Health Cost-effectiveness Research Articles

Cost-effectiveness analysis of atezolizumab plus bevacizumab and chemotherapy for the treatment of metastatic, persistent, or recurrent cervical cancer (BEATcc)

ABSTRACT Background The addition of atezolizumab to bevacizumab plus platinum regimen has demonstrated notable improvements in treating metastatic, persistent, or recurrent cervical cancer, but its cost-effectiveness requires further investigation. From a US payer perspective, we aimed to evaluate the cost-effectiveness of atezolizumab plus bevacizumab and chemotherapy vs. standard chemotherapy as a first-line treatment for metastatic, persistent, or recurrent cervical cancer. Methods A partitioned survival model based on the data from the BEATcc trial was used to calculate the incremental cost-effectiveness ratio (ICER), using cost and health utility information obtained from literature and publicly accessible databases. One-way and probabilistic sensitivity analyses were performed to evaluate the model’s responsiveness to variations in parameters. Results The addition of atezolizumab resulted in an additional 0.839 quality-adjusted life years (QALY) at an additional cost of $458,237, leading to an ICER of $545,943/QALY. One-way sensitivity analysis indicated that the cost of atezolizumab had the greatest impact on the ICER, followed by the utility value of progression-free survival (PFS) and follow-up costs. Probabilistic sensitivity analysis showed a 0% cost-effectiveness probability at the current willingness-to-pay (WTP) threshold of $150,000 per QALY. Conclusion Adding atezolizumab to chemotherapy is cost-prohibitive in the US and may not be cost-effective for patients.

Analytics of the Cost Effectiveness and Real-Time Health Risk Assessments for Pharmacy-Based Preventive Health Services

More patient-centered care and participation in managing chronic illnesses are features of the modern pharmacist's task, which has evolved substantially in recent years. Still, the issue of whether or not pharmacists are cost-effective in diabetes care persists. Cost-effectiveness analyses (CEA) have emerged as a crucial tool when making informed decisions about healthcare delivery. Patients' present health status, past medical history (personal and family), and lifestyle variables influencing their health are all part of a health risk assessment (HRA). Hence, this study proposed a Cost-Effectiveness Analysis of Pharmacy-based Preventive Health Services (CEA-PBPHS) model for real-time health risk assessment. Nowadays, medical professionals place a greater emphasis on preventative health care. This research aims to examine the potential impact of risk assessment tools on males past due for a physical examination and evaluate the return on investment (ROI) for community pharmacists who provide this service for free. More cost-efficient or cost-saving than conventional treatment is pharmacist engagement in diabetes management due to better glucose control, higher patient compliances, and lower risks of medication-related issues. The experimental outcomes demonstrate that the suggested CEA-PBPHS model increases the health risk assessment ratio by 98.9%, the personalized health service ratio by 97.5% and the cost-effectiveness analysis ratio by 98.3% compared to other existing models.

Cost-effectiveness of promoting population health management through education, seminars, and participatory learning for individuals diagnosed with chronic diseases

Population health management is a sustainable, strategic, and interprofessional collaboration that focuses on the health needs of individuals diagnosed with and living with chronic diseases. A chronic disease is defined as a longstanding health condition that persists for more than a year and requires ongoing medical care, such as heart disease, cancer, and diabetes. Since many chronic diseases are incurable, the management and financial burden of chronic diseases remain significant concerns for individuals, clinicians, and health-care systems. Preventing and managing chronic diseases through health promotion and education continues to be a fundamental cost-effective strategy. Educational seminars and participatory learning for individuals with chronic diseases play an important role in improving health outcomes and reducing health-care costs. This perspective aims to highlight objective insights into how health education contributes to cost-effectiveness and strategic population health management.

