 241.29/100000 in 2020 to 125.71/100000 in 2030. Conclusion: The burden of noise-induced hearing loss (NIHL) in China is significant and should not be overlooked. To reduce this burden, we need to focus on strengthening source management, process control, personal protection, and comprehensive prevention and treatment through various methods.

Systematic analysis and prediction of the burden of lower respiratory tract infections attribute to non-optimal temperature, 1990-2019.

Lower respiratory infections (LRIs) remain one of the most deadly infectious diseases in the world, and non-optimal temperature is a risk factor for LRIs. The aim of this study was to analyze the global burden of LRI attribute to non-optimal temperature and its trends from 1990 to 2019, and to project long-term trends. Excerpts from the release of the 2019 Global Burden of Disease (GBD) study, which analyses the burden of lower respiratory infections due to non-optimal temperatures from 1990 to 2019 using data on deaths and disability adjusted life years (DALYs); explores differences across regions, populations and seasons, and projects future trends in burden. Between 1990 and 2019, there is a significant downward trend in the global burden of deaths and DALYs, but it remains high in infants and young children, the older adult, African countries and LOW SDI regions. Differences in geographical risk factors and economic levels lead to heterogeneous disease burdens across regions. In 2019, low SDI regions will have the highest burden, but high SDI regions will have the highest number of deaths. In addition, increasing SDI values were associated with decreasing trends in age-standardized mortality rates and disability-adjusted life years. BAPC model projections suggest a downward trend in the future burden of death and DALYs from the disease, but the improvement in the burden of death for women was not significant. Our study comprehensively elucidates the distribution and dynamic trends in the burden of lower respiratory tract infections due to non-optimal temperatures from 1990 to 2019 along multiple dimensions. The burden of deaths and DALYs showed an overall decreasing trend, but the improvement was uneven in different regions. In addition, the results suggest that efforts should be made to reduce lower respiratory health losses in infants, young children, and older adult populations. Effective public health policies and interventions to reduce the burden of lower respiratory tract infections should be sustained globally.

Cost-effectiveness of prophylactic ramosetron in the prevention of postoperative nausea and vomiting.

This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea. A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses. The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000/QALY from both payer and societal perspectives. The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life.

Cost-effectiveness of Procalcitonin (PCT) guidance for antibiotics management of adult sepsis patients in the Egyptian context

BackgroundSepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs).Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients.Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context.MethodsWe developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the“Delphi technique” to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon.Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software.ResultsBase-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice. ConclusionsIn the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.

Cost-effectiveness Improves for Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-Year Follow-up.

Secondary data analysis of the NIH sponsored study on Adult Symptomatic Lumbar Scoliosis (ASLS). The purpose of this study is to perform a cost-effectiveness analysis comparing operative versus non-operative care for ASLS eight years after enrollment. A prior cost-effectiveness analysis of the current cohort comparing operative to non-operative care at five years after enrollment showed and ICER of $44,033 in the As-Treated analysis and a ICER of $27,480 in the Intent-to-treat analysis. Data was collected every three months for the first two years, then every six months for the remainder of the study. Data included use of non-operative modalities, medications and employment status. Costs for index and revision surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF6D. There were 101 cases in the Operative (Op) and 103 in the Non-operative (Non-Op) group with complete eight year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An As-Treated analysis including only cases who never had surgery (N=65) or cases with complete eight-year post-operative data (N=101) showed that operative treatment was favored with an ICER of $20,569 per QALY gained which is within Willingness-to-Pay (WTP) thresholds. An Intent-to-Treat analysis demonstrated greater QALY gains and lower cost in the Op group (ICER = $-13,911). However, Intent-to-Treat analysis is influenced by Non-Op patients who crossed over to operative treatment at variable times during follow-up. Operative treatment was more cost-effective than non-operative treatment for ASLS at eight-year follow-up. The ICER continued to improve as compared to the five-year values ($20,569 vs. $44,033).