Social and Personal Determinants of Herbal Supplement Use in Metro Cebu, the Philippines

The present study identified herbal supplement usage patterns in Metro Cebu and comprehensively examined consumer education and behavior regarding these supplements. A cross-sectional online survey was conducted from March–July 2023 involving 316 respondents, selected through purposive sampling. The study collected data on demographic characteristics, usage patterns, sources of information, and potential hesitations related to herbal supplement use. Results indicate that the typical Metro Cebu herbal supplement user is more likely to be female, possess higher education, earn above the minimum wage, and primarily reside in Cebu City (n = 202, 63.9%). Usage of herbal supplements is driven by proactive health behaviors often influenced by social networks. Respondents generally hold a positive view of herbal supplement use, particularly those who consume them daily, attributing their preference to natural products, and their perceived cost-effectiveness and potential health benefits compared to conventional medicines. The following subgroups also tend to have more positive views about herbal supplements: [a] older age, [b] employed, [c] at a lower level of education, [d] have known illnesses, and [e] have used the product for 1-5 yr. While respondents actively verify information (n = 243, 76.9%) and inform healthcare providers (n = 180, 57%) about their supplement use, the extent to which they rely on healthcare professionals and scientific sources for guidance in shaping their behavior and product choices is limited. The study underscores the need for enhanced guidance and surveillance from healthcare providers. Furthermore, it highlights a regulatory gap in the governing framework for herbal supplement use and marketing, emphasizing the importance of revisiting or introducing regulations and guidelines to ensure safe and informed consumption practices.

Cost-effectiveness and public health impact of typhoid conjugate vaccine introduction strategies in Bangladesh

PurposeTyphoid fever causes substantial morbidity and mortality in Bangladesh. The government of Bangladesh plans to introduce typhoid conjugate vaccines (TCV) in its expanded program on immunization (EPI) schedule. However, the optimal introduction strategy in addition to the costs and benefits of such a program are unclear. MethodsWe extended an existing mathematical model of typhoid transmission to integrate cost data, clinical incidence data, and recently conducted serosurveys in urban, semi-urban, and rural areas. In our primary analysis, we evaluated the status quo (i.e., no vaccination) and eight vaccine introduction strategies including routine and 1-time campaign strategies, which differed by age groups targeted and geographic focus. Model outcomes included clinical incidence, seroincidence, deaths, costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for each strategy. We adopted a societal perspective, 10-year model time horizon, and 3 % annual discount rate. We performed probabilistic, one-way, and scenario sensitivity analyses including adopting a healthcare perspective and alternate model time horizons. ResultsWe projected that all TCV strategies would be cost saving compared to the status quo. The preferred strategy was a nationwide introduction of TCV at 9–12 months of age with a single catch-up campaign for children ages 1–15, which was cost saving compared to all other strategies and the status quo. In the 10 years following implementation, we projected this strategy would avert 3.77 million cases (95 % CrI: 2.60 – 5.18), 11.31 thousand deaths (95 % CrI: 3.77 – 23.60), and save $172.35 million (95 % CrI: −14.29 – 460.59) compared to the status quo. Our findings were broadly robust to changes in parameter values and willingness-to-pay thresholds. ConclusionsWe projected that nationwide TCV introduction with a catch-up campaign would substantially reduce typhoid incidence and very likely be cost saving in Bangladesh.

Citrus peel pectin and alginate-based emulgel particles for small intestine-targeted oral delivery of curcumin

Polysaccharides are a prominent choice in the realm of food-grade oral delivery systems due to their resistance to degradation by digestive enzymes in the oral, gastric, and small intestinal environments, as well as their ease of production, cost-effectiveness, and potential health benefits as prebiotics. Furthermore, their ability to respond to pH-induced dissolution, along with their emulsifying properties, can be strategically employed to achieve precise targeting of lipophilic bioactives to the small intestine. In this study, citrus peel pectin and alginate served as stabilizers for emulgel particles without supplementary emulsifiers or gelling agents. Within this system, pectin functioned as an emulsifier, while alginate acted as a gelling agent, facilitated by Ca2+-induced ionic crosslinking. The synergistic interplay between pectin and alginate efficiently protected curcumin in gastric conditions and controlled dissolution in the small intestine, depending on the pectin/alginate ratio. These controlled phenomena facilitated lipolysis, curcumin release, and ultimately enhanced curcumin bioaccessibility. Furthermore, once the emulgel particle released all the entrapped curcumin in the small intestine, residual polysaccharides underwent facile degradation by pectinase and alginate lyase, yielding fermentable monosaccharides. This confirms the potential of the emulgel particles for use as a prebiotic in the colon. These findings offer significant promise for enhancing the systematic design of food-grade delivery systems that encapsulate lipophilic bioactives, achieving controlled release, enhanced stability, and improved bioaccessibility. Importantly, this system can comprise components that undergo complete digestion, absorption, and utilization in the human body, encompassing materials such as oil, nutraceuticals, and prebiotics, all without presenting health risks.

EE286 Cost Effectiveness and Public Health Impact of Implementing Gender-Neutral Vaccination with the 9-Valent Human Papillomavirus Vaccine in Turkiye

EE286 Cost Effectiveness and Public Health Impact of Implementing Gender-Neutral Vaccination with the 9-Valent Human Papillomavirus Vaccine in Turkiye

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.

Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV.

Antimicrobial Sensitivity of Plant Extracts of Acacia arabica, Prosopis juliflora, Abutilon indicum, and Bryonia laciniosa on Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli

BACKGROUND: In the recent era, biological treatment using therapeutic microbes or phytochemicals has proven more beneficial than conventional methods due to several reasons - permanent control of weeds, host-specific control, cost-effectiveness, and low health risk. This study determined the antimicrobial sensitivity profile of _Staphylococcus aureus_, _Pseudomonas aeruginosa_, and _Escherichia coli_ against plants like _Acacia arabica_, _Prosopis juliflora_, _Abutilon indicum_, and _Bryonia laciniosa_. Given the importance and ease of using phytochemicals in modern Microbiology, this study has been carried out towards the approach of green synthesis of antimicrobial agents. METHODS: The primary purpose of this study was to determine the antimicrobial sensitivity of _Staphylococcus aureus_, _Pseudomonas aeruginosa_, and _Escherichia coli_ using extracts from plants like _Acacia arabica_, _Prosopis juliflora_, _Abutilon indicum_, and _Bryonia laciniosa_. Antimicrobial properties of plant extracts were analyzed by determining the _Zone of Inhibition_ (_ZOI_). The antibiogram pattern of isolated _Staphylococcus aureus_, _Pseudomonas aeruginosa_, and _Escherichia coli_ was observed to be Susceptible, Intermediate, and Slightly Resistant to _Acacia arabica_, _Prosopis juliflora_, _Abutilon indicum_, and _Bryonia laciniosa_. RESULTS: Phytochemical analysis indicates that the extracts of _Acacia arabica_, _Prosopis juliflora_, _Abutilon indicum_, and _Bryonia laciniosa_ have the potential for use in managing _Staphylococcus aureus_, _Pseudomonas aeruginosa_, and _Escherichia coli_. Further phytochemical analysis is required to identify the active components of plant extracts showing antimicrobial activity.

Low-Income Caregiver Perspectives on a State Education Savings Program and Receptivity to Clinic-Based Financial Counseling

Background and ObjectiveIn 2019, Pennsylvania launched a Children’s Development Account (CDA) program that invests $100 in an education savings account for every child born in the state. However, as of 2021, only 10.6% of families claimed the investment. Low-income communities may stand to benefit most from educational investments, but few studies have assessed barriers and facilitators of uptake in these communities. We sought to examine low-income caregivers’ perceptions of and barriers and facilitators to participation in a statewide CDA program and their receptivity to clinic-based financial counseling through a medical financial partnership. MethodsWe surveyed 100 caregivers of Medicaid-insured children from 2 primary care practices serving a predominantly low-income community. From these 100, we purposively sampled 30 caregivers for follow-up interviews. ResultsThe 100 survey participants were predominantly female (83%), Black or African American (92%), and non-Hispanic or Latino (93%). Twenty-nine percent of survey participants were aware of the CDA program, 4% had enrolled, and 64% were interested in clinic-based financial counseling. In interviews, caregivers identified several barriers to and facilitators of engagement in the CDA program. They also identified several strategies to boost engagement, including simplifying registration, providing additional and personalized program information, expanding the investment amount, and providing clinic- and community-based outreach. ConclusionsLow-income caregivers identified several barriers to enrollment in a statewide CDA program and strategies to boost enrollment, including clinic-based financial counseling. Future research should examine the effectiveness, cost-effectiveness, and long-term financial and health consequences of clinic-based financial services for low-income families.

Cost-Effectiveness of Four Tobacco Control Interventions in Mongolia.

The aim of this study is to quantify the cost-effectiveness of four tobacco control interventions: Tobacco taxation, mass media campaigns, school programs, and cessation support, and to illustrate how available evaluation tools can be adapted to the local setting. We used the dynamic population health modeling-health impact assessment tool to project the future smoking prevalence associated with the interventions and to simulate the resulting smoking-related disease burden over time. Applying the most recent available national Mongolian data as input, the costs and effects of four interventions were compared to a business-as-usual scenario, resulting in costs per life year gained and per disability-adjusted life years (DALYs) averted. Three years after implementation, all interventions reduce the prevalence of current smoking, with the strongest reduction observed with the increase in tobacco tax (5.1% points), followed by mass media campaigns (1.6% points), school programs (1.3% points), and cessation support interventions (0.6% points). School programs were a cost-saving tobacco control intervention compared to current practice in Mongolia, while the other programs resulted in additional costs compared to business as usual. Compared to the World Health Organization (WHO) thresholds, all interventions would be considered "very cost-effective" in terms of cost per DALY averted (below US$ 4295 per DALY averted) in Mongolia. Large-scale interventions such as taxation and mass media campaigns result in both cost-effectiveness and important health benefits in relation to intervention costs. Reducing the prevalence of smoking among the male population would be particularly worthwhile in Mongolia. This study shows that in Mongolia school programs were a cost-saving intervention, while the cost-effectiveness ratios were US$ 25 per disability-adjusted life year (DALY) averted for mass media campaigns, US$ 74 for taxation, and US$ 1961 for cessation support interventions. Compared to the WHO thresholds, all interventions would be considered "very cost-effective" in terms of expenses per DALY averted (<US$ 4295 per DALY averted), making it beneficial to scale up the WHO-Monitor tobacco use and prevention, Protect people from smoke, Offer help to quit smoking, Warn about the danger, Enforce bans, and Raise taxes (MPOWER) interventions to reduce the burden from smoking in Mongolia.

Optimal Equipment Capacity Planning in the Neonatal Intensive Care Unit with Simulation-Optimization Approach

Capacity planning should be performed to balance investment costs and benefits of investing to meet the current and future demand in intensive care units. Having a high capacity to increase patient admission will lead to unutilized capacity in some periods, thereby increasing costs. On the other hand, patient admission requests from inborn and transported patients might be rejected due to lack of equipment. It should be considered in terms of cost-effectiveness and patient health; therefore, optimal equipment capacity must be determined. In this study, the optimal capacity planning problem has been considered for the neonatal intensive care unit of a hospital adopting the simulation-optimization approach. A discrete event simulation model is proposed for a neonatal intensive care unit in Adana, Turkey. Then, the optimization model identified the optimal numbers of incubators, ventilators, and nitric oxide devices to maximize equipment efficiency and minimize total inborn patient rejection and transport ratios. Three different resource allocations are presented, and the best is obtained from these three objectives as 72 incubators, 35 ventilators, and three nitric oxide devices. The application results obtained have revealed that the rejection and transport rate, which is found to be 1.12% in the current situation, can be reduced to 0.2% with different numbers of equipment and that equipment efficiency can be achieved with optimal numbers of equipment. The results of the study can help the decision-makers when minimum transport and rejection ratios are critical which almost intensive care units are required. Furthermore, the proposed simulation-optimization model can be adapted to different neonatal intensive care units having the same characteristics.

The Double Dividend of International Cooperation for Climate Mitigation Cost Effectiveness and Public Health Cobenefits.

Current National Determined Contributions require strengthening to achieve the 2-degree target set in the Paris Agreement. Here, we contrast two mitigation effort strengthening ideas: the "burden-sharing" principle, which requires each region to meet the mitigation goal through domestic mitigation with no international cooperation, and the cooperation focused "cost effective conditional-enhancing" principle, which combines domestic mitigation with carbon trading and low-carbon investment transfer. By applying a burden-sharing model covering several equity principles, we analyze the 2030 mitigation burden for each region, then the energy system model generates the results for the carbon trade and the investment transfer for the conditional-enhancing plan, and an air pollution cobenefit model is used to analyze the cobenefit on air quality and public health. Here, we show that the conditional-enhancing plan leads to an international carbon trading volume of 339.2 billion USD per year and reduces the marginal mitigation cost of the quota-purchase regions by 25%-32%. Furthermore, the international cooperation incentivizes a faster and deeper decarbonization in developing and emerging regions, raising the air pollution health cobenefits by 18% to 731,000 avoided premature deaths annually compared to the "burden-sharing" principle, amounting to a reduction in the life value loss of 131 billion dollars per year.

Intraoperative neuromonitoring in spine surgery: large database analysis of cost-effectiveness

BackgroundGiven the increased attention to functional improvement in spine surgery as it relates to activities of daily living and cost, it is critical to fully understand the health care economic impact of enabling technologies. The use of intraoperative neuromonitoring (IOM) during spine surgery has long been controversial. Questions pertaining to utility, medico-legal considerations, and cost-effectiveness continue to be unresolved. The purpose of this study is to determine the cost-effectiveness by assessing quality-of-life due to adverse events averted, decreased postoperative pain, decreased revision rates, and improved patient reported outcomes (PROs). MethodsThe study patient population was extracted from a large multicenter database collected by a single, national IOM provider. Over 50,000 patient charts were abstracted and included in this analysis. The analysis was conducted in accordance with the second panel on cost-effectiveness health and medicine. Health-related utility was derived from questionnaire answers and expressed in quality-adjusted life years (QALYs). Both cost and QALY outcomes were discounted at a yearly rate of 3% to reflect their present value. Cost-effectiveness was calculated as the incremental cost-effectiveness ratio (ICER) for IOM. A value under the commonly accepted United States-based willingness-to-pay (WTP) threshold of $100,000 per QALY was considered cost-effective. Scenario (including litigation), probabilistic (PSA), and threshold sensitivity analyses were conducted to determine model discrimination and calibration. ResultsThe primary time horizon used to estimate cost and health utility was 2-years following index surgery. On average, index surgery for patients with IOM costs are approximately $1,547 greater than non-IOM cases. The base case assumed an inpatient Medicare population however multiple outpatient and payer scenarios were assessed in the sensitivity analysis. From a health system perspective IOM is cost-effective, yielding better utilities but at a higher cost than the non-IOM strategy (ICER $60,734 per QALY). From a societal perspective the IOM strategy was dominant, suggesting that better outcomes were achieved at less cost. Except for an entirely privately insured population, alternative scenarios such as, outpatient and a 50:50 Medicare/privately insured population sample also demonstrated cost-effectiveness. Notably, IOM benefits were unable to overcome the sheer costs associated many litigation scenarios, but the data was severely limited. In the 5,000 iteration PSA, at a WTP of $100,000, 74% of simulations using IOM were cost-effective. ConclusionsThe use of IOM in spine surgery is cost-effective in most scenarios examined. In the emerging and rapidly expanding field of value-based medicine, there will be an increased demand for these analyses, ensuring surgeons are empowered to make the best, most sustainable solutions for their patients and the health care system.

Gene Therapy Equity in Sickle Cell Disease: Distributional Cost-Effectiveness Analysis (DCEA) of Gene Therapy Vs. Standard-of-Care in Patients with Sickle Cell Disease in the United States

Introduction: Patients with sickle cell disease (SCD) face substantial mortality risks and decreased quality-of-life for every year lived with disease. Once approved in the United States (US), gene therapy treatment for patients with SCD would allow the possibility of lifelong disease remission and, unlike allotransplantation, do so without the concomitant risks of allotransplantation. While gene therapy has previously been projected to be cost-ineffective using traditional cost-effectiveness criteria in the US, this does not include a quantification of the health disparities present in the clinical care of patients with SCD. We sought to address this knowledge gap by conducting the first distributional cost-effectiveness analysis, a method that quantifies the tradeoffs between traditional cost-effectiveness outcomes and health equity, for gene therapy use in SCD. Methods: We built and validated a Markov simulation model of patients with a diagnosis of mild, moderate, or severe SCD to examine the cost-effectiveness of gene therapy versus patients treated with standard-of-care (SOC). Gender-, age-, and disease-severity-specific annual costs and transition probabilities between disease severities were informed by ten years of real-world data from commercially insured patients in the United States with SCD (2007-2017; Optum claims data). Disease severity was defined based on annual number of hospitalizations and SOC was inclusive of hydroxyurea, opioid therapy, antibiotics, vaccinations, blood transfusions, and stem cell transplantation. Quality-adjusted life-years (QALYs) were informed by published lifetime simulation of patients living with SCD and matched controls. These were originally derived from a polynomial fit linking Euroqual-5 Dimensions to the visual analog scale for pain in patients with SCD in several studies. Age-, gender- and disease-specific background mortality probabilities were employed. Traditional cost-effectiveness was quantified using an incremental cost-effectiveness ratio (ICER) and a cost-effectiveness threshold of $100,000/QALY. Base-case gene therapy was assumed to cost $2.1 million based on other recently approved indications, be 100% effective in achieving disease remission, and applied to a minimum eligibility age of 12, as studied in randomized, controlled trials. To account for health inequities in SCD we then conducted a distributional cost-effectiveness analysis (DCEA), which applies an inequality aversion parameter (i.e., equity weight) to the distribution of outcomes across relevant sub-groups. Specifically, we derived the threshold inequality aversion parameters needed for gene therapy to be favored over SOC and justify funding per DCEA standards. These were compared to prior estimates for commonly used equity weights in the US (range 0.5-3.0) and the United Kingdom (UK) (11.0-28.9). Results: Base-case gene therapy versus SOC treatment starting at age 12 yields 25.5 versus 16.0 discounted lifetime QALYs at costs of $2.4 and $1.1 million, respectively. The ICER of $144,000/QALY is not good value for money using traditional cost-effectiveness methods and a cost-effectiveness threshold of $100,000/QALY. When using DCEA that account for health disparities in SCD, the inequality aversion parameter threshold is 1.7. This implies a preference for reducing disparities in SCD care that is in line with prior estimates in the US and well below those of the UK, per DCEA standards to favor gene therapy over SOC. A corresponding price range for gene therapy for SCD across the range of commonly used equity weights in the US is $1.4-$3.0 million (Figure 1). Conclusion: Gene therapy can be an equitable therapeutic strategy for patients with SCD in the United States despite a projected minimum cost of $2.1 million once approved, based on commonly-used equity weight values used in DCEA. Equitable gene therapy use would include expanding eligibility to include patients with mild and moderate disease severity, in addition to those with severe SCD, assuming similar therapeutic efficacy of gene therapy across disease severity. Rather than relying on ranges of commonly-used equity weights, nationally representative surveys should be fielded to empirically deriving an inequality aversion parameter value for addressing this SCD-specific health disparity to further help inform an equitable price benchmark for gene therapy in the US. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Intensive support teams for adults with intellectual disabilities displaying challenging behaviour: the IST-ID mixed-methods study

Background National policy recommends intensive support teams for all areas of England for adults with intellectual disabilities who display challenging behaviour. However, to the best of our knowledge, there has not been a systematic evaluation of intensive support teams to date. Objectives Our objectives were to identify and describe the geographical distribution and characteristics of intensive support teams in England; to create a typology of intensive support teams; to investigate clinical and cost outcomes of intensive support team models and factors associated with those outcomes; and to explore professionals’, service users’ and carers’ experiences and describe the wider system context in which they operate. Design This was a two-phase mixed-methods study. In phase 1, a national survey examined the intensive support team models in operation in England. In phase 2, an observational study of adults with intellectual disabilities investigated the clinical effectiveness and cost-effectiveness of the two intensive support team models. Semistructured interviews with intensive support team managers and professionals, carers, and adults with intellectual disabilities explored their experiences of intensive support team care. In parallel, we examined service-level outcomes related to the function of intensive support teams. Setting Phase 1 included 80 intensive support teams serving 242 community intellectual disability services in England. Phase 2 included 21 intensive support teams, half of which were in the enhanced intensive support teams model and half of which were in the independent model. Participants In phase 1, a total of 73 intensive support team managers provided data. In phase 2, a total of 226 participants with intellectual disabilities from 21 intensive support teams (enhanced: teams, n = 11; participants, n = 115; independent: teams, n = 10; participants, n = 111) were enrolled in the study. A total of 42 stakeholders were interviewed. Main outcome measure The main outcome measure was the Aberrant Behaviour Checklist-Community, version 2, total score. Additional data sources were the carer and self-reported questionnaires, qualitative interviews and focus groups. Results Two intensive support team models were identified in England – enhanced and independent. Challenging behaviour at 9 months was reduced in both intensive support team models (β 3.08, 95% confidence interval –7.32 to 13.48; p = 0.561), but the observed Aberrant Behaviour Checklist-Community, version 2, score reduction appeared larger in the independent model than in the enhanced model (21% vs. 13%, respectively). No statistically significant differences were found in the secondary outcomes [Psychiatric Assessment Schedule for Adults with Developmental Disabilities Clinical Interview organic condition (odds ratio 1.09, 95% confidence interval 0.39 to 3.02), affective or neurotic disorder (odds ratio 0.91, 95% confidence interval 0.32 to 2.59), or psychotic disorder score (odds ratio 1.08, 95% confidence interval 0.21 to 5.50); risk score (β 1.12, 95% confidence interval –0.44 to 2.68); or quality of life questionnaire score (β –2.63, 95% confidence interval –5.65 to 0.40)]. Similarly, no differences were observed between models in relation to cost-effectiveness (health and social care costs mean difference £3409.95, 95% confidence interval –£9957.92 to £4039.89; societal costs mean difference –£4712.30, 95% confidence interval –£11,124.85 to £2106.36). The experiences of stakeholders did not differ between the intensive support team models, with carers and adults with intellectual disabilities valuing service accessibility, person-centred care and engagement. All stakeholders reported a range of barriers to intensive support team care. Service-level data and the operational policies from intensive support teams showed variation in organisational function and the roles of intensive support teams. The most commonly delivered intervention was positive behaviour support. Conclusions The study describes the operation of intensive support teams in England and identified two distinct models. We did not find advantages or disadvantages associated with clinical outcomes between models, nor did we find cost differences. On this basis, we recommend that local services decide which model best suits their circumstances. Limitations This was not a randomised controlled trial. It is possible that confounding factors have not been controlled for as there was no matching between intensive support teams. Last, there was no comparison with usual care. Future work There is need to develop model fidelity and investigate clinical effectiveness and cost-effectiveness in a randomised controlled evaluation of intensive support teams against treatment as usual. Study registration This study is registered as ClinicalTrials.gov NCT03586375, Integrated Research Application System (IRAS) 239820 and National Institute for Health and Care Research (NIHR) Central Portfolio Management System (CPMS) 38554. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 33. See the NIHR Journals Library website for further project information.

Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders.

Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists. Children aged 6-12 years (n = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; n = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; n = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU. Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages.

CN76 Cost effectiveness of high versus low-to-moderate intensity exercise during oncological treatment: The Phys-Can RCT

A cost-effectiveness analysis, considering both costs and health outcomes of interventions, are important for decision-making and implementation in the health care. Exercise during oncological treatment is beneficial for health and have been found to counteract side effects of treatment. The Swedish Phys-Can RCT compared a six-month exercise program combining supervised resistance training and homebased endurance training of high-intensity ( HI ) versus low-to-moderate intensity (LMI), with or without additional behaviour change support. At post intervention, HI yielded small improvements of fitness and physical fatigue compared with LMI. At 18 months, no differences were found in total costs between the intensities. However, knowledge of the cost effectiveness in exercise interventions with regard to intensity is limited. In this study, we aimed to evaluate the long-term cost-effectiveness of an exercise program at HI versus LMI during oncological treatment. A cost-effectiveness analysis was undertaken from a societal perspective for 18 months. 189 (n=99 HI and n=90 LMI) participants with breast, colorectal, or prostate cancer were included from the Phys-Can RCT. Health outcomes were measured as quality-adjusted life years (QALYs), using EQ-5D-5L at baseline, six months and 18 months. Costs included the exercise intervention, health care utilisation and productivity loss. At 18 months, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensities. On average HI generated 1.190 (SD = 0.223) QALYs and LMI 1.185 (SD = 0.211) QALYs for 18 months, meaning HI led to an additional 0.005 QALYs. The incremental cost-effectiveness ratio (ICER) indicates that HI was more effective and saved costs compared with LMI. The uncertainty around the ICER was large, however our results indicates that HI exercise was cost-effective compared to LMI exercise at longer term since there was lower total costs per QALY gained. Thus, we suggest that exercise with its health benefits may be implemented regardless of intensity.

Cost-Effectiveness Analysis Update of the Adjuvanted Recombinant Zoster Vaccine in Japanese Older Adults

IntroductionThis study aimed to update cost-effectiveness and public health impact estimates of the two-dose recombinant zoster vaccine (RZV) compared with no vaccination against herpes zoster (HZ) in the Japanese population aged 65 years. List price of the vaccine and latest RZV efficacy and waning estimates were incorporated.MethodsA multicohort static Markov model with a cycle length of 1 year was used to follow a hypothetical cohort of one million people aged 65 years over their remaining lifetime (base case). Age-stratified vaccine efficacy and waning rates were updated on the basis of the latest clinical trial data (interim ZOE-LTFU; NCT02723773). First-dose coverage was assumed at 40%, and second-dose compliance was assumed at 95%. Costs and outcomes were discounted at 2% annually, and the incremental cost-effectiveness ratio (ICER) was calculated from payer and societal perspectives. The societal perspective considered productivity loss due to suffering HZ, or due to suffering HZ and time required for vaccination. Sensitivity analyses explored the overall uncertainties in the model. Scenario analyses for Japanese adults aged 50, 60, 70, 80, ≥ 50, and ≥ 65 years (main scenario) were conducted. An ICER below ¥5–6 million/quality-adjusted life-year (QALY) was considered cost-effective.ResultsRZV was estimated to prevent 71,423 HZ cases and 15,858 post-herpetic neuralgia (PHN) cases per million people aged 65 years compared with no vaccine in Japan. The ICER was ¥4,205,515 from a payer perspective and was most sensitive to assumptions regarding vaccine efficacy waning, proportion of patients with HZ developing PHN, and HZ incidence. From societal perspectives, ICERs were ¥3,854,192 (productivity loss from suffering HZ only) and ¥4,622,212 (productivity loss from suffering HZ and time required for vaccination). Overall, the results were considered robust under extensive sensitivity and scenario analyses.ConclusionVaccination against HZ with RZV is cost-effective compared with no vaccination in Japanese adults aged 65 years.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00744-8.

The Coronavirus Disease 2019 Spatial Care Path: Home, Community, and Emergency Diagnostic Portals.

This research uses mathematically derived visual logistics to interpret COVID-19 molecular and rapid antigen test (RAgT) performance, determine prevalence boundaries where risk exceeds expectations, and evaluate benefits of recursive testing along home, community, and emergency spatial care paths. Mathematica and open access software helped graph relationships, compare performance patterns, and perform recursive computations. Tiered sensitivity/specificity comprise: (T1) 90%/95%; (T2) 95%/97.5%; and (T3) 100%/≥99%, respectively. In emergency medicine, median RAgT performance peaks at 13.2% prevalence, then falls below T1, generating risky prevalence boundaries. RAgTs in pediatric ERs/EDs parallel this pattern with asymptomatic worse than symptomatic performance. In communities, RAgTs display large uncertainty with median prevalence boundary of 14.8% for 1/20 missed diagnoses, and at prevalence > 33.3–36.9% risk 10% false omissions for symptomatic subjects. Recursive testing improves home RAgT performance. Home molecular tests elevate performance above T1 but lack adequate validation. Widespread RAgT availability encourages self-testing. Asymptomatic RAgT and PCR-based saliva testing present the highest chance of missed diagnoses. Home testing twice, once just before mingling, and molecular-based self-testing, help avoid false omissions. Community and ER/ED RAgTs can identify contagiousness in low prevalence. Real-world trials of performance, cost-effectiveness, and public health impact could identify home molecular diagnostics as an optimal diagnostic portal.